General Information of Disease (ID: DISEMUGZ)

Disease Name Tuberous sclerosis
Synonyms
tuberous sclerosis Complex; ts - tuberous sclerosis; syndrome, Bourneville's; syndrome, Bourneville; sclerosis, tuberous; sclerosis, tuberose; sclerosis, cerebral; sclerosis Tuberosa; phakomatosis, Bourneville; disease, Bourneville-pringle's; disease, Bourneville-pringle; cerebral Scleroses; bourneville's disease; adenoma sebaceum syndrome; adenoma sebaceum; Phacomatosis, Bourneville; Bourneville-pringle's disease; Bourneville-pringle disease; Bourneville-Pringles disease; Bourneville pringle's disease; Bourneville pringle disease; Bourneville phakomatosis; Bourneville disease; Bourneville Phacomatosis; tuberous sclerosis syndrome; tuberous sclerosis complex; tuberous sclerosis; tuberose sclerosis; cerebral sclerosis; TSC; Epiloia; Bourneville's syndrome; Bourneville's disease; Bourneville syndrome
Disease Class LD2D: Phakomatoses/hamartoneoplastic syndrome
Definition
Hereditary disease characterized by seizures, mental retardation, developmental delay, and skin and ocular lesions. First signs usually occur during infancy or childhood but in rare cases may not occur until 2nd or 3rd decade.
Disease Hierarchy
DIS3HIWD: Autosomal dominant disease
DISGXLG5: Hereditary neoplastic syndrome
DISNC82H: Neurocutaneous syndrome
DISD715V: Hereditary neurological disease
DISEMUGZ: Tuberous sclerosis
ICD Code
ICD-11
ICD-11: LD2D.2
ICD-10
ICD-10: Q85.1
Expand ICD-11
'LD2D.2
Expand ICD-10
'Q85.1
Disease Identifiers
MONDO ID
MONDO_0001734
MESH ID
D014402
UMLS CUI
C0041341
MedGen ID
22518
Orphanet ID
805
SNOMED CT ID
7199000

Drug-Interaction Atlas (DIA) of This Disease

Drug-Interaction Atlas (DIA)
This Disease is Treated as An Indication in 1 Approved Drug(s)
Drug Name Drug ID Highest Status Drug Type REF
Everolimus DM8X2EH Approved Small molecular drug [1]
------------------------------------------------------------------------------------
This Disease is Treated as An Indication in 1 Clinical Trial Drug(s)
Drug Name Drug ID Highest Status Drug Type REF
TAK-935 DMOZAMN Phase 2 NA [2]
------------------------------------------------------------------------------------

Molecular Interaction Atlas (MIA) of This Disease

Molecular Interaction Atlas (MIA)
This Disease Is Related to 23 DTT Molecule(s)
Gene Name DTT ID Evidence Level Mode of Inheritance REF
CLN3 TTORF9W Limited Biomarker [3]
GNA11 TTSRXJW Limited Genetic Variation [4]
LILRB2 TTHC6XU Limited Altered Expression [5]
MLYCD TT9Z4YD Limited Biomarker [6]
OGG1 TTRU01G Limited Biomarker [7]
PIM3 TTCGOIN Limited Biomarker [8]
PRKD1 TTSLUMT Limited Genetic Variation [9]
SLC12A5 TTH6UZY Limited Altered Expression [10]
RGS6 TTJ96M8 Disputed Biomarker [11]
HMBS TTT0HW3 moderate Genetic Variation [12]
LINGO1 TTZYQ80 moderate Altered Expression [13]
NTF4 TTIM2WO moderate Altered Expression [14]
PAK2 TT279WO moderate Biomarker [15]
TRPC4 TTX0H5W moderate Altered Expression [16]
CRTC1 TT4GO0F Strong Altered Expression [17]
DDIT4 TTVEOY6 Strong Altered Expression [18]
EIF4EBP1 TTKGEBL Strong Biomarker [19]
GRIN2C TT1M8OW Strong Biomarker [20]
HTR2C TTWJBZ5 Strong Genetic Variation [21]
RASA1 TTPNZ1F Strong Biomarker [22]
RPS6KB1 TTG0U4H Strong Biomarker [23]
