Choi K, Huang M, Savige J
Department of Medicine (Melbourne Health and Northern Health), Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3052, Australia.
Sci Rep. 2025 Mar 18;15(1):9292. doi: 10.1038/s41598-025-93832-6.
Marfan syndrome is an autosomal dominantly (AD)-inherited disease that results from pathogenic variants in the Fibrillin 1 (FBN1) gene, and is characterised by tall stature, elongated limbs and digits, lens abnormalities and aortic root dilatation, aneurysms and dissection, but milder forms also occur. Radiological imaging suggests that Marfan syndrome affects between one in 3000 and 5000 of the population. The aim of this study was to determine the population frequency of Marfan syndrome from the number of predicted pathogenic FBN1 changes found in a normal database. FBN1 variants were downloaded from gnomAD v2.1.1 and annotated with ANNOVAR. The population frequency was determined from the number of pathogenic null and structural variants, and the number of predicted pathogenic missense changes classified by rarity and computational scores. This population frequency was then compared with the frequencies in the control subset, and from gnomAD variants assessed as Pathogenic or Likely pathogenic in the ClinVar or LOVD databases. Our strategy identified predicted pathogenic FBN1 variants in one in 416 individuals, which was confirmed in the control subset (one in 356, p NS). Predicted pathogenic variants were most common in East Asian people (one in 243, p < 0.0001) and least common in Ashkenazim (one in 5185, p = 0.0082). The population frequencies based on pathogenic variants in the ClinVar or LOVD databases were one in 718 and one in 1014 respectively. Null variants which are associated with aortic aneurysms affected only one in 8624. Thus, Marfan syndrome is more common than previously recognised. Emergency departments and cardiac clinics in particular should be aware of undiagnosed Marfan syndrome and its cardiac risks, but many of those affected still have a milder phenotype.
马凡综合征是一种常染色体显性(AD)遗传病,由原纤维蛋白1(FBN1)基因的致病变异引起,其特征为身材高大、四肢和手指细长、晶状体异常以及主动脉根部扩张、动脉瘤和夹层形成,但也有症状较轻的类型。放射影像学显示,马凡综合征在人群中的发病率约为三千分之一至五千分之一。本研究旨在通过在正常数据库中发现的预测致病变异数量来确定马凡综合征的人群发病率。从gnomAD v2.1.1下载FBN1变异并使用ANNOVAR进行注释。根据致病性无效和结构变异的数量以及根据稀有性和计算分数分类的预测致病性错义变异数量来确定人群发病率。然后将该人群发病率与对照组子集中的发病率以及ClinVar或LOVD数据库中评估为致病性或可能致病性的gnomAD变异的发病率进行比较。我们的策略在416人中发现了1例预测致病性FBN1变异,这在对照组子集中得到了证实(356人中1例,p无统计学意义)。预测致病性变异在东亚人群中最为常见(243人中1例,p<0.0001),在德系犹太人中最不常见(5185人中1例,p=0.0082)。ClinVar或LOVD数据库中基于致病变异的人群发病率分别为718人中1例和1014人中1例。与主动脉瘤相关的无效变异仅在8624人中出现1例。因此,马凡综合征比以前认为的更为常见。特别是急诊科和心脏科诊所应意识到未确诊的马凡综合征及其心脏风险,但许多患者仍表现出较轻的表型。
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