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Luta X, Zanchi F, Fresa M, Porccedu E, Keller S, Bouchardy J, Déglise S, Qanadli SD, Kirsch M, Wuerzner G, Superti-Furga A, Buso G, Mazzolai L. Tortuosity in non-atherosclerotic vascular diseases is associated with age, arterial aneurysms, and hypertension. Orphanet J Rare Dis 2024; 19:227. [PMID: 38849913 PMCID: PMC11157772 DOI: 10.1186/s13023-024-03231-9] [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: 11/22/2023] [Accepted: 05/27/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Increased arterial tortuosity has been associated with various cardiovascular complications. However, the extent and role of arterial tortuosity in non-atherosclerotic vascular diseases remain to be fully elucidated. This study aimed to assess arterial tortuosity index (ATI) in patients with non-atherosclerotic vascular diseases and the associated factors. METHODS This is a retrospective analysis of patients with non-atherosclerotic vascular diseases referred to the Malformation and Rare Vascular Disease Center at the University Hospital in Lausanne (Switzerland). Computed tomography angiography (CTA) images performed between October 2010 and April 2022 were retrieved and the aortic tortuosity index (ATI) was calculated. Patients were classified based on diagnosis into the following groups: arterial dissection & aneurysm, arteritis & autoimmune disease, hereditary connective tissue diseases, and fibromuscular dysplasia (FMD). Univariate and multivariate logistic regression analysis was used to determine potentially relevant predictors of aortic tortuosity. RESULTS The mean age upon computed tomography angiography (CTA) was 46.8 (standard deviation [SD] 14.6) years and 59.1% of the patients were female. Mean ATI was higher in patients over 60 years old (1.27), in those with arterial aneurysms (mean: 1.11), and in those diagnosed with hypertension (mean: 1.13). When only patients over 60 years old were considered, those diagnosed with connective tissue diseases had the highest ATI. At multivariate regression analysis, increasing age (p < 0.05), presence of arterial aneurysms (p < 0.05), and hypertension (p < 0.05) were independently associated with ATI. CONCLUSIONS The ATI may be a promising tool in diagnostic evaluation, cardiovascular risk stratification, medical or surgical management, and prognostic assessment in several non-atherosclerotic vascular conditions. Further studies with longitudinal design and larger cohorts are needed to validate the role of ATI in the full spectrum of vascular diseases.
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Affiliation(s)
- Xhyljeta Luta
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
| | - Fabio Zanchi
- Department of Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Marco Fresa
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Enrica Porccedu
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sanjiv Keller
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Judith Bouchardy
- Department of Cardiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Sébastien Déglise
- Department of Vascular Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Salah Dine Qanadli
- Department of Radiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
- Riviera-Chablais Hospital, University of Lausanne, Lausanne, Switzerland
| | - Matthias Kirsch
- Department of Cardiac Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Grégoire Wuerzner
- Department of Nephrology and Hypertension, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Andrea Superti-Furga
- Department of Genetic Medicine, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Giacomo Buso
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Lucia Mazzolai
- Department of Angiology, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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2
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Budrys D, Tarutis V, Jonas K. Giant aortic aneurysm repair in a child due to arterial tortuosity syndrome. Cardiol Young 2024:1-3. [PMID: 38557429 DOI: 10.1017/s1047951124000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Arterial tortuosity syndrome is an extremely rare hereditary connective tissue disorder. We present a case of an incidentally diagnosed aneurysm of the aortic root and the ascending aorta caused by arterial tortuosity syndrome, which was confirmed genetically. The aneurysm was repaired surgically. One year after the procedure, there was no further dilation of the aorta or formation of new aneurysms.
