The c.1438-2A>G variant alters the canonical acceptor splice site of intron 9 and has been shown by RT-PCR to causing skipping of exon 10, resulting in an in frame deletion that removes about 4% of the gene product (PMID 24158270). Exon 10 forms part of the GAA catalytic barrel, including two residues, Trp481 and Trp516, which are part of the GAA active site (PMIDs 1856189; 22253258; DOI 10.1101/212837). Therefore, loss of this exon is expected to abolish GAA activity, and PVS1 can be applied. The variant is absent in gnomAD v2.1.1, meeting PM2. This variant has been reported in two individuals with Pompe disease who meet the ClinGen LSD VCEP’s specifications for PP4, and who are compound heterozygotes for this variant and a second pathogenic variant, c.-32-13T>G in one case (PMIDs 24158270), and c.955+1G>A in the other (PMID 29422078), meeting PM3. Other variants altering the same canonical splice site, c.1438-1G>T (PMID 18425781) and c.1438-1G>C (PMIDs 22538254, 24495340), have been reported in patients with Pompe disease. There is a ClinVar entry for this variant (Variation ID: 526521) with one submitters 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 applied: PVS1, PM2, PM3, and PP4.