p.arg119gly p.arg119his p.ala179thr c.540+1g>a c.617_633+6del Prediction basis structure

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1 a Missense ATG p.arg119gly p.arg119his p.ala179thr p.ala189val p.gly206trp p.gly206arg p.arg251his p.ala257thr TGA 5 UTR UTR Splice Site, Frameshift b Mutation p.gly206trp p.gly4fsx50 c.138+1g>a Prediction probably damaging Prediction basis structure c.540+1g>a c.617_633+6del c.633+1g>c Substitution effect 1.1.2: structural effect, buried site, overpacking Overpacking at buried site c.797g>a; p.arg266gln c.797+1g>a c.797+2_797+5del Prophyler MAPP P- value p.arg266gln benign alignment N/A p.arg119gly probably damaging alignment N/A 9.923*E-4 p.arg119his probably damaging alignment N/A p.ala189val benign alignment N/A 0,2072 p.ala179thr probably damaging alignment N/A 3.392*E-5 p.gly206arg p.arg251his p.ala257thr probably damaging probably damaging probably damaging structure structure structure 1.1.2: structural effect, buried site, overpacking Overpacking at buried site 1.1.1: structural effect, buried site, hydrophobicity Hydrophobicity change at buried site 1.1.1: structural effect, buried site, hydrophobicity Hydrophobicity change at buried site 5.365*E Supplementary Figure 1 Localization and effect of PYCR1 mutations. ( a) Genomic localization. Note that mutations accumulate in exons 4-6 of PYCR1. Red= position of amino acids essential for NAD(P)H binding. Orange= 100% conserved residues. Yellow= >80% conserved residues. White= spice site and frameshift mutations. ( b) Assessment of effect of missense mutations. The computational tools PolyPhen ( and Prophyler ( were used to estimate the effects of the PYCR1 missense mutations on protein function. The first column shows the mutation, columns 2-4 show the PolyPhen predictions, and column 5 shows the Prophyler MAPP P value. Low P-values are strong predictions for deleteriousness, high P-values mean the variant is unlikely to be deleterious. Note that mutation p.arg266gln, which is predicted to be benign by both PolyPhen and Prophyler on the basis of protein characteristics, is predicted to affect splicing by altering the invariable donor splice site at the 3' end of exon 6. Splicing is not judged by these programs. The mutation p.ala189val was also judged to be benign by both programs. In this case, the other allele carries the Arg119His mutation which is predicted to be deleterious. As the p.ala189val change was not present in more than 100 control samples, it likely results in reduced residual activity. However, we cannot rule out a rare variant.

2 a fold expression change fold expression change Fold expression change b ,4 1,2 1,0 0,8 0,6 Liver Kidney Heart Skin Brain Eye spinal nerve Bone Osteoblast Osteoclast Liver Kidney Heart Skin Brain Eye spinal nerve Bone Osteoblast mosteoclast Liver Kidney Heart Skin Brain Eye spinal nerve Bone Osteoblast Osteoclast Liver Kidney Heart Skin Brain Eye Pycr1 Pycr2 Pycrl P5cs spinal nerve Bone Osteoblast Osteoclast 0,4 0,2 0,0 Ctr 1 Ctr 2 HJ DI MJ Ctr 1 Ctr 2 HJ DI MJ Ctr 1 Ctr 2 HJ DI MJ PYCR1 PYCR2 P5CS Supplementary Figure 2 Expression of genes involved in the proline metabolic pathway determined by quantitative PCR. ( a) Expression of genes involved in proline metabolism in tissues from 4 day old mice normalized to expression levels in the heart determined by quantitative PCR. Note extremely high Pycr1 expression levels in osteoblasts and skin. Pycr2 and Pycrl are also most highly expressed in osteoblasts, but otherwise show uniform expression, as does P5cs. ( b) Gene expression changes in fibroblasts from individuals with PYCR1 mutations and controls. While the Gly206Trp mutation in patient TP does not affect PYCR1 expression levels the mutations in DI and SJ clearly reduce mrna levels due to nonsense-mediated decay. Expression of PYCR2 and P5CS is not affected.

3 a [ mol/l] Ctr (n=8) Pat (n=13) Ctr (n=8) Pat (n=13) Proline Ornithine b [ mol/l] Ctr (n=4) Pat (n=4) Proline c % cells BrdU positive 60% 50% 40% 30% 20% 10% 0% Ctr (n=3) Pat (n=3) Ctr (n=3) Pat (n=3) Ctr (n=3) Pat (n=3) 0mMPro 0,2mMPro 5mMPro Supplementary Figure 3 Loss of PYCR1 does not cause hypoprolinemia or a cell proliferation defect. ( a) Proline and ornithine levels in individuals with PYCR1 mutations (Pat) compared to controls (Ctr). Note non-significant (p=0,051) reduction of proline concentrations in affected individuals. ( b) Proline levels in fibroblast lysates from controls and from individuals with PYCR1 mutation. No significant differenced were detectable. (c) Proliferation rates of fibroblasts from individuals with PYCR1 mutations (Pat) and controls (Ctr) grown in medium with different proline concentrations. No significant differences were observed, but mutant cells showed slightly higher proliferation. Representative result of two independent experiments. Ctr = control; Pat = patient. Errors are given as s.d..

