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Procknow SS, Kozel BA. Emerging mechanisms of elastin transcriptional regulation. Am J Physiol Cell Physiol 2022; 323:C666-C677. [PMID: 35816641 PMCID: PMC9448287 DOI: 10.1152/ajpcell.00228.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 11/22/2022]
Abstract
Elastin provides recoil to tissues that stretch such as the lung, blood vessels, and skin. It is deposited in a brief window starting in the prenatal period and extending to adolescence in vertebrates, and then slowly turns over. Elastin insufficiency is seen in conditions such as Williams-Beuren syndrome and elastin-related supravalvar aortic stenosis, which are associated with a range of vascular and connective tissue manifestations. Regulation of the elastin (ELN) gene occurs at multiple levels including promoter activation/inhibition, mRNA stability, interaction with microRNAs, and alternative splicing. However, these mechanisms are incompletely understood. Better understanding of the processes controlling ELN gene expression may improve medicine's ability to intervene in these rare conditions, as well as to replace age-associated losses by re-initiating elastin production. This review describes what is known about the ELN gene promoter structure, transcriptional regulation by cytokines and transcription factors, and posttranscriptional regulation via mRNA stability and micro-RNA and highlights new approaches that may influence regenerative medicine.
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Affiliation(s)
- Sara S Procknow
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Beth A Kozel
- Translational Vascular Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Kronquist EK, Kaur M, Gober LM, Knutsen RH, Fu YP, Yu ZX, Donahue DR, Chen MY, Osgood S, Raja N, Levin MD, Barochia A, Kozel BA. Airflow Obstruction in Adults with Williams Syndrome and Mice with Elastin Insufficiency. Diagnostics (Basel) 2022; 12:diagnostics12061438. [PMID: 35741248 PMCID: PMC9221558 DOI: 10.3390/diagnostics12061438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/23/2022] Open
Abstract
Williams−Beuren syndrome (WS) results from the deletion of 25−27 coding genes, including elastin (ELN), on human chromosome 7q11.23. Elastin provides recoil to tissues; emphysema and chronic obstructive pulmonary disease have been linked to its destruction. Consequently, we hypothesized that elastin insufficiency would predispose to obstructive features. Twenty-two adults with WS (aged 18−55) and controls underwent pulmonary function testing, 6 min walk, and chest computed tomography (CT). Lung and airspace dimensions were assessed in Eln+/− and control mice via microCT and histology. The forced expiratory volume in 1 s (FEV1) and the ratio of FEV1 to forced vital capacity (FVC) were lower in adults with WS (p < 0.0001 and p < 0.05, respectively). The FEV1/FVC ratio was more frequently below the lower limit of normal in cases (p < 0.01). The ratio of residual volume to total lung capacity (RV/TLC, percent predicted) was higher in cases (p < 0.01), suggesting air trapping. People with WS showed reduced exercise capacity (p < 0.0001). In Eln+/− mice, ex vivo lung volumes were increased (p < 0.0001), with larger airspaces (p < 0.001). Together these data show that elastin insufficiency impacts lung physiology in the form of increased air trapping and obstruction, suggesting a role for lung function monitoring in adults with WS.
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Affiliation(s)
- Elise K. Kronquist
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Maninder Kaur
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Leah M. Gober
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Russell H. Knutsen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Yi-Ping Fu
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Zu-Xi Yu
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Danielle R. Donahue
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20824, USA;
| | - Marcus Y. Chen
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Sharon Osgood
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Neelam Raja
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Mark D. Levin
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Amisha Barochia
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
| | - Beth A. Kozel
- National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA; (E.K.K.); (M.K.); (L.M.G.); (R.H.K.); (Y.-P.F.); (Z.-X.Y.); (M.Y.C.); (S.O.); (N.R.); (M.D.L.); (A.B.)