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Affiliation(s)
| | - Virgilijus Tarutis
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Department of Cardiovascular Diseases, Cardiothoracic Surgery Center, Vilnius, Lithuania
| | - Karolis Jonas
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine, Department of Cardiovascular Diseases, Cardiothoracic Surgery Center, Vilnius, Lithuania
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3
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Inserra MC, Di Mari A, Passaniti G, Cannizzaro MT, La Rosa G, Poli D, Gitto P, Patanè L, Romeo P. Imaging in a Rare Case of Neonatal Arterial Tortuosity Syndrome. Glob Med Genet 2023; 10:271-277. [PMID: 37822417 PMCID: PMC10564566 DOI: 10.1055/s-0043-1775980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Arterial tortuosity syndrome (ATS) is a very rare autosomal recessive disorder that affects the connective tissue. The incidence of ATS is not well known and to date only 106 patients have been described in the literature. ATS affects medium and large size arteries, leading to widespread elongation and intensification of the average vessel tortuousness, responsible of several loops and kinks. Like other connective tissue disorders, ATS can present with joint laxity, hernias, pectus excavatum, scoliosis or other musculoskeletal abnormalities, and ocular defects. Due to the extreme variability of clinical symptoms and the fact that ATS has no curative management, prompt diagnosis is of tremendous importance to prevent disease-associated complications. In this situation, imaging techniques have a central role. In this study, we describe a rare case of a male newborn with tortuosity and lengthening of the main arterial and venous medium and large caliber branches with associated aortic coarctation who passed away prematurely. The finding of aortic coarctation in a newborn with ATS has rarely been described in the literature.
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Affiliation(s)
| | - Alessia Di Mari
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia,” University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
| | - Giulia Passaniti
- CAST Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco,” Catania, Italy
| | | | - Giuliana La Rosa
- Department of Medical Surgical Sciences and Advanced Technologies “GF Ingrassia,” University Hospital Policlinico “G. Rodolico-San Marco,” Catania, Italy
| | - Daniela Poli
- CCPM – Centro Cardiologico Pediatrico del Mediterraneo “Bambino Gesù” di Taormina, Italy
| | - Placido Gitto
- CCPM – Centro Cardiologico Pediatrico del Mediterraneo “Bambino Gesù” di Taormina, Italy
| | - Laura Patanè
- CAST Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco,” Catania, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco,” A.U.O. Policlinico “G.Rodolico-San Marco,” Catania, Italy
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4
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Wu Q, Hu Z, Wang Z, Che Y, Zhang M, Zheng S, Xing K, Zhong X, Chen Y, Shi F, Yuan S. Glut10 restrains neointima formation by promoting SMCs mtDNA demethylation and improving mitochondrial function. Transl Res 2023; 260:1-16. [PMID: 37220836 DOI: 10.1016/j.trsl.2023.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 05/07/2023] [Accepted: 05/09/2023] [Indexed: 05/25/2023]
Abstract
Neointimal hyperplasia is a major clinical complication of coronary artery bypass graft and percutaneous coronary intervention. Smooth muscle cells (SMCs) play a vital roles in neointimal hyperplasia development and undergo complex phenotype switching. Previous studies have linked glucose transporter member 10(Glut10) to the phenotypic transformation of SMCs. In this research, we reported that Glut10 helps maintain the contractile phenotype of SMCs. The Glut10-TET2/3 signaling axis can arrest neointimal hyperplasia progression by improving mitochondrial function via promotion of mtDNA demethylation in SMCs. Glut10 is significantly downregulated in both human and mouse restenotic arteries. Global Glut10 deletion or SMC-specific Glut10 ablation in the carotid artery of mice accelerated neointimal hyperplasia, while Glut10 overexpression in the carotid artery triggered the opposite effects. All of these changes were accompanied by a significant increase in vascular SMCs migration and proliferation. Mechanistically, Glut10 is expressed primarily in the mitochondria after platelet-derived growth factor-BB (PDGF-BB) treatment. Glut10 ablation induced a reduction in ascorbic acid (VitC) concentrations in mitochondria and mitochondrial DNA (mtDNA) hypermethylation by decreasing the activity and expression of the Ten-eleven translocation (TET) protein family. We also observed that Glut10 deficiency aggravated mitochondrial dysfunction and decreased the adenosinetriphosphate (ATP) content and the oxygen consumption rate, which also caused SMCs to switch their phenotype from contractile to synthetic phenotype. Furthermore, mitochondria-specific TET family inhibition partially reversed these effects. These results suggested that Glut10 helps maintain the contractile phenotype of SMCs. The Glut10-TET2/3 signaling axis can arrest neointimal hyperplasia progression by improving mitochondrial function via the promotion of mtDNA demethylation in SMCs.
