The variant NM_001100.4:c.686T>C in ACTA1 is a missense variant predicted to cause substitution of methionine by threonine at amino acid 229 (p.Met229Thr). This variant is absent from gnomAD v4.1.0 (PM2_Supporting). The REVEL computational prediction analysis tool produced a score of 0.934, which is above the threshold predicting a damaging impact on ACTA1 function. 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). Six different missense variants, [c.685A>G (p.Met229Val), c.686T>G (p.Met229Arg), c.685A>T (p.Met229Leu), c.687G>A (p.Met229Ile), c.687G>C (p.Met229Ile), c.687G>T (p.Met229Ile)], in the same codon have been reported in patients with congenital myopathies (PMIDs: 12921789, 19562689, VCEP internal contributor]. This variant has been reported as de novo occurrences in at least three probands with features of nemaline myopathy, of which one was de novo with confirmed parentage (PS2, PS4_Supporting; PMIDs: 12921789, 19562689, 35810298, 38982518, 40225930; Institut de Génétique et Biologie Moléculaire et Cellulaire, ClinVar Accession: SCV005038471.2). At least one patient with this variant displayed characteristic muscle biopsy with fiber size variability, intranuclear rods, cytoplasmic bodies, and other features, which is highly compatible with alpha-actinopathy (PP4_Moderate, PMIDs:35810298, 38982518). In summary, the variant meets criteria to be classified as pathogenic for autosomal dominant alpha-actinopathy. ACMG/AMP criteria met, as specified by the ClinGen Congenital Myopathies VCEP: PS2, PP4_M, PS4_P, PM2_P, PP2, PP3 (ClinGen Congenital Myopathies VCEP specifications version 2.0.0).