4 a b c background DCDHF only d # Cells DCDHF + H 2 O Ctrl (n=2) Pat (n=4) Ctrl (n=2) Pat (n=4) DCDHF Intrinsic ROS level ROS level after treatment with 1mM H2O2 Supplementary Figure 4 Mitochondrial function in fibroblasts and lymphoblastoid cell lines. (a) Respiratory rates (oxygen consumption) were measured in 7 x 106 cultured, digitonin-permeabilized fibroblasts from patients and normal controls. No significant differences were found in respiratory chain function. (b) Respiratory rates (oxygen consumption) were measured in 2 x 107 cultured,digitonin-permeabilized EBV-immortalized lymphoblastoid cell lines (LCL) from patients, heterozygous parents and normal controls. No significant differences were found in respiratory chain function between the different genotypes. ( c) ROS detection by DCDHF. Representative traces showing fluorescence intensity levels without DCDHF, whith DCDHF and with DCDHF and H2O 2. ( c) Quantita- tive comparison of mean DCDHF fluorescence intensity in controls and patients with and without H O. Representative results of one experiment are given. 2 2

5 a b c Control d Pycr1 Mo e Pycr2 Mo f g Pycr1+2 Mo h Pycr1+2 Mo + PYCR1 i Control j Pycr1+2 Mo Pycr1+2 Mo + PYCR1 k l m Control Pycr1+2 Mo Pycr1+2 Mo + PYCR1 n o p Supplementary Figure 5 Morpholino (MO)-mediated knockdown of Pycr1 and Pycr2 in zebrafish leads to malformation, epidermal atrophy and increased apoptosis. ( a-h) Control, Pycr1 morphant, Pycr2 morphant, Pycr1+2 morphant and Pycr1+2 morphant zebrafish injected with 20pg human PYCR1 mrna at stage 24h. ( f-h) Control, Pycr 1+2 morphant and Pycr1+2 morphant zebrafish injected with 20 pg human PYCR1 mrna at stage 48 hours. Note reduced length of morphant fishes, abnormally bowed tail and loosening of the epidermis around the yolk sac. The severity of the phenotype increases when Pycr1 and Pycr2 are both knocked down. Only subtle changes are seen after rescue of the morphant phenotype with 20pg of human PYCR1 mrna. ( i,j) Dermal atrophy in Pycr1+2 morphants. In 48 hours-old control fish () i adouble-layered epidermis surrounds the yolk sac. In Pycr1+2 morphants ( j) this epidermis is atrophic. Goldner trichrome staining. ( k-m) Acridine orange staining of apoptotic cells at stage 24h. Note significant increased number of apoptotic cells in morphants and almost complete reversion of the phenotype by co-injection of the human PYCR1 mrna. ( n-p) Acridine staining of apoptotic cells in the tail, higher magnification.

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7 Supplementary Table 1 Results of high throughput sequencing Strategy flowchart 5 lanes of Illumina sequence 47,880,719 raw reads Bfast uniquely aligned reads 19,271,149 (40%) Total mismatches to reference in chr17: ,611,834 Mismatches to reference >= 2x coverage, % 71,495 Mismatches to reference >= 2x coverage, homozygous (80-100%) 3,083 Mismatches to reference in dbsnp 2,531 Mismatches to reference not in dbsnp 552 Mismatches causing a coding change in UCSC genes 11 Intersection of genes with mutations in other samples

8 Supplementary Table 1 Results of high throughput sequencing List of mismatches on chr17 pos Chromosome Mismatch position Mismatch description and Coverage chr C >T(10:10:100%[F:7:70% R:3:30%]) chr G >A(15:15:100%[F:13:86.7% R:2:13.3%]) chr C >T(8:8:100%[F:7:87.5% R:1:12.5%]) chr G >A(2:2:100%[F:0:0% R:2:100%]) chr C >T(2:2:100%[F:0:0% R:2:100%]) chr C >A(2:2:100%[F:2:100% R:0:0%]) chr C >T(7:7:100%[F:6:85.7% R:1:14.3%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(3:3:100%[F:0:0% R:3:100%]) chr T >G(16:16:100%[F:3:18.8% R:13:81.2%]) chr G >A(5:5:100%[F:4:80% R:1:20%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr A >T(11:11:100%[F:8:72.7% R:3:27.3%]) chr G >A(4:4:100%[F:0:0% R:4:100%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr T >C(12:12:100%[F:7:58.3% R:5:41.7%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr G >C(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr DEL:C > (5:5:100%[F:1 R:4]) chr T >C(3:3:100%[F:3:100% R:0:0%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr G >C(25:25:100%[F:11:44% R:14:56%]) chr C >T(9:9:100%[F:4:44.4% R:5:55.6%]) chr G >A(3:3:100%[F:3:100% R:0:0%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr A >G(7:7:100%[F:5:71.4% R:2:28.6%]) chr C >T(20:20:100%[F:10:50% R:10:50%]) chr C >G(3:3:100%[F:1:33.3% R:2:66.7%]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr T >G(43:43:100%[F:18:41.9% R:25:58.1%]) chr T >C(6:6:100%[F:1:16.7% R:5:83.3%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr T >C(2:2:100%[F:1:50% R:1:50%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(11:11:100%[F:5:45.5% R:6:54.5%]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr C >T(55:55:100%[F:4:7.27% R:51:92.7%]) chr C >A(11:11:100%[F:3:27.3% R:8:72.7%]) chr C >G(3:3:100%[F:0:0% R:3:100%]) chr C >T(16:16:100%[F:11:68.8% R:5:31.2%])