- Correspondence: ; Tel.: +1-301-451-2888
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Knutsen RH, Gober LM, Kronquist EK, Kaur M, Donahue DR, Springer D, Yu ZX, Chen MY, Fu YP, Choobdar F, Nguyen ML, Osgood S, Freeman JL, Raja N, Levin MD, Kozel BA. Elastin Insufficiency Confers Proximal and Distal Pulmonary Vasculopathy in Mice, Partially Remedied by the KATP Channel Opener Minoxidil: Considerations and Cautions for the Treatment of People With Williams-Beuren Syndrome. Front Cardiovasc Med 2022; 9:886813. [PMID: 35665242 PMCID: PMC9160528 DOI: 10.3389/fcvm.2022.886813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Williams Beuren syndrome (WBS) is a recurrent microdeletion disorder that removes one copy of elastin (ELN), resulting in large artery vasculopathy. Early stenosis of the pulmonary vascular tree is common, but few data are available on longer-term implications of the condition. Methods Computed tomography (CT) angiogram (n = 11) and echocardiogram (n = 20) were performed in children with WBS aged 3.4–17.8 years. Controls (n = 11, aged 4.4–16.8 years) also underwent echocardiogram. Eln+/− mice were analyzed by invasive catheter, echocardiogram, micro-CT (μCT), histology, and pressure myography. We subsequently tested whether minoxidil resulted in improved pulmonary vascular endpoints. Results WBS participants with a history of main or branch pulmonary artery (PA) stenosis requiring intervention continued to exhibit increased right ventricular systolic pressure (RVSP, echocardiogram) relative to their peers without intervention (p < 0.01), with no clear difference in PA size. Untreated Eln+/− mice also show elevated RVSP by invasive catheterization (p < 0.0001), increased normalized right heart mass (p < 0.01) and reduced caliber branch PAs by pressure myography (p < 0.0001). Eln+/− main PA medias are thickened histologically relative to Eln+/+ (p < 0.0001). Most Eln+/− phenotypes are shared by both sexes, but PA medial thickness is substantially greater in Eln+/− males (p < 0.001). Eln+/− mice showed more acute proximal branching angles (p < 0.0001) and longer vascular segment lengths (p < 0.0001) (μCT), with genotype differences emerging by P7. Diminished PA acceleration time (p < 0.001) and systolic notching (p < 0.0001) were also observed in Eln+/− echocardiography. Vascular casting plus μCT revealed longer generation-specific PA arcade length (p < 0.0001), with increased PA branching detectable by P90 (p < 0.0001). Post-weaning minoxidil decreased RVSP (p < 0.01) and normalized PA caliber (p < 0.0001) but not early-onset proximal branching angle or segment length, nor later-developing peripheral branch number. Conclusions Vascular deficiencies beyond arterial caliber persist in individuals with WBS who have undergone PA stenosis intervention. Evaluation of Eln+/− mice reveals complex vascular changes that affect the proximal and distal vasculatures. Minoxidil, given post-weaning, decreases RVSP and improves lumen diameter, but does not alter other earlier-onset vascular patterns. Our data suggest additional therapies including minoxidil could be a useful adjunct to surgical therapy, and future trials should be considered.