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Affiliation(s)
- Qi Wu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhipeng Hu
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhiwei Wang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China.
| | - Yanjia Che
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Zhang
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Sihao Zheng
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Kai Xing
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xiaohan Zhong
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuanyang Chen
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Feng Shi
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
| | - Shun Yuan
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China; Cardiovascular Surgery Laboratory, Renmin Hospital of Wuhan University, Wuhan, China; Central Laboratory, Renmin Hospital of Wuhan University, Wuhan, China
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Ekhator C, Devi M, Barker C, Safdar S, Irfan R, Malineni J, Hussain I, Bisharat P, Ramadhan A, Abdelaziz AM, Bellegarde SB, Saddique MN. Arterial Tortuosity Syndrome: Unraveling a Rare Vascular Disorder. Cureus 2023; 15:e44906. [PMID: 37692180 PMCID: PMC10491927 DOI: 10.7759/cureus.44906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2023] [Indexed: 09/12/2023] Open
Abstract
Arterial tortuosity syndrome (ATS) is a rare genetic disorder characterized by abnormal twists and turns of arteries, leading to cardiovascular complications. This syndrome, first reported around 55 years ago, is inherited in an autosomal recessive manner and affects both genders. ATS manifests primarily in childhood, with arterial abnormalities disrupting blood circulation, increasing shear stress, and causing complications, such as atherosclerosis and strokes. This article reviews the genetics, etiology, pathophysiology, clinical presentation, diagnosis, associated conditions, management, and challenges of ATS. The syndrome's genetic cause is linked to mutations in the SLC2A10 gene, affecting collagen and elastin synthesis. Arterial tortuosity, a complex phenomenon, arises from factors such as vessel elongation, anatomic fixation, and vessel diameter. ATS is one of many conditions associated with arterial tortuosity, including Marfan syndrome and Loeys-Dietz syndrome. Recent studies highlight arterial tortuosity's potential as a prognostic indicator for adverse cardiovascular events. Management requires a multidisciplinary approach, and surveillance and prevention play key roles. Despite challenges, advancements in understanding ATS offer hope for targeted therapies and improved patient care.
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Affiliation(s)
- Chukwuyem Ekhator
- Neuro-Oncology, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | | | - Chad Barker
- Public Health, University of South Florida, Tampa, USA
| | | | | | - Jahnavi Malineni
- Medicine and Surgery, Maharajah's Institute of Medical Sciences, Vizianagaram, IND
| | - Iqbal Hussain
- Medicine and Surgery, Khyber Medical University, Peshawar, PAK
| | | | - Afif Ramadhan
- Medicine, Universal Scientific Education and Research Network (USERN), Yogyakarta, IDN
- Medicine, Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University, Yogyakarta, IDN
| | - Ali M Abdelaziz
- Internal Medicine, Alexandria University Faculty of Medicine, Alexandria, EGY
| | - Sophia B Bellegarde
- Pathology and Laboratory Medicine, American University of Antigua, St. John's, ATG
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Esmel-Vilomara R, Valenzuela I, Riaza L, Rodríguez-Santiago B, Rosés-Noguer F, Boronat S, Sabaté-Rotés A. Arterial tortuosity syndrome: Phenotypic features and cardiovascular manifestations in 4 newly identified patients. Eur J Med Genet 2023; 66:104823. [PMID: 37619836 DOI: 10.1016/j.ejmg.2023.104823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/12/2023] [Accepted: 08/22/2023] [Indexed: 08/26/2023]
Abstract
Arterial tortuosity syndrome (ATS) is an autosomal recessive connective tissue disease caused by biallelic variants in the SLC2A10 gene (NG_016284.1) and characterised by tortuosity and elongation of the aorta and medium-sized arteries. It is considered an extremely rare disease; only 106 individuals with genetically confirmed ATS have been identified to date. Four cases of ATS from two families are described, contributing to the clinical delineation of this condition. A patient with microcephaly and a complex uropathy and two cases with diaphragmatic hernia are noticed. Regarding the vascular involvement, a predominant supra-aortic involvement stands out and only 1 patient with significant arterial stenoses was described. All presented severe tortuosity of the intracranial arteries. To reduce hemodynamic stress on the arterial wall, beta-adrenergic blocking treatment was prescribed. A not previously described variant (NM_030777.4:c.899T>G (p.Leu300Trp)) was detected in a proband; it has an allegedly deleterious effect in compound heterozygous state with the pathogenic variant c.417T>A (p.Tyr139Ter). The other 3 patients, siblings born to healthy consanguineous parents, had a variant in homozygous state: c.510G>A (p.Trp170Ter).