GRM5 TTHS256 Definitive Biomarker [24]
IL21R TTZO9B0 Definitive Altered Expression [25]
------------------------------------------------------------------------------------
⏷ Show the Full List of 23 DTT(s)
This Disease Is Related to 1 DME Molecule(s)
Gene Name DME ID Evidence Level Mode of Inheritance REF
UBASH3B DE10BJ5 moderate Genetic Variation [26]
------------------------------------------------------------------------------------
This Disease Is Related to 53 DOT Molecule(s)
Gene Name DOT ID Evidence Level Mode of Inheritance REF
CD8A OTDWQJXK Limited Biomarker [27]
ELOC OT0XHHWP Limited Genetic Variation [28]
GRHL3 OT1V4ZEH Limited Biomarker [29]
HEXD OTTMQKLM Limited Biomarker [30]
ING2 OT6H0EWF Limited Biomarker [27]
INHA OT7HWCO3 Limited Biomarker [31]
MYO1B OTGZUJ0I Limited Biomarker [32]
NEUROG2 OTAEMIGT Limited Altered Expression [33]
OPN1MW OTPJ7LX4 Limited Biomarker [34]
PEX13 OTXUAYEW Limited Genetic Variation [35]
PHLPP1 OTIFXW8D Limited Biomarker [36]
PIK3C3 OTLUM9L7 Limited Altered Expression [37]
PRRX1 OTTZK5G8 Limited Biomarker [38]
RHEB OTFLTSEC Limited Biomarker [39]
RPGRIP1L OT6Z069I Limited Biomarker [40]
SHOX OTE0YZJO Limited Biomarker [41]
SPINT1 OT1CLR5L Limited Biomarker [42]
TBC1D7 OT1ALJ63 Limited Biomarker [43]
TRIM31 OT7VW6RP Limited Biomarker [44]
BEX2 OT4G5SIC moderate Biomarker [45]
BEX3 OTW1V1L5 moderate Biomarker [46]
CANX OTYP1F6J moderate Biomarker [47]
CASK OT8EF7ZF moderate Biomarker [48]
CCDC8 OTO295IH moderate Biomarker [47]
CCL24 OT9LGHV0 moderate Altered Expression [49]
DEPDC5 OTE70JLY moderate Biomarker [50]
FUZ OTC427QQ moderate Genetic Variation [51]
GCHFR OTEOT8GI moderate Genetic Variation [52]
MARCHF10 OTAYGHDM moderate Biomarker [53]
MPP2 OTPH8CZY moderate Biomarker [54]
PITX1 OTA0UN4C moderate Genetic Variation [55]
PLCD1 OT6WFVXZ moderate Altered Expression [16]
PPP1R15A OTYG179K moderate Genetic Variation [56]
RALGAPB OTY8CGA3 moderate Biomarker [57]
RAP1GAP OTC31ONQ moderate Genetic Variation [58]
RBBP4 OTG3BT3M moderate Altered Expression [59]
RPTOR OT4TQZ9F moderate Posttranslational Modification [60]
TCOF1 OT4BOYTM moderate Biomarker [61]
AMELX OTIN26MM Strong Biomarker [62]
BCL2L11 OTNQQWFJ Strong Biomarker [63]
DCX OTISR7K3 Strong Biomarker [64]
FLCN OTVM78XM Strong Biomarker [65]
FMR1 OTWEV0T5 Strong Altered Expression [66]
GLRX3 OTUPAU1N Strong Altered Expression [67]
KIF1A OT3JVEGV Strong Genetic Variation [68]
PKD1 OT5ALRZ5 Strong Genetic Variation [69]
PTPN4 OT6SXU5Y Strong Biomarker [70]
RABGEF1 OTWC3Z3R Strong Altered Expression [58]
RAP1A OT5RH6TI Strong Altered Expression [58]
RPS6 OTT4D1LN Strong Altered Expression [71]
TERF2IP OT3M5P3G Strong Altered Expression [58]
TSC1 OTFF4YZ7 Definitive Autosomal dominant [72]
TSC2 OT47LWI9 Definitive Autosomal dominant [72]
------------------------------------------------------------------------------------
⏷ Show the Full List of 53 DOT(s)

References

1 Everolimus FDA Label
2 Clinical pipeline report, company report or official report of the Pharmaceutical Research and Manufacturers of America (PhRMA)
3 Wnt3a Activates the WNT-YAP/TAZ Pathway to Sustain CDX2 Expression in Bovine Trophoblast Stem Cells.DNA Cell Biol. 2019 May;38(5):410-422. doi: 10.1089/dna.2018.4458. Epub 2019 Mar 21.
