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We completed prospective clinical evaluations of 16 individuals with mutations and eight with deletions in <jats:italic>CHAMP1<\/jats:italic>. Analyses revealed significantly lower adaptive functioning across all domains assessed (i.e., communication, daily living skills, socialization, and motor skills) in the mutation group. Developmental milestones and medical features further showed difference between groups. The phenotypes associated with mutations, as compared to deletions, indicate likely difference in pathogenesis between groups, where deletions are acting through <jats:italic>CHAMP1<\/jats:italic> haploinsufficiency and mutations are acting through dominant negative or gain of function mechanisms, leading to a more severe clinical phenotype. Understanding this pathogenesis is important to the future of novel therapies for CHAMP1 disorder and illustrates that mechanistic understanding of mutations must be carefully considered prior to treatment development.<\/jats:p>","DOI":"10.1007\/s00439-023-02578-6","type":"journal-article","created":{"date-parts":[[2023,7,16]],"date-time":"2023-07-16T11:01:27Z","timestamp":1689505287000},"page":"1385-1394","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Prospective phenotyping of CHAMP1 disorder indicates that coding mutations may not act through haploinsufficiency"],"prefix":"10.1007","volume":"142","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2207-0440","authenticated-orcid":false,"given":"Tess","family":"Levy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6792-0156","authenticated-orcid":false,"given":"Thariana","family":"Pichardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4630-1071","authenticated-orcid":false,"given":"Hailey","family":"Silver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9032-1224","authenticated-orcid":false,"given":"Bonnie","family":"Lerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5392-8839","authenticated-orcid":false,"given":"Jessica","family":"Zweifach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6745-1197","authenticated-orcid":false,"given":"Danielle","family":"Halpern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9659-8232","authenticated-orcid":false,"given":"Paige M.","family":"Siper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8129-2671","authenticated-orcid":false,"given":"Alexander","family":"Kolevzon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8898-8313","authenticated-orcid":false,"given":"Joseph D.","family":"Buxbaum","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,7,16]]},"reference":[{"key":"2578_CR1","volume-title":"Aberrant Behavior Checklist","author":"MG Aman","year":"1994","unstructured":"Aman MG, Singh N (1994) Aberrant Behavior Checklist. 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A.K. is on the Advisory Board for the Klingenstein Third Generation Foundation, Ovid Therapeutics, David Lynch Foundation, ADNP Kids Research Foundation, and Ritrova Therapeutics and consults to Acadia, Alkermes, Jaguar Therapeutics, GW Pharmaceuticals, Neuren Pharmaceuticals, Scioto Biosciences, and Biogen. P.M.S. consults to Deerfield. J.D.B. consults to BridgeBio and to Rumi, holds a patent for IGF-1 in Phelan-McDermid syndrome, holds an honorary professorship from Aarhus University Denmark, receives research support from Takeda and Oryzon, and is a journal editor for Springer Nature. The other authors declare no financial interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was performed in line with the principles of the Program for Protection of Human Subjects at the Icahn School of Medicine at Mount Sinai.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Written informed consent was obtained from all participant\u2019s parents or legal guardians in the study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}