The c.868G>C variant in ACTA1 is a missense variant predicted to cause substitution of aspartic acid by histidine at amino acid 290 (legacy nomenclature: p.Asp288His). This variant is absent from gnomAD v4.1.0 (PM2_Supporting). The computational predictor REVEL gives a score of 0.985, which is above the threshold of 0.7, evidence that correlates with impact to ACTA1 function (PP3). ACTA1, in which the variant was identified, is defined by the ClinGen Congenital Myopathies VCEP as a gene that has a low rate of benign missense variation and where pathogenic missense variants are a common mechanism of disease (PP2). This variant has been reported in 2 probands , including one with a muscle biopsy containing nemaline rods (PS4_Supporting, PP4_Moderate; PMIDs: 29565416, 28516742). In both individuals, the variant has been identified as a de novo occurrence with confirmed parental relationships (PS2). Another missense variant c.868G>A, p.Asp290Asn (PMIDs: 19562689, 27242277) in the same codon has been classified as pathogenic for AD nemaline myopathy by the ClinGen Congenital Myopathies VCEP (PM5). In summary, this variant meets the criteria to be classified as pathogenic for autosomal dominant alpha-actinopathy based on the ACMG/AMP criteria applied, as specified by the ClinGen Congenital Myopathies VCEP: PS2, PM5, PP4_Moderate, PS4_Supporting, PM2_Supporting, PP2, PP3 (Congenital Myopathies VCEP specifications version 1; 08/27/2024).