“…6,7 CHD3 is extremely intolerant for both loss-of-function (LoF) and missense variation (probability of LoF intolerance = 1, observed/expected = 0.09 [0.05-0.15]; Z = 6.15, observed/expected = 0.5 [0.46-0.53]), suggesting haploinsufficiency as a possible disease mechanism. However, the large majority of cases diagnosed with SNIBCPS carry confirmed de novo missense variants or single amino acid in-frame deletion variants (51/55, 93% of cases), 6,7 clustering in the adenosine triphosphatase (ATPase)-helicase domain of the encoded protein and affecting its ATPase activity and/or chromatin remodeling functions, which could be consistent with a dominantnegative mechanism. 6 We assembled a cohort of 21 families with inherited CHD3 variants and used a combination of objectified indepth clinical analyses, cell-based expression studies, and large population cohort analyses to confirm the association of inherited CHD3 variants with SNIBCPS and to show that heterozygote parents, who were predominantly females, often have (very) mild phenotypes, showing variable expressivity.…”