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Affiliation(s)
- Roger Esmel-Vilomara
- Department of Paediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Department of Paediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Irene Valenzuela
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Genetics, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Lucía Riaza
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Paediatric Radiology, Vall d'Hebron Hospital Campus, Barcelona, Spain
| | - Benjamín Rodríguez-Santiago
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Genetics, Hospital de la Santa Creu i Sant Pau and Center for Biomedical Network Research on Rare Diseases (CIBERER) and Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Ferran Rosés-Noguer
- Department of Paediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Susana Boronat
- Department of Paediatrics, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Sabaté-Rotés
- Department of Paediatric Cardiology, Vall d'Hebron Hospital Campus, Barcelona, Spain; Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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7
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Han HC, Sultan S, Xiang M. The effects of axial twisting and material non-symmetry on arterial bent buckling. J Biomech 2023; 157:111735. [PMID: 37499429 DOI: 10.1016/j.jbiomech.2023.111735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/25/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
Artery buckling occurs due to hypertensive lumen pressure or reduced axial tension and other pathological conditions. Since arteries in vivo often experience axial twisting and the collagen fiber alignment in the arterial wall may become nonsymmetric, it is imperative to know how axial twisting and nonsymmetric collagen alignment would affect the buckling behavior of arteries. To this end, the objective of this study was to determine the effect of axial twisting and nonsymmetric collagen fiber distribution on the critical pressure of arterial bent buckling. The buckling model analysis was generalized to incorporate an axial twist angle and nonsymmetric fiber alignment. The effect of axial twisting on the critical pressure was simulated and experimentally tested in a group of porcine carotid arteries. Our results showed that axial twisting tends to reduce the critical pressure depending on the axial stretch ratio and twist angle. In addition, nonsymmetric fiber alignment reduces the critical pressure. Experimental results confirmed that a twist angle of 90° reduces the critical pressure significantly (p < 0.05). It was concluded that axial twisting and non-axisymmetric collagen fibers distribution could make arteries prone to bent buckling. These results enrich our understanding of artery buckling and vessel tortuosity. The model analysis and results could also be applicable to other fiber reinforced tubes under lumen pressure and axial twisting.
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Affiliation(s)
- Hai-Chao Han
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, United States.
| | - Sarah Sultan
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, United States
| | - Michael Xiang
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, United States
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8
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Ophthalmic Manifestations of Arterial Tortuosity Syndrome: Case Series of Patient and Carriers. Cornea 2023; 42:476-481. [PMID: 36728218 DOI: 10.1097/ico.0000000000003226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to report the detailed ophthalmic findings in a young patient with genetically confirmed arterial tortuosity syndrome (ATS) and the findings in 8 family members who were carriers. METHODS Nine members of the same Saudi family were assessed at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia, for ATS-related ocular changes after homozygosity for the pathogenic variant of SLC2A10 gene was confirmed in 1 member. All family members underwent complete ophthalmic examination, genetic testing, and corneal tomography at presentation and at 6-month follow-up. RESULTS All ophthalmic features were manifested in our patient with ATS including schisis-like splitting of the stromal layer with greater peripheral thinning, pannus, deep posterior stromal opacities, myopia, high astigmatism, and keratoglobus. The ocular phenotype was also expressed in some carriers ranging from mild myopia to the full spectrum of corneal abnormalities associated with ATS. CONCLUSIONS Our study provided further insights into the phenotype in both patients with ATS and carriers. Annual ophthalmic examination is warranted in both types of patients and must undergo from early life onward to detect progressive ectasia which may necessitate corneal crosslinking.
