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The role of lysine methyltransferases (KMTs) and demethylases (KDMs) in the regulation of chromatin modification is well-established. Recently, deleterious heterozygous variants in  KMT5B  were implicated in individuals with intellectual disability (ID) and/or autism spectrum disorder. We describe three unrelated patients with global developmental delay (GDD) or ID, macrocephaly and additional features. Using whole exome sequencing, each of the probands was found to harbor a distinct  de novo  heterozygous disease-causing variant in  KMT5B : c.541C &amp;gt; G (p.His181Asp); c.833A &amp;gt; T (p.Asn278Ile); or c.391_394delAAAG (p.Lys131GlufsTer6). We discuss herein their clinical presentations, and compare them to those of previously reported patients. Furthermore, using a three-dimensional computational model of the  KMT5B  protein, we demonstrate the predicted structural effects of the two missense variants. Our findings support the role of  de novo  missense and nonsense variants in  KMT5B -associated GDD/ID, and suggest that this gene should be considered in the differential diagnosis of neurodevelopmental disorders accompanied by macrocephaly and/or overgrowth.

Refining the Phenotypic Spectrum of KMT5B-Associated Developmental Delay