4 Extracutaneous manifestations in phacomatosis cesioflammea and cesiomarmorata: Case series and literature review.Am J Med Genet A. 2019 Jun;179(6):966-977. doi: 10.1002/ajmg.a.61134. Epub 2019 Mar 28.
5 Activation of leukocyte immunoglobulin-like receptor B2 signaling pathway in cortical lesions of pediatric patients with focal cortical dysplasia type IIb and tuberous sclerosis complex.Brain Dev. 2019 Nov;41(10):829-838. doi: 10.1016/j.braindev.2019.08.002. Epub 2019 Sep 5.
6 Impaired oligodendroglial turnover is associated with myelin pathology in focal cortical dysplasia and tuberous sclerosis complex.Brain Pathol. 2017 Nov;27(6):770-780. doi: 10.1111/bpa.12452. Epub 2017 Feb 9.
7 Novel mechanism of regulation of the DNA repair enzyme OGG1 in tuberin-deficient cells.Carcinogenesis. 2010 Nov;31(11):2022-30. doi: 10.1093/carcin/bgq189. Epub 2010 Sep 13.
8 mTORC1 suppresses PIM3 expression via miR-33 encoded by the SREBP loci.Sci Rep. 2017 Nov 23;7(1):16112. doi: 10.1038/s41598-017-16398-y.
9 Tuberous sclerosis complex with autosomal dominant polycystic kidney disease: a rare duo.BMJ Case Rep. 2014 Dec 17;2014:bcr2014207471. doi: 10.1136/bcr-2014-207471.
10 A novel GABAergic dysfunction in human Dravet syndrome.Epilepsia. 2018 Nov;59(11):2106-2117. doi: 10.1111/epi.14574. Epub 2018 Oct 11.
11 Therapeutic targeting of mTOR in tuberous sclerosis.Biochem Soc Trans. 2009 Feb;37(Pt 1):259-64. doi: 10.1042/BST0370259.
12 Evidence for genetic heterogeneity in tuberous sclerosis.J Med Genet. 1989 Aug;26(8):511-6. doi: 10.1136/jmg.26.8.511.
13 Expression of the Nogo-A system in cortical lesions of pediatric patients with tuberous sclerosis complex and focal cortical dysplasia type IIb.J Neuropathol Exp Neurol. 2012 Jul;71(7):665-77. doi: 10.1097/NEN.0b013e31825d6585.
14 Differential cellular expression of neurotrophins in cortical tubers of the tuberous sclerosis complex.Am J Pathol. 2001 Oct;159(4):1541-54. doi: 10.1016/S0002-9440(10)62539-4.
15 PAK2 is an effector of TSC1/2 signaling independent of mTOR and a potential therapeutic target for Tuberous Sclerosis Complex.Sci Rep. 2015 Sep 28;5:14534. doi: 10.1038/srep14534.
16 Elevated Expression of TRPC4 in Cortical Lesions of Focal Cortical Dysplasia II and Tuberous Sclerosis Complex.J Mol Neurosci. 2017 Jun;62(2):222-231. doi: 10.1007/s12031-017-0923-z. Epub 2017 Apr 28.
17 Comparison of the functional and structural characteristics of rare TSC2 variants with clinical and genetic findings.Hum Mutat. 2020 Apr;41(4):759-773. doi: 10.1002/humu.23963. Epub 2019 Dec 19.
18 p53/TAp63 and AKT regulate mammalian target of rapamycin complex 1 (mTORC1) signaling through two independent parallel pathways in the presence of DNA damage.J Biol Chem. 2014 Feb 14;289(7):4083-94. doi: 10.1074/jbc.M113.530303. Epub 2013 Dec 23.
19 ERK crosstalks with 4EBP1 to activate cyclin D1 translation during quinol-thioether-induced tuberous sclerosis renal cell carcinoma.Toxicol Sci. 2011 Nov;124(1):75-87. doi: 10.1093/toxsci/kfr203. Epub 2011 Aug 2.
20 Selective suppression of excessive GluN2C expression rescues early epilepsy in a tuberous sclerosis murine model.Nat Commun. 2014 Aug 1;5:4563. doi: 10.1038/ncomms5563.
