The variant NM_001100.4:c.685A>T in ACTA1 is a missense variant predicted to cause substitution of methionine by leucine at amino acid 229 (p.Met229Leu). This variant is absent from gnomAD v4.1.0 (PM2_Supporting). The REVEL computational prediction analysis tool produced a score of 0.617, which is neither above nor below the thresholds predicting a damaging or benign 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.686T>C (p.Met229Thr), 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], of which at least two has met the criteria to be classified as pathogenic by the ClinGen Congenital Myopathies VCEP (PM5_Strong). This variant has been reported in a proband with features of congenital myopathy (PS4 not met; Labcorp Genetics, ClinVar Accession: SCV000954285.6). In summary, the variant meets criteria to be classified as likely pathogenic for autosomal dominant alpha-actinopathy. ACMG/AMP criteria met, as specified by the ClinGen Congenital Myopathies VCEP: PM5_Strong, PM2_P, PP3 (ClinGen Congenital Myopathies VCEP specifications version 2.0.0).