9 chr G >A(11:11:100%[F:6:54.5% R:5:45.5%]) chr A >G(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr A >G(4:4:100%[F:1:25% R:3:75%]) chr DEL:T > (8:8:100%[F:3 R:5]) chr C >T(12:12:100%[F:9:75% R:3:25%]) chr T >G(6:6:100%[F:2:33.3% R:4:66.7%]) chr G >A(39:39:100%[F:22:56.4% R:17:43.6%]) chr T >C(8:8:100%[F:0:0% R:8:100%]) chr DEL:GCAC > (3:3:100%[F:3 R:0]) chr A >G(4:4:100%[F:4:100% R:0:0%]) chr DEL:T > (2:2:100%[F:0 R:2]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr G >A(9:9:100%[F:8:88.9% R:1:11.1%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr G >A(2:2:100%[F:1:50% R:1:50%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr C >G(17:17:100%[F:0:0% R:17:100%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr C >T(15:15:100%[F:9:60% R:6:40%]) chr T >A(3:3:100%[F:0:0% R:3:100%]) chr T >A(2:2:100%[F:0:0% R:2:100%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr T >A(4:4:100%[F:4:100% R:0:0%]) chr G >C(4:4:100%[F:3:75% R:1:25%]) chr C >G(19:19:100%[F:11:57.9% R:8:42.1%]) chr G >T(3:3:100%[F:3:100% R:0:0%]) chr INS: >T(2:2:100%[F:1 R:0]) chr A >G(18:18:100%[F:8:44.4% R:10:55.6%]) chr C >A(4:4:100%[F:4:100% R:0:0%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(4:4:100%[F:3:75% R:1:25%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr INS: >C(2:2:100%[F:1 R:0]) chr T >A(8:8:100%[F:1:12.5% R:7:87.5%]) chr A >T(2:2:100%[F:2:100% R:0:0%]) chr T >C(22:22:100%[F:12:54.5% R:10:45.5%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr INS: >A(3:3:100%[F:3 R:0]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr DEL:A > (2:2:100%[F:2 R:0]) chr DEL:AC > (3:3:100%[F:3 R:0]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(16:16:100%[F:8:50% R:8:50%]) chr G >A(9:9:100%[F:5:55.6% R:4:44.4%])

10 chr C >A(2:2:100%[F:0:0% R:2:100%]) chr C >T(22:22:100%[F:12:54.5% R:10:45.5%]) chr A >G(55:55:100%[F:23:41.8% R:32:58.2%]) chr C >A(2:2:100%[F:2:100% R:0:0%]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr C >A(12:12:100%[F:9:75% R:3:25%]) chr G >A(16:16:100%[F:13:81.2% R:3:18.8%]) chr T >G(4:4:100%[F:1:25% R:3:75%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(3:3:100%[F:0:0% R:3:100%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr T >A(2:2:100%[F:0:0% R:2:100%]) chr C >G(19:19:100%[F:17:89.5% R:2:10.5%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(2:2:100%[F:0:0% R:2:100%]) chr C >T(3:3:100%[F:3:100% R:0:0%]) chr A >G(3:3:100%[F:0:0% R:3:100%]) chr G >A(19:19:100%[F:14:73.7% R:5:26.3%]) chr DEL:T > (2:2:100%[F:0 R:2]) chr C >T(13:13:100%[F:8:61.5% R:5:38.5%]) chr C >A(2:2:100%[F:2:100% R:0:0%]) chr G >A(5:5:100%[F:1:20% R:4:80%]) chr G >C(3:3:100%[F:1:33.3% R:2:66.7%]) chr INS: >C(6:6:100%[F:3 R:0]) chr A >G(15:15:100%[F:3:20% R:12:80%]) chr G >A(6:6:100%[F:1:16.7% R:5:83.3%]) chr A >T(2:2:100%[F:1:50% R:1:50%]) chr G >C(15:15:100%[F:6:40% R:9:60%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(28:28:100%[F:24:85.7% R:4:14.3%]) chr A >C(25:25:100%[F:13:52% R:12:48%]) chr G >A(11:11:100%[F:7:63.6% R:4:36.4%]) chr A >G(25:25:100%[F:21:84% R:4:16%]) chr C >G(26:26:100%[F:12:46.2% R:14:53.8%]) chr A >C(4:4:100%[F:2:50% R:2:50%]) chr DEL:CTT > (2:2:100%[F:1 R:1]) chr G >T(2:2:100%[F:1:50% R:1:50%]) chr G >A(36:36:100%[F:20:55.6% R:16:44.4%]) chr G >T(8:8:100%[F:5:62.5% R:3:37.5%]) chr C >A(6:6:100%[F:2:33.3% R:4:66.7%]) chr G >C(10:10:100%[F:0:0% R:10:100%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr DEL:G > (2:2:100%[F:2 R:0]) chr T >G(8:8:100%[F:6:75% R:2:25%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr G >A(22:22:100%[F:16:72.7% R:6:27.3%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr G >A(20:20:100%[F:15:75% R:5:25%]) chr G >A(3:3:100%[F:0:0% R:3:100%])