21 Tuberous sclerosis complex: disease modifiers and treatments.Curr Opin Pediatr. 2008 Dec;20(6):628-33. doi: 10.1097/MOP.0b013e328318c529.
22 Structure of the Tuberous Sclerosis Complex 2 (TSC2) N Terminus Provides Insight into Complex Assembly and Tuberous Sclerosis Pathogenesis.J Biol Chem. 2016 Sep 16;291(38):20008-20. doi: 10.1074/jbc.M116.732446. Epub 2016 Aug 4.
23 NitroSynapsin for the treatment of neurological manifestations of tuberous sclerosis complex in a rodent model.Neurobiol Dis. 2019 Jul;127:390-397. doi: 10.1016/j.nbd.2019.03.029. Epub 2019 Mar 27.
24 mGluR5 Modulation of Behavioral and Epileptic Phenotypes in a Mouse Model of Tuberous Sclerosis Complex.Neuropsychopharmacology. 2018 May;43(6):1457-1465. doi: 10.1038/npp.2017.295. Epub 2017 Dec 5.
25 IL-21 and IL-21 receptor expression in lymphocytes and neurons in multiple sclerosis brain.Am J Pathol. 2011 Feb;178(2):794-802. doi: 10.1016/j.ajpath.2010.10.043.
26 Restraining PI3K: mTOR signalling goes back to the membrane.Trends Biochem Sci. 2005 Jan;30(1):35-42. doi: 10.1016/j.tibs.2004.11.003.
27 Tactile stimulation partially prevents neurodevelopmental changes in visual tract caused by early iron deficiency.Brain Res. 2017 Feb 15;1657:130-139. doi: 10.1016/j.brainres.2016.12.003. Epub 2016 Dec 9.
28 "Renal Cell Carcinoma With Leiomyomatous Stroma" Harbor Somatic Mutations of TSC1, TSC2, MTOR, and/or ELOC (TCEB1): Clinicopathologic and Molecular Characterization of 18 Sporadic Tumors Supports a Distinct Entity.Am J Surg Pathol. 2020 May;44(5):571-581. doi: 10.1097/PAS.0000000000001422.
29 Improved crop yield and reduced nitrate nitrogen leaching with straw return in a rice-wheat rotation of Ningxia irrigation district.Sci Rep. 2018 Jun 21;8(1):9458. doi: 10.1038/s41598-018-27776-5.
30 Absence of metabolic cross-correction in Tay-Sachs cells: implications for gene therapy.J Biol Chem. 2002 Jun 7;277(23):20177-84. doi: 10.1074/jbc.M106164200. Epub 2002 Mar 28.
31 Vaccination with inhibin- provides effective immunotherapy against testicular stromal cell tumors.J Immunother Cancer. 2017 Apr 18;5:37. doi: 10.1186/s40425-017-0237-2. eCollection 2017.
32 Arginase-II activates mTORC1 through myosin-1b in vascular cell senescence and apoptosis.Cell Death Dis. 2018 Feb 22;9(3):313. doi: 10.1038/s41419-018-0356-9.
33 Biallelic Mutations in TSC2 Lead to Abnormalities Associated with Cortical Tubers in Human iPSC-Derived Neurons.J Neurosci. 2019 Nov 20;39(47):9294-9305. doi: 10.1523/JNEUROSCI.0642-19.2019. Epub 2019 Oct 7.
34 Cannabidiol modulates phosphorylated rpS6 signalling in a zebrafish model of Tuberous Sclerosis Complex.Behav Brain Res. 2019 May 2;363:135-144. doi: 10.1016/j.bbr.2019.01.040. Epub 2019 Jan 23.
35 Molecular mechanism of a temperature-sensitive phenotype in peroxisomal biogenesis disorder.Pediatr Res. 2005 Aug;58(2):263-9. doi: 10.1203/01.PDR.0000169984.89199.69. Epub 2005 Jul 8.
36 The tuberous sclerosis complex subunit TBC1D7 is stabilized by Akt phosphorylation-mediated 14-3-3 binding.J Biol Chem. 2018 Oct 19;293(42):16142-16159. doi: 10.1074/jbc.RA118.003525. Epub 2018 Aug 24.
37 Vps34-mediated macropinocytosis in Tuberous Sclerosis Complex 2-deficient cells supports tumorigenesis.Sci Rep. 2018 Sep 21;8(1):14161. doi: 10.1038/s41598-018-32256-x.
