The NM_000152.5:c.1958C>A variant in GAA is a missense variant predicted to cause substitution of threonine by asparagine at amino acid 653 (p.Thr653Asn). At least three probands with Pompe disease have been reported with this variant (PMIDs 21232767, 24513544, clinical laboratory data), two with documented deficiency of GAA activity (PMID: 23884227, 25612604) (PP4_Moderate). One patient is compound heterozygous for (c.1958C>A p.Thr653Asn) and (c.752 C>T; 761 C>T, p.Ser251Leu; Ser254Leu, P/LP haplotype based on classification by the ClinGen Lysosomal Diseases VCEP); phase confirmed by parental testing (1 point, PMID: 21232767). Another patient was identified on newborn screen, currently asymptomatic, therefore data not included, compound heterozygous for the variant and c.424_440del17 (PMID: 24513544). Another patient is compound heterozygous for the variant and c.1551G>T. The allelic data from this patient may be used in the classification of c.1551 and is not include here to avoid circular logic (PMID: 29995633). Total 1 point (PM3). The highest population minor allele frequency in gnomAD v2.1.1 is 0.0002548 (5/19624 alleles) in the East Asian population, which is lower than the ClinGen LD VCEP's threshold (<0.001) for meeting PM2_Supporting (PM2_Supporting). The computational predictor REVEL gives a score of 0.748 which is above the threshold of 0.7, evidence that correlates with impact to GAA function (PP3). There is a ClinVar entry for this variant (Variation ID: 972798). In summary, this variant meets the criteria to be classified as Likely Pathogenic for Pompe disease. GAA-specific ACMG/AMP criteria met, based on the specifications of the ClinGen Lysosomal Diseases Variant Curation Expert Panel (Specifications Version 2.0): PM3, PP4_Moderate, PM2_Supporting, PP3. (Classification approved by the ClinGen Lysosomal Diseases Expert panel on July 21, 2024).