Intellectual disability syndromic and non-syndromic
Gene: PAICS Amber List (moderate evidence)I don't know
PAICS encodes one of six enzymes used in de novo purine synthesis (DNPS). Biallelic variants in PAICS have been reported in 4 unrelated individuals with significant phenotypic variability with a spectrum of congenital pulmonary, cardiac, ocular and skeletal anomalies along with neurodevelopmental outcomes ranging from normal to severe delay/regression.
PMID: 31600779 - two siblings with multiple malformations (IUGR, polyhydramnios, brachycephaly, short neck, facial dysmorphisms, pulmonary hypoplasia, oesophageal atresia, GU abnormalities, skeletal malformations) resulting in early neonatal death at day2/3 life due to progressive hypotension and hypoxia, found to have homozygous missense mutations in PAICS (c.158A>G; p.Lys53Arg), biparentally inherited, confirmed on sanger. Enzyme activity of PAICS in patient fibroblasts was reduced to 10% in proband, compared to 50% in heterozygous carriers. Reduced purinosome formation in fibroblasts was rescued by wild type but not mutant transcripts.
PMID: 39604553 - two sibs with infantile onset disease including poor appetite and irritability, seizures, developmental delay/regression, microcephaly, truncal hypotonia, peripheral spasticity and hyperreflexia, macular dystrophy, abnormalities on MRI/MRS brain. Found to have compound het variants in PAICS c.535T>C, p.(Ser179Pro);c.1207C>T, p.(Arg403Ter). Elevated dephosphorylated substrates of PAICS substrates (Alr and CAlr) found on plasma and urine testing. Testing of patient fibroblast showed undetectable levels of PAICS protein and enzyme activity. In vitro enzyme activity of PAICS S179P and R403Ter was reduced compared to wild type.
PMID: 39726239 - complex congenital heart disease, vertebral anomalies, aberrant bronchus, congenital distal oesophagus stenosis, normal neurodevelopmental, facial dysmorphisms. Homozygous for previously reported missense in PAICS: c.158A > G, p.(Lys53Arg), no biochemical testing was reported. Possibly affected second pregnancy, however no genetic testing was performed.
PMID: 42569864 - congenital oesophageal atresia without fistula, MRI brain abnormalities, Klippel Feil anomaly, rib anomalies, multiple vascular anomalies (including aberrant right subclavian, common carotid trunk, vertebral artery arising from aortic arch), developmental delay, dysmorphic facial features. Biparental inherited compound heterozygous variants in PAICS: c.843_844del, p.(Cys281*); c.104C>T p.(Ser35Phe), however p.(Ser35Phe) is classified as a VUS. No biochemical or functional data was reported for this case.Created: 11 Sep 2026, 2:53 p.m. | Last Modified: 11 Sep 2026, 2:53 p.m.
Panel Version: 2.545
Mode of inheritance
BIALLELIC, autosomal or pseudoautosomal
Phenotypes
PAICS deficiency, MONDO:0859003; Phosphoribosylaminoimidazole carboxylase deficiency, MIM:619859; Disorders of purine metabolism
Publications
Gene: paics has been classified as Amber List (Moderate Evidence).
gene: PAICS was added gene: PAICS was added to Intellectual disability syndromic and non-syndromic. Sources: Expert Review Amber,Literature Mode of inheritance for gene: PAICS was set to BIALLELIC, autosomal or pseudoautosomal Publications for gene: PAICS were set to 31600779; 42569864; 39726239; 39604553 Phenotypes for gene: PAICS were set to PAICS deficiency, MONDO:0859003; Phosphoribosylaminoimidazole carboxylase deficiency, MIM:619859; Disorders of purine metabolism
If promoting or demoting a gene, please provide comments to justify a decision to move it.
Genes included in a Genomics England gene panel for a rare disease category (green list) should fit the criteria A-E outlined below.
These guidelines were developed as a combination of the ClinGen DEFINITIVE evidence for a causal role of the gene in the disease(a), and the Developmental Disorder Genotype-Phenotype (DDG2P) CONFIRMED DD Gene evidence level(b) (please see the original references provided below for full details). These help provide a guideline for expert reviewers when assessing whether a gene should be on the green or the red list of a panel.
A. There are plausible disease-causing mutations(i) within, affecting or encompassing an interpretable functional region(ii) of this gene identified in multiple (>3) unrelated cases/families with the phenotype(iii).