38 Tsc1 ablation in Prx1 and Osterix lineages causes renal cystogenesis in mouse.Sci Rep. 2019 Jan 29;9(1):837. doi: 10.1038/s41598-018-37139-9.
39 MCRS1 binds and couples Rheb to amino acid-dependent mTORC1 activation.Dev Cell. 2015 Apr 6;33(1):67-81. doi: 10.1016/j.devcel.2015.02.010. Epub 2015 Mar 26.
40 Nipple-Areolar Complex Position in Female-to-Male Transsexuals After Non-skin-excisional Mastectomy: A Case-Control Study in Japan.Aesthetic Plast Surg. 2019 Oct;43(5):1195-1203. doi: 10.1007/s00266-019-01409-2. Epub 2019 May 29.
41 Phenotypes Associated with SHOX Deficiency.J Clin Endocrinol Metab. 2001 Dec;86(12):5674-80. doi: 10.1210/jcem.86.12.8125.
42 Thymidylate synthase expression in hepatic tumors is a predictor of survival and progression in patients with resectable metastatic colorectal cancer.J Clin Oncol. 2003 Feb 1;21(3):406-12. doi: 10.1200/JCO.2003.06.060.
43 dTBC1D7 regulates systemic growth independently of TSC through insulin signaling.J Cell Biol. 2018 Feb 5;217(2):517-526. doi: 10.1083/jcb.201706027. Epub 2017 Nov 29.
44 TRIM31 is upregulated in hepatocellular carcinoma and promotes disease progression by inducing ubiquitination of TSC1-TSC2 complex.Oncogene. 2018 Jan 25;37(4):478-488. doi: 10.1038/onc.2017.349. Epub 2017 Oct 2.
45 Brain-expressed X-linked 2 Is Pivotal for Hyperactive Mechanistic Target of Rapamycin (mTOR)-mediated Tumorigenesis.J Biol Chem. 2015 Oct 16;290(42):25756-65. doi: 10.1074/jbc.M115.665208. Epub 2015 Aug 20.
46 The TSC1 gene product hamartin interacts with NADE.Mol Cell Neurosci. 2007 May;35(1):100-8. doi: 10.1016/j.mcn.2007.02.007. Epub 2007 Feb 12.
47 Tumor-promoting phorbol esters and activated Ras inactivate the tuberous sclerosis tumor suppressor complex via p90 ribosomal S6 kinase.Proc Natl Acad Sci U S A. 2004 Sep 14;101(37):13489-94. doi: 10.1073/pnas.0405659101. Epub 2004 Sep 1.
48 Rheb activation disrupts spine synapse formation through accumulation of syntenin in tuberous sclerosis complex.Nat Commun. 2015 Apr 16;6:6842. doi: 10.1038/ncomms7842.
49 Inflammatory Characteristics of Monocytes from Pediatric Patients with Tuberous Sclerosis.Neuropediatrics. 2015 Oct;46(5):335-43. doi: 10.1055/s-0035-1562925. Epub 2015 Sep 10.
50 mTOR signaling in epilepsy: insights from malformations of cortical development.Cold Spring Harb Perspect Med. 2015 Apr 1;5(4):a022442. doi: 10.1101/cshperspect.a022442.
51 Crystal structure of the yeast TSC1 core domain and implications for tuberous sclerosis pathological mutations.Nat Commun. 2013;4:2135. doi: 10.1038/ncomms3135.
52 Are developmental dysplastic lesions epileptogenic?.Epilepsia. 2012 Jun;53 Suppl 1:35-44. doi: 10.1111/j.1528-1167.2012.03473.x.
53 Advances and Future Directions for Tuberous Sclerosis Complex Research: Recommendations From the 2015 Strategic Planning Conference.Pediatr Neurol. 2016 Jul;60:1-12. doi: 10.1016/j.pediatrneurol.2016.03.015. Epub 2016 Apr 2.
54 Cells derived from tuberous sclerosis show a prolonged S phase of the cell cycle and increased apoptosis.Arch Dermatol Res. 2001 Sep;293(9):460-9. doi: 10.1007/s004030100259.
55 Tuberous sclerosis complex: genotype/phenotype correlation of retinal findings.Ophthalmology. 2012 Sep;119(9):1917-23. doi: 10.1016/j.ophtha.2012.03.020. Epub 2012 May 16.
