Structural analysis of variants was performed using Pymol (The Pymol Molecular Graphics System, Version 2.5, Schrödinger, LLC). All Figures were generated using Pymol. Four in silico prediction algorithms were consulted: Sorting Intolerant from Tolerant, Metadome, MutationTaster, and Polymorphism Phenotyping v2.26 (link)–29 (link) All variants were manually analyzed using Alamut Visual v2.15 (Sophia Genetics). Variants were classified according to the 2015 American College of Medical Genetics and Genomics/Association for Molecular Pathology guidelines.30 (link) Episign results were used to support classification according to criterium Pathogenic Strong 3 (PS3), and Pathogenic Moderate 1 (PM1) was applied for variants in the CxxC domain.
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