Meester Josephina A N, Verstraeten Aline, Schepers Dorien, Alaerts Maaike, Van Laer Lut, Loeys Bart L
Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium.
Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands.
Ann Cardiothorac Surg. 2017 Nov;6(6):582-594. doi: 10.21037/acs.2017.11.03.
Many different heritable connective tissue disorders (HCTD) have been described over the past decades. These syndromes often affect the connective tissue of various organ systems, including heart, blood vessels, skin, joints, bone, eyes, and lungs. The discovery of these HCTD was followed by the identification of mutations in a wide range of genes encoding structural proteins, modifying enzymes, or components of the TGFβ-signaling pathway. Three typical examples of HCTD are Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), and Loeys-Dietz syndrome (LDS). These syndromes show some degree of phenotypical overlap of cardiovascular, skeletal, and cutaneous features. MFS is typically characterized by cardiovascular, ocular, and skeletal manifestations and is caused by heterozygous mutations in , coding for the extracellular matrix (ECM) protein fibrillin-1. The most common cardiovascular phenotype involves aortic aneurysm and dissection at the sinuses of Valsalva. LDS is caused by mutations in , , or , all coding for components of the TGFβ-signaling pathway. LDS can be distinguished from MFS by the unique presence of hypertelorism, bifid uvula or cleft palate, and widespread aortic and arterial aneurysm and tortuosity. Compared to MFS, LDS cardiovascular manifestations tend to be more severe. In contrast, no association is reported between LDS and the presence of ectopia lentis, a key distinguishing feature of MFS. Overlapping features between MFS and LDS include scoliosis, pes planus, anterior chest deformity, spontaneous pneumothorax, and dural ectasia. EDS refers to a group of clinically and genetically heterogeneous connective tissue disorders and all subtypes are characterized by variable abnormalities of skin, ligaments and joints, blood vessels, and internal organs. Typical presenting features include joint hypermobility, skin hyperextensibility, and tissue fragility. Up to one quarter of the EDS patients show aortic aneurysmal disease. The latest EDS nosology distinguishes 13 subtypes. Many phenotypic features show overlap between the different subtypes, which makes the clinical diagnosis rather difficult and highlights the importance of molecular diagnostic confirmation.
在过去几十年里,人们描述了许多不同的遗传性结缔组织疾病(HCTD)。这些综合征常常影响各个器官系统的结缔组织,包括心脏、血管、皮肤、关节、骨骼、眼睛和肺。在发现这些HCTD之后,人们又鉴定出了多种编码结构蛋白、修饰酶或转化生长因子β(TGFβ)信号通路成分的基因突变。HCTD的三个典型例子是马凡综合征(MFS)、埃勒斯-当洛综合征(EDS)和洛伊-迪茨综合征(LDS)。这些综合征在心血管、骨骼和皮肤特征方面表现出一定程度的表型重叠。MFS的典型特征是心血管、眼部和骨骼表现,由编码细胞外基质(ECM)蛋白原纤蛋白-1的基因杂合突变引起。最常见的心血管表型包括主动脉瘤和主动脉瓣窦处的夹层。LDS由TGFβ信号通路成分的编码基因、或的突变引起。LDS可通过独特的眼距增宽、悬雍垂裂或腭裂以及广泛的主动脉和动脉动脉瘤及迂曲与MFS区分开来。与MFS相比,LDS的心血管表现往往更严重。相比之下,未报道LDS与晶状体异位(MFS的一个关键鉴别特征)之间存在关联。MFS和LDS的重叠特征包括脊柱侧凸、扁平足、前胸畸形、自发性气胸和硬脊膜扩张。EDS是一组临床和遗传异质性的结缔组织疾病,所有亚型的特征是皮肤、韧带和关节、血管及内脏存在不同程度的异常。典型的表现特征包括关节活动过度、皮肤过度伸展和组织脆弱。高达四分之一的EDS患者表现出主动脉瘤性疾病。最新的EDS分类法区分出13个亚型。许多表型特征在不同亚型之间存在重叠,这使得临床诊断相当困难,并凸显了分子诊断确认的重要性。