11 chr A >G(2:2:100%[F:0:0% R:2:100%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr A >G(14:14:100%[F:8:57.1% R:6:42.9%]) chr G >A(12:12:100%[F:8:66.7% R:4:33.3%]) chr G >T(14:14:100%[F:1:7.14% R:13:92.9%]) chr T >C(8:8:100%[F:5:62.5% R:3:37.5%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr A >G(2:2:100%[F:1:50% R:1:50%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(5:5:100%[F:3:60% R:2:40%]) chr T >G(3:3:100%[F:1:33.3% R:2:66.7%]) chr T >A(8:8:100%[F:0:0% R:8:100%]) chr T >G(5:5:100%[F:5:100% R:0:0%]) chr C >T(11:11:100%[F:8:72.7% R:3:27.3%]) chr A >T(2:2:100%[F:2:100% R:0:0%]) chr G >T(2:2:100%[F:0:0% R:2:100%]) chr G >T(2:2:100%[F:0:0% R:2:100%]) chr G >A(3:3:100%[F:3:100% R:0:0%]) chr C >T(13:13:100%[F:9:69.2% R:4:30.8%]) chr A >G(2:2:100%[F:0:0% R:2:100%]) chr A >G(25:25:100%[F:18:72% R:7:28%]) chr T >C(12:12:100%[F:6:50% R:6:50%]) chr G >A(3:3:100%[F:1:33.3% R:2:66.7%]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(4:4:100%[F:2:50% R:2:50%]) chr C >T(9:9:100%[F:5:55.6% R:4:44.4%]) chr A >G(4:4:100%[F:1:25% R:3:75%]) chr T >A(10:10:100%[F:9:90% R:1:10%]) chr G >A(2:2:100%[F:0:0% R:2:100%]) chr C >T(19:19:100%[F:17:89.5% R:2:10.5%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(23:23:100%[F:11:47.8% R:12:52.2%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr A >C(6:6:100%[F:6:100% R:0:0%]) chr T >C(3:3:100%[F:2:66.7% R:1:33.3%]) chr T >C(4:4:100%[F:3:75% R:1:25%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr T >C(2:2:100%[F:1:50% R:1:50%]) chr C >A(4:4:100%[F:4:100% R:0:0%]) chr G >A(10:10:100%[F:6:60% R:4:40%]) chr G >A(11:11:100%[F:7:63.6% R:4:36.4%]) chr A >G(20:20:100%[F:12:60% R:8:40%]) chr C >T(14:14:100%[F:9:64.3% R:5:35.7%]) chr INS: >C(2:2:100%[F:2 R:0]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr A >T(2:2:100%[F:2:100% R:0:0%])

12 chr A >T(2:2:100%[F:2:100% R:0:0%]) chr G >A(6:6:100%[F:4:66.7% R:2:33.3%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr T >G(17:17:100%[F:11:64.7% R:6:35.3%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr DEL:T > (2:2:100%[F:0 R:2]) chr A >G(2:2:100%[F:1:50% R:1:50%]) chr G >A(2:2:100%[F:1:50% R:1:50%]) chr A >G(28:28:100%[F:17:60.7% R:11:39.3%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(21:21:100%[F:11:52.4% R:10:47.6%]) chr T >G(9:9:100%[F:6:66.7% R:3:33.3%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(17:17:100%[F:14:82.4% R:3:17.6%]) chr G >A(3:3:100%[F:3:100% R:0:0%]) chr C >T(8:8:100%[F:5:62.5% R:3:37.5%]) chr DEL:A > (2:2:100%[F:1 R:1]) chr T >C(8:8:100%[F:4:50% R:4:50%]) chr C >A(2:2:100%[F:1:50% R:1:50%]) chr T >C(8:8:100%[F:4:50% R:4:50%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr A >G(2:2:100%[F:1:50% R:1:50%]) chr DEL:A > (2:2:100%[F:2 R:0]) chr INS: >A(17:17:100%[F:9 R:0]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr A >T(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(4:4:100%[F:2:50% R:2:50%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr A >G(15:15:100%[F:7:46.7% R:8:53.3%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr INS: >T(23:23:100%[F:7 R:0]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr INS: >T(5:5:100%[F:5 R:0]) chr C >T(7:7:100%[F:4:57.1% R:3:42.9%]) chr A >G(2:2:100%[F:1:50% R:1:50%]) chr G >A(11:11:100%[F:5:45.5% R:6:54.5%]) chr G >A(13:13:100%[F:9:69.2% R:4:30.8%]) chr INS: >G(4:4:100%[F:1 R:0]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr T >G(28:28:100%[F:12:42.9% R:16:57.1%]) chr C >G(9:9:100%[F:2:22.2% R:7:77.8%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(2:2:100%[F:1:50% R:1:50%]) chr C >G(13:13:100%[F:5:38.5% R:8:61.5%])

