The NM_000152.5:c.2185del (p.Leu729TrpfsTer35) variant in GAA is a frameshift variant predicted to cause a premature stop codon and to lead to nonsense mediated decay in a gene in which loss-of-function is an established disease mechanism (PVS1). This variant has been reported in three individuals with infantile onset Pompe disease (PMIDs 19588081, 24269976, 28394184)(PP4). One of these individuals is homozygous for the variant (PMID 19588081)(PM3_Supporting); another individual is heterozygous for the variant but a second variant was not found (PMID, 24269976), and one is compound heterozygous for the variant and c.1935C>A (p.Asp645Glu)(PMID 28394184). The allelic data for this latter patient was used in the assessment of p.Asp645Glu and is not included here to avoid circular logic. The variant is absent in gnomAD v2.1.1 (PM2_Supporting). There is a ClinVar entry for this variant (Variant ID 370552; 2 star review status) with one submitter classifying the variant as pathogenic and one as likely pathogenic. In summary, this variant meets the criteria to be classified as pathogenic for Pompe disease. GAA-specific ACMG/AMP criteria met, as specified by the ClinGen LSD VCEP (Specifications Version 2.0): PVS1, PP4, PM2_Supporting, PM3_Supporting.