56 GADD34 inhibits mammalian target of rapamycin signaling via tuberous sclerosis complex and controls cell survival under bioenergetic stress.Int J Mol Med. 2007 Mar;19(3):475-83.
57 Adipocytes contain a novel complex similar to the tuberous sclerosis complex.Cell Signal. 2006 Oct;18(10):1626-32. doi: 10.1016/j.cellsig.2006.01.002. Epub 2006 Feb 21.
58 Rap1 activity is elevated in malignant astrocytomas independent of tuberous sclerosis complex-2 gene expression.Int J Oncol. 2003 Jan;22(1):195-200.
59 Regulation of PCNA and CAF-1 expression by the two tuberous sclerosis gene products.Biochem Biophys Res Commun. 2003 Aug 1;307(3):737-42. doi: 10.1016/s0006-291x(03)01238-5.
60 Turnover of the active fraction of IRS1 involves raptor-mTOR- and S6K1-dependent serine phosphorylation in cell culture models of tuberous sclerosis.Mol Cell Biol. 2006 Sep;26(17):6425-34. doi: 10.1128/MCB.01254-05.
61 Brain lesions in tuberous sclerosis complex. Review.Folia Neuropathol. 2010;48(3):139-49.
62 Refined quantitative fluorescent PCR of Y-chromosome DNA sequences mosaics in Turner's syndrome patients--alternative to real-time PCR.J Biochem Biophys Methods. 2004 Aug 31;60(2):151-62. doi: 10.1016/j.jbbm.2004.05.004.
63 Correction: miR-9-5p, miR-124-3p, and miR-132-3p regulate BCL2L11 in tuberous sclerosis complex angiomyolipoma.Lab Invest. 2019 Mar;99(3):443-444. doi: 10.1038/s41374-018-0131-7.
64 Doublecortin-like (DCL) expression in focal cortical dysplasia and cortical tubers.Epilepsia. 2009 Dec;50(12):2629-37. doi: 10.1111/j.1528-1167.2009.02191.x. Epub 2009 Jul 2.
65 Renal angiomyolipoma in Birt-Hogg-Dube syndrome: A case study supporting overlap with tuberous sclerosis complex.Am J Med Genet A. 2016 Dec;170(12):3323-3326. doi: 10.1002/ajmg.a.37952. Epub 2016 Sep 19.
66 Purkinje cells derived from TSC patients display hypoexcitability and synaptic deficits associated with reduced FMRP levels and reversed by rapamycin.Mol Psychiatry. 2018 Nov;23(11):2167-2183. doi: 10.1038/s41380-018-0018-4. Epub 2018 Feb 15.
67 Frenolicin B Targets Peroxiredoxin 1 and Glutaredoxin 3 to Trigger ROS/4E-BP1-Mediated Antitumor Effects. Cell Chem Biol. 2019 Mar 21;26(3):366-377.e12. doi: 10.1016/j.chembiol.2018.11.013. Epub 2019 Jan 17.
68 Characterization of a kinesin-related gene ATSV, within the tuberous sclerosis locus (TSC1) candidate region on chromosome 9Q34.Genomics. 1996 May 1;33(3):421-9. doi: 10.1006/geno.1996.0217.
69 Renal disease in tuberous sclerosis complex: pathogenesis and therapy.Nat Rev Nephrol. 2018 Nov;14(11):704-716. doi: 10.1038/s41581-018-0059-6.
70 Resective surgery in tuberous Sclerosis complex, from Penfield to 2018: A critical review.Rev Neurol (Paris). 2019 Mar;175(3):163-182. doi: 10.1016/j.neurol.2018.11.002. Epub 2019 Jan 25.
71 Fibrous papule of the face, similar to tuberous sclerosis complex-associated angiofibroma, shows activation of the mammalian target of rapamycin pathway: evidence for a novel therapeutic strategy?.PLoS One. 2014 Feb 18;9(2):e89467. doi: 10.1371/journal.pone.0089467. eCollection 2014.
72 Technical standards for the interpretation and reporting of constitutional copy-number variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics (ACMG) and the Clinical Genome Resource (ClinGen). Genet Med. 2020 Feb;22(2):245-257. doi: 10.1038/s41436-019-0686-8. Epub 2019 Nov 6.