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Affiliation(s)
- Russell H. Knutsen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Leah M. Gober
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Elise K. Kronquist
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Maninder Kaur
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Danielle R. Donahue
- Mouse Imaging Facility, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Danielle Springer
- Murine Phenotyping Core, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Zu Xi Yu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Marcus Y. Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Yi-Ping Fu
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Feri Choobdar
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - My-Le Nguyen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sharon Osgood
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Joy L. Freeman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Neelam Raja
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Mark D. Levin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Beth A. Kozel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
- *Correspondence: Beth A. Kozel
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Kozel BA, Barak B, Ae Kim C, Mervis CB, Osborne LR, Porter M, Pober BR. Williams syndrome. Nat Rev Dis Primers 2021; 7:42. [PMID: 34140529 PMCID: PMC9437774 DOI: 10.1038/s41572-021-00276-z] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 11/09/2022]
Abstract
Williams syndrome (WS) is a relatively rare microdeletion disorder that occurs in as many as 1:7,500 individuals. WS arises due to the mispairing of low-copy DNA repetitive elements at meiosis. The deletion size is similar across most individuals with WS and leads to the loss of one copy of 25-27 genes on chromosome 7q11.23. The resulting unique disorder affects multiple systems, with cardinal features including but not limited to cardiovascular disease (characteristically stenosis of the great arteries and most notably supravalvar aortic stenosis), a distinctive craniofacial appearance, and a specific cognitive and behavioural profile that includes intellectual disability and hypersociability. Genotype-phenotype evidence is strongest for ELN, the gene encoding elastin, which is responsible for the vascular and connective tissue features of WS, and for the transcription factor genes GTF2I and GTF2IRD1, which are known to affect intellectual ability, social functioning and anxiety. Mounting evidence also ascribes phenotypic consequences to the deletion of BAZ1B, LIMK1, STX1A and MLXIPL, but more work is needed to understand the mechanism by which these deletions contribute to clinical outcomes. The age of diagnosis has fallen in regions of the world where technological advances, such as chromosomal microarray, enable clinicians to make the diagnosis of WS without formally suspecting it, allowing earlier intervention by medical and developmental specialists. Phenotypic variability is considerable for all cardinal features of WS but the specific sources of this variability remain unknown. Further investigation to identify the factors responsible for these differences may lead to mechanism-based rather than symptom-based therapies and should therefore be a high research priority.
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Affiliation(s)
- Beth A. Kozel
- Translational Vascular Medicine Branch, National Heart Lung and Blood Institute, National Institutes of Health, Bethesda, USA
| | - Boaz Barak
- The Sagol School of Neuroscience and The School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Chong Ae Kim
- Department of Pediatrics, Universidade de São Paulo, São Paulo, Brazil
| | - Carolyn B. Mervis
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, USA
| | - Lucy R. Osborne
- Department of Medicine, University of Toronto, Ontario, Canada
| | - Melanie Porter
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Barbara R. Pober
- Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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Ferrari M, Stagi S. Oxidative Stress in Down and Williams-Beuren Syndromes: An Overview. Molecules 2021; 26:molecules26113139. [PMID: 34073948 PMCID: PMC8197362 DOI: 10.3390/molecules26113139] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/17/2022] Open
Abstract
Oxidative stress is the result of an imbalance in the redox state in a cell or a tissue. When the production of free radicals, which are physiologically essential for signaling, exceeds the antioxidant capability, pathological outcomes including oxidative damage to macromolecules, aberrant signaling, and inflammation can occur. Down syndrome (DS) and Williams-Beuren syndrome (WBS) are well-known and common genetic conditions with multi-systemic involvement. Their etiology is linked to oxidative stress with important causative genes, such as SOD-1 and NCF-1, respectively, of the diseases being primarily involved in the regulation of the redox state. Early aging, dementia, autoimmunity, and chronic inflammation are some of the main characteristics of these conditions that can be associated with oxidative stress. In recent decades, there has been a growing interest in the possible role of oxidative stress and inflammation in the pathology of these conditions. However, at present, few studies have investigated these correlations. We provide an overview of the current literature concerning the role of oxidative stress and oxidative damage in genetic syndromes with a focus on Down syndrome and WBS. We hope to provide new insights to improve the management of complications related to these diseases.