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Halsey G, Sinha D, Dhital S, Wang X, Vyavahare N. Role of elastic fiber degradation in disease pathogenesis. Biochim Biophys Acta Mol Basis Dis 2023; 1869:166706. [PMID: 37001705 DOI: 10.1016/j.bbadis.2023.166706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023]
Abstract
Elastin is a crucial extracellular matrix protein that provides structural integrity to tissues. Crosslinked elastin and associated microfibrils, named elastic fiber, contribute to biomechanics by providing the elasticity required for proper function. During aging and disease, elastic fiber can be progressively degraded and since there is little elastin synthesis in adults, degraded elastic fiber is not regenerated. There is substantial evidence linking loss or damage of elastic fibers to the clinical manifestation and pathogenesis of a variety of diseases. Disruption of elastic fiber networks by hereditary mutations, aging, or pathogenic stimuli results in systemic ailments associated with the production of elastin degradation products, inflammatory responses, and abnormal physiology. Due to its longevity, unique mechanical properties, and widespread distribution in the body, elastic fiber plays a central role in homeostasis of various physiological systems. While pathogenesis related to elastic fiber degradation has been more thoroughly studied in elastic fiber rich tissues such as the vasculature and the lungs, even tissues containing relatively small quantities of elastic fibers such as the eyes or joints may be severely impacted by elastin degradation. Elastic fiber degradation is a common observation in certain hereditary, age, and specific risk factor exposure induced diseases representing a converging point of pathological clinical phenotypes which may also help explain the appearance of co-morbidities. In this review, we will first cover the role of elastic fiber degradation in the manifestation of hereditary diseases then individually explore the structural role and degradation effects of elastic fibers in various tissues and organ systems. Overall, stabilizing elastic fiber structures and repairing lost elastin may be effective strategies to reverse the effects of these diseases.
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Affiliation(s)
- Gregory Halsey
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Dipasha Sinha
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Saphala Dhital
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Xiaoying Wang
- Department of Bioengineering, Clemson University, SC 29634, United States of America
| | - Naren Vyavahare
- Department of Bioengineering, Clemson University, SC 29634, United States of America.
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10
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Muacevic A, Adler JR, Al-Abdullatif S, Taher MM. Arterial Tortuosity Syndrome in a Newborn: A Case Report With Literature Review. Cureus 2022; 14:e32899. [PMID: 36578839 PMCID: PMC9789724 DOI: 10.7759/cureus.32899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
Arterial tortuosity syndrome (ATS; OMIM #208050) is a sporadic, autosomal, recessively inherited genetic disorder. ATS primarily causes the tortuosity and elongation of large and medium-sized arteries; however, other skeletal manifestations include dysmorphic features, such as hyperextensible skin, hypermobile joints, and congenital contractures. The present article reports the case of a female neonate, who, at birth, exhibited abnormal facial features, hypermobility of joints, and abnormal physical appearance. The patient was diagnosed with ATS during the first week of life, based on computed tomographic scans. In addition, angiographic results demonstrated elongation and tortuosity of the aorta, which were further supported using the results of genetic analysis. Mutation analysis of the solute carrier family 2 member 10 (SLC2A10) genes (Entrez Gene: 81031) detected a homozygous pathogenic c.243C>G (p. Ser81Arg) variant (dbSNP: rs80358230) in this patient, which supports the clinical diagnosis of ATS. Following the initial diagnosis, further investigations into the family history were carried out, and the results demonstrated that the patient's paternal grandmother and paternal aunt were also positive for ATS. The patient was subsequently referred to a tertiary care center for genetic counseling and further follow-up. Notably, carrier testing for at-risk relatives is recommended to identify family members that may be affected by this condition.
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11
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Krzyżewski RM, Kliś KM, Kwinta BM, Łasocha B, Brzegowy P, Popiela TJ, Gąsowski J. Subarachnoid Hemorrhage from Ruptured Internal Carotid Artery Aneurysm: Association with Arterial Tortuosity. World Neurosurg 2022; 166:e84-e92. [PMID: 35811029 DOI: 10.1016/j.wneu.2022.06.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Many researchers have found a correlation between tortuous arteries and development of aneurysms in cerebral arteries. We decided to determine whether tortuosity of the internal carotid artery can be related to its aneurysm rupture. METHODS We retrospectively analyzed the internal carotid artery anatomy of 149 patients with internal carotid artery aneurysms. For each patient, we calculated relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). RESULTS A total of 33 patients (22.15%) had subarachnoid hemorrhage. These patients had significantly lower SOAM (0.31 ± 0.17 vs. 0.42 ± 0.21; P < 0.01), TI (0.27 ± 0.09 vs. 0.31 ± 0.11; P = 0.03) and ICM (0.25 ± 0.11 vs. 0.31 ± 0.17; P = 0.04). In multivariate logistic regression analysis, higher SOAM (odds ratio, 0.780; 95% confidence interval, 0.619-0.961; P = 0.025) remained independently associated with lower risk of internal carotid artery aneurysm rupture. In addition, we found significant positive correlation of aneurysm dome size with SOAM (R = 0.224; P = 0.013) and PAD (0.269; P < 0.01). Our study also showed that age (R = 0.252; P = 0.036), Glasgow Coma Scale score (R = -0.706; P < 0.01), and TI (R = -0.249; P = 0.042) were independently correlated with modified Rankin Scale score on discharge. CONCLUSIONS Lower tortuosity might be a protective factor against internal carotid artery aneurysm rupture and poor outcome after subarachnoid hemorrhage. Higher tortuosity is correlated with internal carotid artery aneurysm growth.
