ALPK3 and cardiomyopathy: This patient, though, carried a homozygous nonsynonymous single-nucleotide variant in exon 10 of ALPK3, underscoring the variability of symptoms and onset of disease that is seen in cases of cardiomyopathy caused by biallelic variants in ALPK3. On the contrary, Cheawsamoot et al. [43] have very recently reported that a monoallelic ALPK3 variant can cause adult-onset HCM with a penetrance of 70% in a Thai family with 18 individuals, seven of whom had an adult onset HCM.