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Pangallo E, Cianci P, Favuzza F, Milani D, Vimercati C, Moretti A, Picchi R, De Paoli A, Agosti M, Selicorni A. Pulmonary function in Williams-Beuren syndrome: Spirometric data of 22 Italian patients. Am J Med Genet A 2020; 185:390-396. [PMID: 33174385 DOI: 10.1002/ajmg.a.61966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/21/2020] [Accepted: 10/24/2020] [Indexed: 11/12/2022]
Abstract
Williams-Beuren syndrome (WBS) is caused by an haploinsufficiency of the 7q11.2 region which involves the elastin gene (ELN). A deficiency of elastin is a known pathophysiological mechanism of emphysema/chronic obstructive pulmonary disease (COPD). A previous study hypothesized a higher risk of COPD in WBS patients. Herein, this phenomenon was further investigated looking for a possible correlation between COPD and WBS. Dynamic lung volumes (forced vital capacity [FVC], FEV1, FEV1/FVC) were measured in 22 patients (age range 18.9 ± 7.4 years) affected with WBS, genetically confirmed, correlating these parameters to respiratory risk factors. Dyspnea, cough and wheezing were detected in 6/22 (27%) patients. Obstructive and restrictive patterns were identified in 6/22 (27%) and 2/22 (9%) cases, respectively with no evidence of irreversible obstruction. CVF, FEV1 and FEV1/CVF mean values were all normal, with values of 91.3% (n.v. > 80%), 84.2% (n.v. > 80%) and 0.82 (n.v. > 0.7), respectively. The severity of the comorbidities did not show a cause-effect relation with the respiratory patterns, nevertheless patients treated with anti-hypertensive drugs had poorer pulmonary function. Our findings are in accordance with previous observations, showing that emphysema/COPD is not a typical finding in young patients with WBS. However, a respiratory function assessment should be included in the follow-up of WBS patients, especially in adolescents/young adults under treatment with anti-hypertensive drugs.
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Affiliation(s)
- Elisabetta Pangallo
- Pediatric and Neonatology Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Paola Cianci
- Pediatric Department, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Filippo Favuzza
- Pediatric Department, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Donatella Milani
- Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Vimercati
- Pediatric Department, Fondazione MBMM San Gerardo Hospital, Monza, Italy
| | - Alex Moretti
- Pediatric and Neonatology Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Raffaella Picchi
- Pediatric Department, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Anita De Paoli
- Pediatric Department, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
| | - Massimo Agosti
- Pediatric and Neonatology Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Angelo Selicorni
- Pediatric Department, ASST-Lariana, Sant'Anna Hospital, San Fermo della Battaglia, Como, Italy
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Duque Lasio ML, Kozel BA. Elastin-driven genetic diseases. Matrix Biol 2018; 71-72:144-160. [PMID: 29501665 DOI: 10.1016/j.matbio.2018.02.021] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 02/08/2023]
Abstract
Elastic fibers provide recoil to tissues that undergo repeated deformation, such as blood vessels, lungs and skin. Composed of elastin and its accessory proteins, the fibers are produced within a restricted developmental window and are stable for decades. Their eventual breakdown is associated with a loss of tissue resiliency and aging. Rare alteration of the elastin (ELN) gene produces disease by impacting protein dosage (supravalvar aortic stenosis, Williams Beuren syndrome and Williams Beuren region duplication syndrome) and protein function (autosomal dominant cutis laxa). This review highlights aspects of the elastin molecule and its assembly process that contribute to human disease and also discusses potential therapies aimed at treating diseases of elastin insufficiency.
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Affiliation(s)
| | - Beth A Kozel
- National Institutes of Health, National Heart Lung and Blood Institute, Bethesda, MD, USA.
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Wojcik MH, Carmichael N, Bieber FR, Wiener DC, Madan R, Pober BR, Raby BA. A new diagnosis of Williams-Beuren syndrome in a 49-year-old man with severe bullous emphysema. Am J Med Genet A 2017; 173:2235-2239. [PMID: 28574231 DOI: 10.1002/ajmg.a.38289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 12/11/2022]
Abstract
Williams-Beuren syndrome (WBS) is a chromosomal microdeletion syndrome typically presenting with intellectual disability, a unique personality, a characteristic facial appearance, and cardiovascular disease. Several clinical features of WBS are thought to be due to haploinsufficiency of elastin (ELN), as the ELN locus is included within the WBS critical region at 7q11.23. Emphysema, a disease attributed to destruction of pulmonary elastic fibers, has been reported in patients without WBS who have pathogenic variants in ELN but only once (in one patient) in WBS. Here we report a second adult WBS patient with emphysema where the diagnosis of WBS was established subsequent to the discovery of severe bullous emphysema. Haploinsufficiency of ELN likely contributed to this pulmonary manifestation of WBS. This case emphasizes the contribution of rare genetic variation in cases of severe emphysema and provides further evidence that emphysema should be considered in patients with WBS who have respiratory symptoms, as it may be under-recognized in this patient population.