13 chr T >C(3:3:100%[F:2:66.7% R:1:33.3%]) chr T >C(34:34:100%[F:20:58.8% R:14:41.2%]) chr G >A(4:4:100%[F:4:100% R:0:0%]) chr INS: >G(2:2:100%[F:2 R:0]) chr C >T(14:14:100%[F:9:64.3% R:5:35.7%]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr DEL:G > (2:2:100%[F:0 R:2]) chr G >T(8:8:100%[F:8:100% R:0:0%]) chr A >T(3:3:100%[F:3:100% R:0:0%]) chr C >T(24:24:100%[F:13:54.2% R:11:45.8%]) chr DEL:A > (2:2:100%[F:1 R:1]) chr C >T(7:7:100%[F:6:85.7% R:1:14.3%]) chr C >A(57:57:100%[F:14:24.6% R:43:75.4%]) chr T >A(20:20:100%[F:14:70% R:6:30%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr C >A(3:3:100%[F:3:100% R:0:0%]) chr T >C(11:11:100%[F:6:54.5% R:5:45.5%]) chr C >A(5:5:100%[F:5:100% R:0:0%]) chr G >A(9:9:100%[F:6:66.7% R:3:33.3%]) chr G >A(4:4:100%[F:0:0% R:4:100%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(2:2:100%[F:1:50% R:1:50%]) chr C >T(4:4:100%[F:0:0% R:4:100%]) chr C >G(2:2:100%[F:0:0% R:2:100%]) chr T >G(3:3:100%[F:2:66.7% R:1:33.3%]) chr A >G(2:2:100%[F:1:50% R:1:50%]) chr G >A(8:8:100%[F:3:37.5% R:5:62.5%]) chr C >T(21:21:100%[F:13:61.9% R:8:38.1%]) chr G >C(24:24:100%[F:8:33.3% R:16:66.7%]) chr T >C(3:3:100%[F:3:100% R:0:0%]) chr C >T(18:18:100%[F:4:22.2% R:14:77.8%]) chr DEL:CTTCTG > (2:2:100%[F:2 R:0]) chr A >T(6:6:100%[F:3:50% R:3:50%]) chr G >C(21:21:100%[F:11:52.4% R:10:47.6%]) chr C >A(3:3:100%[F:3:100% R:0:0%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr G >C(10:10:100%[F:2:20% R:8:80%]) chr T >C(2:2:100%[F:1:50% R:1:50%]) chr T >C(8:8:100%[F:1:12.5% R:7:87.5%]) chr C >A(2:2:100%[F:1:50% R:1:50%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr INS: >G(21:21:100%[F:20 R:0]) chr A >G(16:16:100%[F:13:81.2% R:3:18.8%]) chr G >C(27:27:100%[F:20:74.1% R:7:25.9%]) chr A >G(7:7:100%[F:3:42.9% R:4:57.1%]) chr C >G(3:3:100%[F:0:0% R:3:100%]) chr A >G(18:18:100%[F:16:88.9% R:2:11.1%])

14 chr T >C(6:6:100%[F:0:0% R:6:100%]) chr G >A(6:6:100%[F:4:66.7% R:2:33.3%]) chr A >G(12:12:100%[F:10:83.3% R:2:16.7%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr G >C(11:11:100%[F:5:45.5% R:6:54.5%]) chr G >A(19:19:100%[F:6:31.6% R:13:68.4%]) chr C >T(7:7:100%[F:3:42.9% R:4:57.1%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr G >T(2:2:100%[F:1:50% R:1:50%]) chr C >T(13:13:100%[F:8:61.5% R:5:38.5%]) chr T >C(14:14:100%[F:9:64.3% R:5:35.7%]) chr INS: >A(4:4:100%[F:4 R:0]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr T >A(3:3:100%[F:0:0% R:3:100%]) chr T >C(42:42:100%[F:37:88.1% R:5:11.9%]) chr DEL:TG > (5:5:100%[F:4 R:1]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr C >G(20:20:100%[F:11:55% R:9:45%]) chr A >T(2:2:100%[F:2:100% R:0:0%]) chr G >T(3:3:100%[F:2:66.7% R:1:33.3%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr A >T(5:5:100%[F:4:80% R:1:20%]) chr A >G(23:23:100%[F:5:21.7% R:18:78.3%]) chr G >A(5:5:100%[F:4:80% R:1:20%]) chr A >G(2:2:100%[F:0:0% R:2:100%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr C >T(14:14:100%[F:11:78.6% R:3:21.4%]) chr C >T(6:6:100%[F:3:50% R:3:50%]) chr G >A(53:53:100%[F:47:88.7% R:6:11.3%]) chr A >G(34:34:100%[F:16:47.1% R:18:52.9%]) chr A >G(3:3:100%[F:2:66.7% R:1:33.3%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr G >T(6:6:100%[F:6:100% R:0:0%]) chr G >A(8:8:100%[F:4:50% R:4:50%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr C >T(9:9:100%[F:5:55.6% R:4:44.4%]) chr C >G(3:3:100%[F:3:100% R:0:0%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr G >A(8:8:100%[F:4:50% R:4:50%]) chr DEL:C > (4:4:100%[F:3 R:1]) chr G >A(2:2:100%[F:0:0% R:2:100%]) chr G >A(17:17:100%[F:6:35.3% R:11:64.7%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr T >G(2:2:100%[F:0:0% R:2:100%]) chr G >T(2:2:100%[F:0:0% R:2:100%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr T >A(17:17:100%[F:7:41.2% R:10:58.8%])