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Affiliation(s)
- Roger M Krzyżewski
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Borys M Kwinta
- Departments of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Kraków, Poland
| | - Bartłomiej Łasocha
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Paweł Brzegowy
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Tadeusz J Popiela
- Department of Radiology, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Gąsowski
- Departments of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Tarr I, Hesselson S, Iismaa SE, Rath E, Monger S, Troup M, Mishra K, Wong CM, Hsu PC, Junday K, Humphreys DT, Adlam D, Webb TR, Baranowska-Clarke AA, Hamby SE, Carss KJ, Samani NJ, Bax M, McGrath-Cadell L, Kovacic JC, Dunwoodie SL, Fatkin D, Muller DW, Graham RM, Giannoulatou E. Exploring the Genetic Architecture of Spontaneous Coronary Artery Dissection Using Whole-Genome Sequencing. Circ Genom Precis Med 2022; 15:e003527. [PMID: 35583931 PMCID: PMC9388555 DOI: 10.1161/circgen.121.003527] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndrome that predominantly affects women. Its pathophysiology remains unclear but connective tissue disorders (CTD) and other vasculopathies have been observed in many SCAD patients. A genetic component for SCAD is increasingly appreciated, although few genes have been robustly implicated. We sought to clarify the genetic cause of SCAD using targeted and genome-wide methods in a cohort of sporadic cases to identify both common and rare disease-associated variants.
Methods:
A cohort of 91 unrelated sporadic SCAD cases was investigated for rare, deleterious variants in genes associated with either SCAD or CTD, while new candidate genes were sought using rare variant collapsing analysis and identification of novel loss-of-function variants in genes intolerant to such variation. Finally, 2 SCAD polygenic risk scores were applied to assess the contribution of common variants.
Results:
We identified 10 cases with at least one rare, likely disease-causing variant in CTD-associated genes, although only one had a CTD phenotype. No genes were significantly associated with SCAD from genome-wide collapsing analysis, however, enrichment for TGF (transforming growth factor)-β signaling pathway genes was found with analysis of 24 genes harboring novel loss-of-function variants. Both polygenic risk scores demonstrated that sporadic SCAD cases have a significantly elevated genetic SCAD risk compared with controls.
Conclusions:
SCAD shares some genetic overlap with CTD, even in the absence of any major CTD phenotype. Consistent with a complex genetic architecture, SCAD patients also have a higher burden of common variants than controls.
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Affiliation(s)
- Ingrid Tarr
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephanie Hesselson
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Siiri E. Iismaa
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Emma Rath
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Steven Monger
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Michael Troup
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Ketan Mishra
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Claire M.Y. Wong
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Pei-Chen Hsu
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Keerat Junday
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David T. Humphreys
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - David Adlam
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Tom R. Webb
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Anna A. Baranowska-Clarke
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Stephen E. Hamby
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Keren J. Carss
- Centre for Genomics Research, Discovery Sciences, BioPharmaceuticals R&D, AstraZeneca, United Kingdom (K.J.C.)
| | - Nilesh J. Samani
- Department of Cardiovascular Sciences, NIHR Leicester Biomedical Research Centre, University of Leicester, United Kingdom (D.A., T.R.W., A.A.B.-C., S.E.H., N.J.S.)
| | - Monique Bax
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Lucy McGrath-Cadell
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Jason C. Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (J.C.K.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Sally L. Dunwoodie
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - David W.M. Muller
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Robert M. Graham
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- Cardiology Department, St Vincent’s Hospital, Darlinghurst, NSW, Australia (J.C.K., D.F., D.W.M.M., R.M.G.)
| | - Eleni Giannoulatou
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW, Australia (I.T., S.H., S.E.I., E.R., S.M., M.T., K.M., C.M.Y.W., P.-C.H., K.J., D.T.H., M.B., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
- UNSW Sydney, Kensington, NSW, Australia (S.E.I., E.R., L.M.-C., J.C.K., S.L.D., D.F., D.W.M.M., R.M.G., E.G.)