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Affiliation(s)
- Monica H Wojcik
- Division of Newborn Medicine, Division of Genetics and Genomics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nikkola Carmichael
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frederick R Bieber
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C Wiener
- Division of Thoracic Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rachna Madan
- Division of Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Barbara R Pober
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Benjamin A Raby
- Pulmonary Genetics Center, Division of Pulmonary and Critical Care Medicine, and the Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Williams-Beuren Syndrome and Congenital Lobar Emphysema: Uncommon Association with Common Pathology? Case Rep Pediatr 2017. [PMID: 28626595 PMCID: PMC5463103 DOI: 10.1155/2017/3480980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Congenital lobar emphysema (CLE) and Williams-Beuren Syndrome are two rare conditions that have only been reported together in a single case study. CASE PRESENTATION We report another case of a male Caucasian newborn with nonspecific initial respiratory distress, with detection of CLE on repeat chest X-ray on Day 25 of life and concurrent ventricular septal defect, supravalvular aortic stenosis, and branch pulmonary stenosis, in whom a 7q11.23 deletion consistent with Williams-Beuren Syndrome was made. CONCLUSION A diagnosis of congenital lobar emphysema should prompt further screening for congenital heart disease and genetic deletion, and further research is needed to investigate the role of elastin gene mutation in the development of the neonatal lung.
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Bódizs R, Gombos F, Gerván P, Szőcs K, Réthelyi JM, Kovács I. Aging and sleep in Williams syndrome: accelerated sleep deterioration and decelerated slow wave sleep decrement. RESEARCH IN DEVELOPMENTAL DISABILITIES 2014; 35:3226-3235. [PMID: 25178705 DOI: 10.1016/j.ridd.2014.07.056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 06/03/2023]
Abstract
Specific developmental and aging trajectories characterize sleep electroencephalogram (EEG) of typically developing (TD) subjects. Williams syndrome (WS) is marked by sleep alterations and accelerated aging of several anatomo-functional and cognitive measures. Here we test the hypothesis of a premature aging of sleep in WS. Age-related changes of home recorded sleep EEG of 42 subjects (21 WS, 21 age- and gender matched TD subjects, age: 6-29 years) were tested by Pearson correlations and homogeneity-of-slopes analysis. Typical developmental/aging effects of sleep EEGs were observed in TD subjects. Accelerated aging in WS was confirmed by overall sleep/wake measures. Specifically, premature aging was evident in accelerated age-dependent declines in WS subjects' sleep efficiency, as well as in steeper age-related rises in wakefulness and wake after sleep onset (WASO) of the WS group. In contrast, NREM sleep-related measures indicated atypical decelerations of the developmental trends of WS subjects, characterized by the slowing down of the age-related slow wave sleep (SWS) declines mirrored by the lack of age-dependent increase in Stage 2 (S2) sleep. Age-effects in sleep EEG power spectra were not different among the groups. Objectively measured sleep disruption of subjects with WS is age-dependent and increasing with age. Moreover, these data suggest atypical pre- and postpubertal neural development in WS, with sleep/wake balance and REM sleep time indicating accelerated aging while NREM sleep composition revealing signs of an as yet unidentified, perhaps compensatory developmental delay.
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Affiliation(s)
- Róbert Bódizs
- Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, H-1089 Budapest, Hungary; Department of General Psychology, Pázmány Péter Catholic University, Mikszáth tér 1, H-1088 Budapest, Hungary.
| | - Ferenc Gombos
- Department of General Psychology, Pázmány Péter Catholic University, Mikszáth tér 1, H-1088 Budapest, Hungary.
| | - Patrícia Gerván
- Department of General Psychology, Pázmány Péter Catholic University, Mikszáth tér 1, H-1088 Budapest, Hungary.
| | - Katalin Szőcs
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa u. 6, H-1083 Budapest, Hungary
| | - János M Réthelyi
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa u. 6, H-1083 Budapest, Hungary.
| | - Ilona Kovács
- Department of General Psychology, Pázmány Péter Catholic University, Mikszáth tér 1, H-1088 Budapest, Hungary.