15 chr A >C(2:2:100%[F:2:100% R:0:0%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr T >C(3:3:100%[F:1:33.3% R:2:66.7%]) chr A >G(18:18:100%[F:6:33.3% R:12:66.7%]) chr C >T(12:12:100%[F:9:75% R:3:25%]) chr C >A(23:23:100%[F:12:52.2% R:11:47.8%]) chr G >A(42:42:100%[F:31:73.8% R:11:26.2%]) chr A >G(13:13:100%[F:6:46.2% R:7:53.8%]) chr T >C(2:2:100%[F:1:50% R:1:50%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr A >T(12:12:100%[F:10:83.3% R:2:16.7%]) chr A >T(2:2:100%[F:0:0% R:2:100%]) chr C >T(4:4:100%[F:3:75% R:1:25%]) chr G >T(31:31:100%[F:12:38.7% R:19:61.3%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr C >G(8:8:100%[F:1:12.5% R:7:87.5%]) chr A >C(3:3:100%[F:0:0% R:3:100%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr C >G(6:6:100%[F:5:83.3% R:1:16.7%]) chr DEL:CAG > (3:3:100%[F:1 R:2]) chr C >T(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr INS: >C(7:7:100%[F:0 R:0]) chr G >C(21:21:100%[F:9:42.9% R:12:57.1%]) chr T >A(12:12:100%[F:3:25% R:9:75%]) chr T >C(5:5:100%[F:1:20% R:4:80%]) chr C >T(7:7:100%[F:3:42.9% R:4:57.1%]) chr G >A(19:19:100%[F:11:57.9% R:8:42.1%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr INS: >A(2:2:100%[F:2 R:0]) chr G >A(6:6:100%[F:1:16.7% R:5:83.3%]) chr T >A(3:3:100%[F:0:0% R:3:100%]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr G >A(4:4:100%[F:2:50% R:2:50%]) chr G >A(15:15:100%[F:5:33.3% R:10:66.7%]) chr G >C(26:26:100%[F:9:34.6% R:17:65.4%]) chr G >A(42:42:100%[F:28:66.7% R:14:33.3%]) chr A >C(10:10:100%[F:9:90% R:1:10%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(41:41:100%[F:25:61% R:16:39%]) chr C >T(38:38:100%[F:26:68.4% R:12:31.6%]) chr C >T(8:8:100%[F:5:62.5% R:3:37.5%]) chr C >T(15:15:100%[F:7:46.7% R:8:53.3%]) chr A >G(7:7:100%[F:7:100% R:0:0%]) chr C >T(19:19:100%[F:9:47.4% R:10:52.6%]) chr C >G(3:3:100%[F:3:100% R:0:0%]) chr T >G(3:3:100%[F:0:0% R:3:100%]) chr T >G(2:2:100%[F:0:0% R:2:100%])

16 chr T >C(3:3:100%[F:3:100% R:0:0%]) chr T >C(12:12:100%[F:6:50% R:6:50%]) chr INS: >C(2:2:100%[F:2 R:0]) chr C >T(9:9:100%[F:7:77.8% R:2:22.2%]) chr C >T(25:25:100%[F:14:56% R:11:44%]) chr A >T(2:2:100%[F:2:100% R:0:0%]) chr G >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(3:3:100%[F:0:0% R:3:100%]) chr C >A(4:4:100%[F:0:0% R:4:100%]) chr G >T(45:45:100%[F:24:53.3% R:21:46.7%]) chr T >C(19:19:100%[F:15:78.9% R:4:21.1%]) chr A >G(9:9:100%[F:8:88.9% R:1:11.1%]) chr G >C(2:2:100%[F:1:50% R:1:50%]) chr G >A(25:25:100%[F:8:32% R:17:68%]) chr G >A(11:11:100%[F:11:100% R:0:0%]) chr G >A(31:31:100%[F:25:80.6% R:6:19.4%]) chr C >T(3:3:100%[F:0:0% R:3:100%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(8:8:100%[F:5:62.5% R:3:37.5%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr G >A(2:2:100%[F:0:0% R:2:100%]) chr G >C(24:24:100%[F:16:66.7% R:8:33.3%]) chr G >C(6:6:100%[F:3:50% R:3:50%]) chr A >T(12:12:100%[F:8:66.7% R:4:33.3%]) chr T >C(3:3:100%[F:0:0% R:3:100%]) chr A >G(8:8:100%[F:6:75% R:2:25%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr T >A(2:2:100%[F:2:100% R:0:0%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr C >T(14:14:100%[F:11:78.6% R:3:21.4%]) chr A >C(3:3:100%[F:2:66.7% R:1:33.3%]) chr DEL:A > (29:29:100%[F:22 R:7]) chr C >A(9:9:100%[F:2:22.2% R:7:77.8%]) chr A >G(12:12:100%[F:6:50% R:6:50%]) chr T >A(2:2:100%[F:0:0% R:2:100%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr G >C(27:27:100%[F:16:59.3% R:11:40.7%]) chr T >C(2:2:100%[F:2:100% R:0:0%]) chr G >T(9:9:100%[F:2:22.2% R:7:77.8%]) chr A >G(4:4:100%[F:2:50% R:2:50%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr T >C(26:26:100%[F:17:65.4% R:9:34.6%]) chr DEL:TT > (2:2:100%[F:2 R:0]) chr G >A(3:3:100%[F:3:100% R:0:0%]) chr A >G(3:3:100%[F:3:100% R:0:0%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr C >T(5:5:100%[F:3:60% R:2:40%])

