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For example, hereditary spastic paraplegia is associated with &gt;80 genes, with frequently only few affected individuals described for each gene. Herein, we characterize a large cohort of individuals with biallelic variation in <jats:italic>ENTPD1<\/jats:italic>, a gene previously linked to spastic paraplegia 64 (Mendelian Inheritance in Man # 615683).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Individuals with biallelic <jats:italic>ENTPD1<\/jats:italic> variants were recruited worldwide. Deep phenotyping and molecular characterization were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 27 individuals from 17 unrelated families were studied; additional phenotypic information was collected from published cases. Twelve novel pathogenic <jats:italic>ENTPD1<\/jats:italic> variants are described (NM 001776.6): c.398_399delinsAA; p.(Gly133Glu), c.540del; p.(Thr181Leufs*18), c.640del; p.(Gly216Glufs*75), c.185\u2009T\u2009&gt;\u2009G; p.(Leu62*), c.1531\u2009T\u2009&gt;\u2009C; p.(*511Glnext*100), c.967C\u2009&gt;\u2009T; p.(Gln323*), c.414\u20102_414\u20101del, and c.146 A\u2009&gt;\u2009G; p.(Tyr49Cys) including 4 recurrent variants c.1109\u2009T\u2009&gt;\u2009A; p.(Leu370*), c.574\u20106_574\u20103del, c.770_771del; p.(Gly257Glufs*18), and c.1041del; p.(Ile348Phefs*19). Shared disease traits include childhood onset, progressive spastic paraplegia, intellectual disability (ID), dysarthria, and white matter abnormalities. <jats:italic>In vitro<\/jats:italic> assays demonstrate that <jats:italic>ENTPD1<\/jats:italic> expression and function are impaired and that c.574\u20106_574\u20103del causes exon skipping. Global metabolomics demonstrate <jats:italic>ENTPD1<\/jats:italic> deficiency leads to impaired nucleotide, lipid, and energy metabolism.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>The <jats:italic>ENTPD1<\/jats:italic> locus trait consists of childhood disease onset, ID, progressive spastic paraparesis, dysarthria, dysmorphisms, and white matter abnormalities, with some individuals showing neurocognitive regression. Investigation of an allelic series of <jats:italic>ENTPD1<\/jats:italic> (1) expands previously described features of <jats:italic>ENTPD1<\/jats:italic>\u2010related neurological disease, (2) highlights the importance of genotype\u2010driven deep phenotyping, (3) documents the need for global collaborative efforts to characterize rare autosomal recessive disease traits, and (4) provides insights into disease trait neurobiology. ANN NEUROL 2022;92:304\u2013321<\/jats:p><\/jats:sec>","DOI":"10.1002\/ana.26381","type":"journal-article","created":{"date-parts":[[2022,4,26]],"date-time":"2022-04-26T18:39:49Z","timestamp":1650998389000},"page":"304-321","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Biallelic Variants in the Ectonucleotidase <scp><i>ENTPD1<\/i><\/scp> Cause a Complex Neurodevelopmental Disorder with Intellectual Disability, Distinct White Matter Abnormalities, and Spastic Paraplegia"],"prefix":"10.1002","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6860-372X","authenticated-orcid":false,"given":"Daniel G.","family":"Calame","sequence":"first","affiliation":[{"name":"Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics Baylor College of Medicine  Houston TX USA"},{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7359-6832","authenticated-orcid":false,"given":"Isabella","family":"Herman","sequence":"additional","affiliation":[{"name":"Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics Baylor College of Medicine  Houston TX USA"},{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"},{"name":"Texas Children's Hospital  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza","family":"Maroofian","sequence":"additional","affiliation":[{"name":"Department of Neuromuscular Disorders Queen Square Institute of Neurology, University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aren E.","family":"Marshall","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute University of Ottawa  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karina Carvalho","family":"Donis","sequence":"additional","affiliation":[{"name":"Graduate Program in Genetics and Molecular Biology Federal University of Rio Grande do Sul  Porto Alegre Brazil"},{"name":"Medical Genetics Service Porto Alegre Clinical Hospital  Porto Alegre Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jawid M.","family":"Fatih","sequence":"additional","affiliation":[{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tadahiro","family":"Mitani","sequence":"additional","affiliation":[{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haowei","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3884-7720","authenticated-orcid":false,"given":"Christopher M.","family":"Grochowski","sequence":"additional","affiliation":[{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergio B.","family":"Sousa","sequence":"additional","affiliation":[{"name":"University Clinic of Genetics, Faculty of Medicine, Universidade de Coimbra  Coimbra Portugal"},{"name":"Medical Genetics Unit, Hospital Pediatrico, Centro Hospitalar e Universitario de Coimbra  Coimbra Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charul","family":"Gijavanekar","sequence":"additional","affiliation":[{"name":"Department of Molecular and Human Genetics Baylor College of Medicine  Houston TX USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Somayeh","family":"Bakhtiari","sequence":"additional","affiliation":[{"name":"Pediatric Movement Disorders Program, Division of Pediatric Neurology Barrow Neurological Institute, Phoenix Children's Hospital  Phoenix AZ USA"},{"name":"Departments of Child Health, Neurology, and Cellular &amp; 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