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Investigation of Genetic Causes in Patients with Congenital Heart Disease in Qatar: Findings from the Sidra Cardiac Registry. Genes (Basel) 2022; 13:genes13081369. [PMID: 36011280 PMCID: PMC9407366 DOI: 10.3390/genes13081369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023] Open
Abstract
Congenital heart disease (CHD) is one of the most common forms of birth defects worldwide, with a prevalence of 1–2% in newborns. CHD is a multifactorial disease partially caused by genetic defects, including chromosomal abnormalities and single gene mutations. Here, we describe the Sidra Cardiac Registry, which includes 52 families and a total of 178 individuals, and investigate the genetic etiology of CHD in Qatar. We reviewed the results of genetic tests conducted in patients as part of their clinical evaluation, including chromosomal testing. We also performed whole exome sequencing (WES) to identify potential causative variants. Sixteen patients with CHD had chromosomal abnormalities that explained their complex CHD phenotype, including six patients with trisomy 21. Moreover, using exome analysis, we identified potential CHD variants in 24 patients, revealing 65 potential variants in 56 genes. Four variants were classified as pathogenic/likely pathogenic based on the American College of Medical Genetics and Genomics and the Association for Molecular Pathology (ACMG/AMP) classification; these variants were detected in four patients. This study sheds light on several potential genetic variants contributing to the development of CHD. Additional functional studies are needed to better understand the role of the identified variants in the pathogenesis of CHD.
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14
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Mizrak D, Feng H, Yang B. Dissecting the Heterogeneity of Human Thoracic Aortic Aneurysms Using Single-Cell Transcriptomics. Arterioscler Thromb Vasc Biol 2022; 42:919-930. [PMID: 35708028 PMCID: PMC9339526 DOI: 10.1161/atvbaha.122.317484] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Thoracic aortic aneurysm is a life-threatening condition caused by weakening of the thoracic aorta wall, often developing silently until dissection or rupture occurs. Despite substantial efforts in the past decade, there have been no significant therapeutic advances to prevent or clinically manage diverse forms of thoracic aortic aneurysm and dissection with the only effective treatment being surgical repair. There is an urgent need to understand intra- and inter-aneurysmal heterogeneity underlying thoracic aortic aneurysm and dissection pathogenesis. The human aortic wall consists of many cell types and exhibits significant regional heterogeneity. High-throughput single-cell RNA sequencing has emerged as the principal tool to reveal the complexity in human tissues and clinical specimens. Recent single-cell RNA sequencing studies of different aortic cell populations both in vivo and in vitro began to dissect this complexity and have provided valuable information. In this review, we summarize these findings and discuss the potential applications of single-cell transcriptomics and related high-content technologies in human thoracic aortic aneurysm and dissection research, as well as the challenges associated with it.
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Affiliation(s)
- Dogukan Mizrak
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.M., H.F., B.Y.)
| | - Hao Feng
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.M., H.F., B.Y.).,Xiangya School of Medicine, Central South University, Changsha, China (H.F.)
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor (D.M., H.F., B.Y.)
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15
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Ajayan N, Hrishi AP, Kumar A, Sethuraman M. Anesthetic Management of a Patient With Arterial Tortuosity Syndrome Undergoing Cerebral Revascularization Surgery—A Case Report. A A Pract 2022; 16:e01593. [DOI: 10.1213/xaa.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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16
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Tempchin AF, Nagesh D, Paulsen KC, Ho E, Santoro JD. Intracranial Vascular Tortuosity in an Infant With Dysmorphic Facies. Pediatr Neurol 2022; 131:20-22. [PMID: 35462107 DOI: 10.1016/j.pediatrneurol.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/24/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Adam F Tempchin
- Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Deepti Nagesh
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Kelli C Paulsen
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California
| | - Eugenia Ho
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Jonathan D Santoro
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, California.