17 chr T >C(43:43:100%[F:28:65.1% R:15:34.9%]) chr DEL:C > (2:2:100%[F:2 R:0]) chr C >G(23:23:100%[F:15:65.2% R:8:34.8%]) chr C >G(2:2:100%[F:2:100% R:0:0%]) chr C >T(2:2:100%[F:0:0% R:2:100%]) chr C >T(12:12:100%[F:7:58.3% R:5:41.7%]) chr C >T(25:25:100%[F:19:76% R:6:24%]) chr T >G(18:18:100%[F:15:83.3% R:3:16.7%]) chr G >A(2:2:100%[F:0:0% R:2:100%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr C >G(90:90:100%[F:8:8.89% R:82:91.1%]) chr G >A(3:3:100%[F:2:66.7% R:1:33.3%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr G >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(17:17:100%[F:9:52.9% R:8:47.1%]) chr C >T(30:30:100%[F:19:63.3% R:11:36.7%]) chr A >G(24:24:100%[F:16:66.7% R:8:33.3%]) chr A >C(3:3:100%[F:1:33.3% R:2:66.7%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr C >T(20:20:100%[F:10:50% R:10:50%]) chr C >T(12:12:100%[F:7:58.3% R:5:41.7%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr A >G(5:5:100%[F:1:20% R:4:80%]) chr G >A(12:12:100%[F:8:66.7% R:4:33.3%]) chr G >A(34:34:100%[F:14:41.2% R:20:58.8%]) chr INS: >C(21:21:100%[F:8 R:0]) chr C >T(30:30:100%[F:14:46.7% R:16:53.3%]) chr T >A(2:2:100%[F:2:100% R:0:0%]) chr T >A(6:6:100%[F:6:100% R:0:0%]) chr T >G(2:2:100%[F:2:100% R:0:0%]) chr G >A(20:20:100%[F:10:50% R:10:50%]) chr T >C(2:2:100%[F:0:0% R:2:100%]) chr T >C(8:8:100%[F:7:87.5% R:1:12.5%]) chr G >C(2:2:100%[F:1:50% R:1:50%]) chr G >A(10:10:100%[F:5:50% R:5:50%]) chr C >T(16:16:100%[F:8:50% R:8:50%]) chr G >T(3:3:100%[F:3:100% R:0:0%]) chr A >G(16:16:100%[F:6:37.5% R:10:62.5%]) chr T >C(6:6:100%[F:6:100% R:0:0%]) chr A >C(3:3:100%[F:3:100% R:0:0%]) chr C >T(19:19:100%[F:16:84.2% R:3:15.8%]) chr C >A(2:2:100%[F:2:100% R:0:0%]) chr A >C(2:2:100%[F:0:0% R:2:100%]) chr C >T(7:7:100%[F:5:71.4% R:2:28.6%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr T >C(10:10:100%[F:1:10% R:9:90%]) chr G >A(10:10:100%[F:5:50% R:5:50%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr C >G(2:2:100%[F:2:100% R:0:0%])

18 chr A >G(9:9:100%[F:7:77.8% R:2:22.2%]) chr C >T(8:8:100%[F:5:62.5% R:3:37.5%]) chr T >C(7:7:100%[F:4:57.1% R:3:42.9%]) chr G >C(2:2:100%[F:0:0% R:2:100%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr G >C(20:20:100%[F:12:60% R:8:40%]) chr A >C(7:7:100%[F:0:0% R:7:100%]) chr A >G(16:16:100%[F:10:62.5% R:6:37.5%]) chr C >T(20:20:100%[F:13:65% R:7:35%]) chr T >C(12:12:100%[F:4:33.3% R:8:66.7%]) chr G >A(6:6:100%[F:3:50% R:3:50%]) chr DEL:AGTG > (5:5:100%[F:2 R:3]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr C >A(2:2:100%[F:0:0% R:2:100%]) chr A >G(2:2:100%[F:0:0% R:2:100%]) chr A >C(2:2:100%[F:1:50% R:1:50%]) chr G >T(4:4:100%[F:2:50% R:2:50%]) chr INS: >TA(2:2:100%[F:2 R:0]) chr G >A(4:4:100%[F:2:50% R:2:50%]) chr A >G(2:2:100%[F:2:100% R:0:0%]) chr C >G(2:2:100%[F:1:50% R:1:50%]) chr C >T(5:5:100%[F:4:80% R:1:20%]) chr C >T(20:20:100%[F:18:90% R:2:10%]) chr C >T(14:14:100%[F:3:21.4% R:11:78.6%]) chr G >A(2:2:100%[F:2:100% R:0:0%]) chr C >T(8:8:100%[F:2:25% R:6:75%]) chr G >A(6:6:100%[F:2:33.3% R:4:66.7%]) chr G >A(13:13:100%[F:11:84.6% R:2:15.4%]) chr C >T(7:7:100%[F:5:71.4% R:2:28.6%]) chr C >T(2:2:100%[F:1:50% R:1:50%]) chr A >C(7:7:100%[F:6:85.7% R:1:14.3%]) chr G >T(2:2:100%[F:2:100% R:0:0%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr C >T(6:6:100%[F:0:0% R:6:100%]) chr C >T(19:19:100%[F:10:52.6% R:9:47.4%]) chr INS: >G(4:4:100%[F:1 R:0]) chr C >T(3:3:100%[F:2:66.7% R:1:33.3%]) chr T >G(2:2:100%[F:1:50% R:1:50%]) chr T >C(10:10:100%[F:5:50% R:5:50%]) chr A >C(2:2:100%[F:2:100% R:0:0%]) chr C >T(2:2:100%[F:0:0% R:2:100%]) chr A >G(19:19:100%[F:9:47.4% R:10:52.6%]) chr C >T(4:4:100%[F:0:0% R:4:100%]) chr T >C(4:4:100%[F:4:100% R:0:0%]) chr T >C(3:3:100%[F:0:0% R:3:100%]) chr C >A(2:2:100%[F:1:50% R:1:50%]) chr A >C(5:5:100%[F:4:80% R:1:20%]) chr C >A(7:7:100%[F:4:57.1% R:3:42.9%]) chr G >A(10:10:100%[F:6:60% R:4:40%]) chr G >A(9:9:100%[F:3:33.3% R:6:66.7%])