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Kozel BA, Bayliss SJ, Berk DR, Waxler JL, Knutsen RH, Danback JR, Pober BR. Skin findings in Williams syndrome. Am J Med Genet A 2014; 164A:2217-25. [PMID: 24920525 DOI: 10.1002/ajmg.a.36628] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 05/05/2014] [Indexed: 01/30/2023]
Abstract
Previous examination in a small number of individuals with Williams syndrome (also referred to as Williams-Beuren syndrome) has shown subtly softer skin and reduced deposition of elastin, an elastic matrix protein important in tissue recoil. No quantitative information about skin elasticity in individuals with Williams syndrome is available; nor has there been a complete report of dermatologic findings in this population. To fill this knowledge gap, 94 patients with Williams syndrome aged 7-50 years were recruited as part of the skin and vascular elasticity (WS-SAVE) study. They underwent either a clinical dermatologic assessment by trained dermatologists (2010 WSA family meeting) or measurement of biomechanical properties of the skin with the DermaLab™ suction cup (2012 WSA family meeting). Clinical assessment confirmed that soft skin is common in this population (83%), as is premature graying of the hair (80% of those 20 years or older), while wrinkles (92%), and abnormal scarring (33%) were detected in larger than expected proportions. Biomechanical studies detected statistically significant differences in dP (the pressure required to lift the skin), dT (the time required to raise the skin through a prescribed gradient), VE (viscoelasticity), and E (Young's modulus) relative to matched controls. The RT (retraction time) also trended longer but was not significant. The biomechanical differences noted in these patients did not correlate with the presence of vascular defects also attributable to elastin insufficiency (vascular stiffness, hypertension, and arterial stenosis) suggesting the presence of tissue specific modifiers that modulate the impact of elastin insufficiency in each tissue.
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Affiliation(s)
- Beth A Kozel
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
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Delio M, Pope K, Wang T, Samanich J, Haldeman-Englert CR, Kaplan P, Shaikh TH, Cai J, Marion RW, Morrow BE, Babcock M. Spectrum of elastin sequence variants and cardiovascular phenotypes in 49 patients with Williams-Beuren syndrome. Am J Med Genet A 2013; 161A:527-33. [DOI: 10.1002/ajmg.a.35784] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 10/24/2012] [Indexed: 11/11/2022]
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Morimoto M, Yu Z, Stenzel P, Clewing JM, Najafian B, Mayfield C, Hendson G, Weinkauf JG, Gormley AK, Parham DM, Ponniah U, André JL, Asakura Y, Basiratnia M, Bogdanović R, Bokenkamp A, Bonneau D, Buck A, Charrow J, Cochat P, Cordeiro I, Deschenes G, Fenkçi MS, Frange P, Fründ S, Fryssira H, Guillen-Navarro E, Keller K, Kirmani S, Kobelka C, Lamfers P, Levtchenko E, Lewis DB, Massella L, McLeod DR, Milford DV, Nobili F, Saraiva JM, Semerci CN, Shoemaker L, Stajić N, Stein A, Taha D, Wand D, Zonana J, Lücke T, Boerkoel CF. Reduced elastogenesis: a clue to the arteriosclerosis and emphysematous changes in Schimke immuno-osseous dysplasia? Orphanet J Rare Dis 2012; 7:70. [PMID: 22998683 PMCID: PMC3568709 DOI: 10.1186/1750-1172-7-70] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 09/14/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Arteriosclerosis and emphysema develop in individuals with Schimke immuno-osseous dysplasia (SIOD), a multisystem disorder caused by biallelic mutations in SMARCAL1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1). However, the mechanism by which the vascular and pulmonary disease arises in SIOD remains unknown. METHODS We reviewed the records of 65 patients with SMARCAL1 mutations. Molecular and immunohistochemical analyses were conducted on autopsy tissue from 4 SIOD patients. RESULTS Thirty-two of 63 patients had signs of arteriosclerosis and 3 of 51 had signs of emphysema. The arteriosclerosis was characterized by intimal and medial hyperplasia, smooth muscle cell hyperplasia and fragmented and disorganized elastin fibers, and the pulmonary disease was characterized by panlobular enlargement of air spaces. Consistent with a cell autonomous disorder, SMARCAL1 was expressed in arterial and lung tissue, and both the aorta and lung of SIOD patients had reduced expression of elastin and alterations in the expression of regulators of elastin gene expression. CONCLUSIONS This first comprehensive study of the vascular and pulmonary complications of SIOD shows that these commonly cause morbidity and mortality and might arise from impaired elastogenesis. Additionally, the effect of SMARCAL1 deficiency on elastin expression provides a model for understanding other features of SIOD.
