Division of Biology and Genetics, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy.
Division of Dermatology, Department of Clinical and Experimental Sciences, Spedali Civili University Hospital, 25123 Brescia, Italy.
Genes (Basel). 2019 Feb 12;10(2):135. doi: 10.3390/genes10020135.
Ehlers-Danlos syndrome (EDS) comprises clinically heterogeneous connective tissue disorders with diverse molecular etiologies. The 2017 International Classification for EDS recognized 13 distinct subtypes caused by pathogenic variants in 19 genes mainly encoding fibrillar collagens and collagen-modifying or processing proteins. Recently, a new EDS subtype, i.e., classical-like EDS type 2, was defined after the identification, in six patients with clinical findings reminiscent of EDS, of recessive alterations in which encodes the aortic carboxypeptidase⁻like protein associating with collagens in the extracellular matrix. Herein, we report on a 53-year-old patient, born from healthy second-cousins, who fitted the diagnostic criteria for classical EDS (cEDS) for the presence of hyperextensible skin with multiple atrophic scars, generalized joint hypermobility, and other minor criteria. Molecular analyses of cEDS genes did not identify any causal variant. Therefore, sequencing was performed that revealed homozygosity for the rare c.1925T>C p.(Leu642Pro) variant classified as likely pathogenetic (class 4) according to the American College of Medical Genetics and Genomics (ACMG) guidelines. The comparison of the patient's features with those of the other patients reported up to now and the identification of the first missense variant likely associated with the condition offer future perspectives for EDS nosology and research in this field.
埃勒斯-当洛斯综合征(EDS)是一种临床异质性的结缔组织疾病,具有不同的分子病因。2017 年国际 EDS 分类将 19 个基因中的致病性变异引起的 13 种不同亚型纳入其中,这些基因主要编码纤维胶原和胶原修饰或加工蛋白。最近,在 6 名具有 EDS 临床特征的患者中,发现编码与细胞外基质中胶原结合的主动脉羧肽酶样蛋白的 基因发生隐性改变,从而定义了一种新的 EDS 亚型,即经典样 EDS 型 2。在此,我们报告了一名 53 岁患者,出生于健康的表亲,因存在皮肤过度伸展、多发性萎缩性瘢痕、全身关节过度活动等其他次要标准而符合经典 EDS(cEDS)的诊断标准。cEDS 基因的分子分析未发现任何致病变异。因此,进行了 测序,发现该患者存在罕见的 c.1925T>C p.(Leu642Pro)纯合变异,根据美国医学遗传学与基因组学学会(ACMG)指南,该变异被归类为可能的致病性变异(类别 4)。将该患者的特征与迄今为止报告的其他患者的特征进行比较,并确定了首个可能与该疾病相关的错义变异,为 EDS 分类学和该领域的研究提供了未来的展望。
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