OR
B. There are plausible disease-causing mutations(i) within, affecting or encompassing cis-regulatory elements convincingly affecting the expression of a single gene identified in multiple (>3) unrelated cases/families with the phenotype(iii).
OR
C. As definitions A or B but in 2 or 3 unrelated cases/families with the phenotype, with the addition of convincing bioinformatic or functional evidence of causation e.g. known inborn error of metabolism with mutation in orthologous gene which is known to have the relevant deficient enzymatic activity in other species; existence of an animal model which recapitulates the human phenotype.
AND
D. Evidence indicates that disease-causing mutations follow a Mendelian pattern of causation appropriate for reporting in a diagnostic setting(iv).
AND
E. No convincing evidence exists or has emerged that contradicts the role of the gene in the specified phenotype.
(i)Plausible disease-causing mutations: Recurrent de novo mutations convincingly affecting gene function. Rare, fully-penetrant mutations - relevant genotype never, or very rarely, seen in controls. (ii) Interpretable functional region: ORF in protein coding genes miRNA stem or loop. (iii) Phenotype: the rare disease category, as described in the eligibility statement. (iv) Intermediate penetrance genes should not be included.
It’s assumed that loss-of-function variants in this gene can cause the disease/phenotype unless an exception to this rule is known. We would like to collect information regarding exceptions. An example exception is the PCSK9 gene, where loss-of-function variants are not relevant for a hypercholesterolemia phenotype as they are associated with increased LDL-cholesterol uptake via LDLR (PMID: 25911073).
If a curated set of known-pathogenic variants is available for this gene-phenotype, please contact us at panelapp@genomicsengland.co.uk
We classify loss-of-function variants as those with the following Sequence Ontology (SO) terms:
Term descriptions can be found on the PanelApp homepage and Ensembl.
If you are submitting this evaluation on behalf of a clinical laboratory please indicate whether you report variants in this gene as part of your current diagnostic practice by checking the box
Standardised terms were used to represent the gene-disease mode of inheritance, and were mapped to commonly used terms from the different sources. Below each of the terms is described, along with the equivalent commonly-used terms.
A variant on one allele of this gene can cause the disease, and imprinting has not been implicated.
A variant on the paternally-inherited allele of this gene can cause the disease, if the alternate allele is imprinted (function muted).
A variant on the maternally-inherited allele of this gene can cause the disease, if the alternate allele is imprinted (function muted).
A variant on one allele of this gene can cause the disease. This is the default used for autosomal dominant mode of inheritance where no knowledge of the imprinting status of the gene required to cause the disease is known. Mapped to the following commonly used terms from different sources: autosomal dominant, dominant, AD, DOMINANT.
A variant on both alleles of this gene is required to cause the disease. Mapped to the following commonly used terms from different sources: autosomal recessive, recessive, AR, RECESSIVE.
The disease can be caused by a variant on one or both alleles of this gene. Mapped to the following commonly used terms from different sources: autosomal recessive or autosomal dominant, recessive or dominant, AR/AD, AD/AR, DOMINANT/RECESSIVE, RECESSIVE/DOMINANT.
A variant on one allele of this gene can cause the disease, however a variant on both alleles of this gene can result in a more severe form of the disease/phenotype.
A variant in this gene can cause the disease in males as they have one X-chromosome allele, whereas a variant on both X-chromosome alleles is required to cause the disease in females. Mapped to the following commonly used term from different sources: X-linked recessive.
A variant in this gene can cause the disease in males as they have one X-chromosome allele. A variant on one allele of this gene may also cause the disease in females, though the disease/phenotype may be less severe and may have a later-onset than is seen in males. X-linked inactivation and mosaicism in different tissues complicate whether a female presents with the disease, and can change over their lifetime. This term is the default setting used for X-linked genes, where it is not known definitately whether females require a variant on each allele of this gene in order to be affected. Mapped to the following commonly used terms from different sources: X-linked dominant, x-linked, X-LINKED, X-linked.
The gene is in the mitochondrial genome and variants within this can cause this disease, maternally inherited. Mapped to the following commonly used term from different sources: Mitochondrial.
Mapped to the following commonly used terms from different sources: Unknown, NA, information not provided.
For example, if the mode of inheritance is digenic, please indicate this in the comments and which other gene is involved.