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Affiliation(s)
- Marie Morimoto
- Provincial Medical Genetics Program, Department of Medical Genetics, Children's and Women's Health Centre of BC, 4500 Oak Street, Room C234, Vancouver, BC, V6H 3N1, Canada
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Louw JJ, Verleden G, Gewillig M, Devriendt K. Haploinsufficiency of elastin gene may lead to familial cardiopathy and pulmonary emphysema. Am J Med Genet A 2012; 158A:2053-4. [DOI: 10.1002/ajmg.a.35464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 04/16/2012] [Indexed: 11/06/2022]
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Mutation of Gtf2ird1 from the Williams-Beuren syndrome critical region results in facial dysplasia, motor dysfunction, and altered vocalisations. Neurobiol Dis 2011; 45:913-22. [PMID: 22198572 DOI: 10.1016/j.nbd.2011.12.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 11/10/2011] [Accepted: 12/04/2011] [Indexed: 01/09/2023] Open
Abstract
Insufficiency of the transcriptional regulator GTF2IRD1 has become a strong potential explanation for some of the major characteristic features of the neurodevelopmental disorder Williams-Beuren syndrome (WBS). Genotype/phenotype correlations in humans indicate that the hemizygous loss of the GTF2IRD1 gene and an adjacent paralogue, GTF2I, play crucial roles in the neurocognitive and craniofacial aspects of the disease. In order to explore this genetic relationship in greater detail, we have generated a targeted Gtf2ird1 mutation in mice that blocks normal GTF2IRD1 protein production. Detailed analyses of homozygous null Gtf2ird1 mice have revealed a series of phenotypes that share some intriguing parallels with WBS. These include reduced body weight, a facial deformity resulting from localised epidermal hyperplasia, a motor coordination deficit, alterations in exploratory activity and, in response to specific stress-inducing stimuli; a novel audible vocalisation and increased serum corticosterone. Analysis of Gtf2ird1 expression patterns in the brain using a knock-in LacZ reporter and c-fos activity mapping illustrates the regions where these neurological abnormalities may originate. These data provide new mechanistic insight into the clinical genetic findings in WBS patients and indicate that insufficiency of GTF2IRD1 protein contributes to abnormalities of facial development, motor function and specific behavioural disorders that accompany this disease.
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Kounis NG, Soufras GD, Mazarakis A. The mystery of sudden death in Williams-Beuren syndrome: cardiomyopathy or Kounis syndrome? Int J Cardiol 2011; 156:251-2. [PMID: 22078390 DOI: 10.1016/j.ijcard.2011.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 10/18/2011] [Indexed: 11/26/2022]
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Kounis NG, Giannopoulos S, Goudevenos JA. The mystery of Williams-Beuren syndrome associated with pulmonary dysfunction, sudden death, and Kounis syndrome. Am J Med Genet A 2010; 152A:2417-8. [DOI: 10.1002/ajmg.a.33549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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