19 chr C >G(2:2:100%[F:0:0% R:2:100%]) chr C >T(7:7:100%[F:2:28.6% R:5:71.4%]) chr C >T(18:18:100%[F:16:88.9% R:2:11.1%]) chr T >C(4:4:100%[F:2:50% R:2:50%]) chr T >C(2:2:100%[F:1:50% R:1:50%]) chr T >A(5:5:100%[F:1:20% R:4:80%])

20 Supplementary Table 1 Results of high throughput sequencing List of novel non synonymous sequence changes Known_Gene Known_Gene_URL Coding_Region Strand Mutation Mutation_Type Mutation_Position Codon_Position Codon_Change AA_Change ST6GALNAC2 bin/hggene?hgg_gene=uc002jsg.2 chr17: A VAR chr17: CAT >AAT M >I RNF213 bin/hggene?hgg_gene=uc002jyh.1 chr17: G VAR chr17: ATC >GTC I >V PYCR1 bin/hggene?hgg_gene=uc002kcr.1 chr17: T VAR chr17: GCG >GTG R >H UTS2R bin/hggene?hgg_gene=uc002ker.1 chr17: G VAR chr17: TCC >GCC S >A SGSH bin/hggene?hgg_gene=uc002jxz.2 chr17: G VAR chr17: CTC >CTG E >Q C17orf90 bin/hggene?hgg_gene=uc002kbb.2 chr17: G VAR chr17: GGT >GGG T >P SLC16A3 bin/hggene?hgg_gene=uc002kea.1 chr17: G VAR chr17: GCC >GGC A >G

21 Supplementary Table 2 Primer and morpholino sequences Supplementary Table 2.1 Genomic DNA primer sequences Exon Primer Sequence 1 right GAACCTCCACCCCTCCAG left CTCCCCATTCCCAGGAAG 2 right AGCCAAAGCTAGCCATGAAG left CAGGTCCCAAGAGCAATCAG 3-4 right CAGCATTCTCTGTGCCATTC left TTCTCCTCCTTCCCTTCTGG 5-6 right GGTGGAAGAGGACCTGATTG left ATCTGCTGAGTGCGTGAATG 7 right TGGTGATGCTGAGCTGATTC left TTCTCACACGGGAAGGAGAG Product Size [bp] Supplementary Table 2.2 Human cdna primer sequences used for RT-PCR Gene Primer Sequence Product Size [bp] GAPDH PYCR1 PYCR2 P5CS right right right right TGCACCACCAACTGCTTAGC ATGAGCGTGGGCTTCATC TCGGCTCACAAGATAATAGCC GGCTGATGGCCTTGTATGAG left left left left GGCATGGACTGTGGTCATGAG GGGAGCTAGCCATTATCTTGTG TTCACCGTCTCCTTGTTGC TCATGGAAATCCAAATTGGTC Supplementary Table 2.3 Mouse cdna primer sequences used for RT-PCR Gene Primer Sequence Product Size [bp] Gapdh Pycr1 Pycr2 Pycrl P5cs right right right right right GGGAAGCCCATCACCATCTT AGACATGGACCAAGCTACGG GTCGGCTCACAAGATAATAGCC GTCTCAGTGGCAGTGGTGTG GCATTCTTCACCTCCTGACC left left left left left CGGCCTCACCCCATTTG TCACAGCCAGGAAGAGCAC TCCTTATTGCTTCGGGTCAG CAGGGTCTGAGCAGCAATG CGGCAGAGATCCTCAACTTC Supplementary Table 2.4 Morpholino sequences Species Morpholino sequence Gene Xenopus laevis 5 -AGCTCCTATGAAGCCCACACTCATG-3 Pycr1 Danio rerio 5 -CAGCTCCGATAAATCCCACACTCAT-3 Pycr1 Danio rerio 5 -CCGCTCCAATGAAGCCCACACTCAT-3 Pycr2

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