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17
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Arterial Tortuosity and Its Correlation with White Matter Hyperintensities in Acute Ischemic Stroke. Neural Plast 2022; 2022:4280410. [PMID: 35369646 PMCID: PMC8970938 DOI: 10.1155/2022/4280410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction The association between arterial tortuosity and acute ischemic stroke (AIS) has been reported, but showing inconsistent results. We hypothesized that tortuosity of extra- and intracranial large arteries might be higher in AIS patients. Furthermore, we explored the correlation between artery tortuosity and white matter hyperintensity (WMH) severity in AIS patients. Methods 166 AIS patients identified as large artery atherosclerosis, and 83 control subjects were enrolled. All subjects received three-dimensional computed tomography angiography (CTA). Arterial tortuosity was evaluated using the tortuosity index. WMHs were evaluated using magnetic resonance imaging in all AIS patients. Results AIS patients showed significantly increased arterial tortuosity index relative to controls, including left carotid artery (CA) (p = 0.001), right CA (p < 0.001), left common carotid artery (CCA) (p < 0.001), right CCA (p < 0.001), left internal carotid artery (p = 0.001), right internal carotid artery (p = 0.01), left extracranial internal carotid artery (EICA) (p < 0.001), right EICA (p = 0.01), and vertebral artery dominance (VAD) (p = 0.001). The tortuosity of all above arteries was associated with the presence of AIS. AIS patients with moderate or severe WMHs had a higher tortuosity index in left CA (p = 0.005), left CCA (p = 0.003), left EICA (p = 0.07), and VAD (p = 0.001). In addition, the tortuosity of left EICA and VAD was associated with WMH severity in AIS patients. Conclusions Increased extra- and intracranial large arteries tortuosity is associated with AIS. The tortuosity of left carotid artery system and vertebral artery may be the independent risk factors for WMH severity in AIS patients. Clinical Trial Registration. This trial is registered with NCT03122002 (http://www.clinicaltrials.gov).
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18
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Faiyaz-Ul-Haque M, Mubarak M, AbdulWahab A, AlRikabi AC, Alsaeed AH, Al-Otaiby M, Nawaz Z, Zaidi SHE, Basit S. Ultrastructure abnormalities of collagen and elastin in Arab patients with arterial tortuosity syndrome. J Cutan Pathol 2022; 49:618-622. [PMID: 35302653 DOI: 10.1111/cup.14228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 01/13/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
Arterial tortuosity syndrome (ATS) is a rare autosomal recessive disease characterized by elongation and tortuosity of the large and medium sized arteries. ATS patients display features that are also found in Ehlers-Danlos syndromes (EDS) patients. ATS is caused by pathogenic mutations in the SLC2A10 gene, which encodes for the glucose transporter, GLUT10. The study aimed at examining the ultrastructure of skin for abnormalities that can explain the loose skin and arterial phenotypes of Arab patients with the p.S81R mutation in SLC2A10. Forty eight patients with SLC2A10 mutation were recruited for this study. Skin biopsy specimens from 3 children with ATS and a healthy child were examined by electron microscopy to determine the ultrastructure of collagen and elastin. Histopathologic staining of sections from tissue biopsy specimens were also performed. In the skin from ATS patients, large spaces are discovered among collagen fibrils suggesting disorganization of the collagen structures. Furthermore, elastin fiber contents and their thickness are reduced in the skin. In small muscular arteries in the skin from ATS patients, discontinued internal elastic lamina, lack of myofilaments, and disorganized medial smooth muscle cells with vacuolated cytoplasm are present. The disorganization of collagen fibrils and reduced elastin contents in the skin may explain the loose skin phenotype of ATS patients similar to the EDS patients. The lack of elastin in small muscular arteries may have contributed to the development of arterial tortuosity in these patients. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Muhammad Faiyaz-Ul-Haque
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Mubarak
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Atqah AbdulWahab
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Ammar C AlRikabi
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abbas H Alsaeed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Maram Al-Otaiby
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zafar Nawaz
- Department of Pathology and Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Syed H E Zaidi
- Genomics, Ontario Institute for Cancer Research, Toronto, Canada
| | - Sulman Basit
- Center for Genetics and Inherited Diseases, Taibah University Almadinah Almunawwarah, Medina, Saudi Arabia
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19
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Update on the molecular landscape of thoracic aortic aneurysmal disease. Curr Opin Cardiol 2022; 37:201-211. [PMID: 35175228 DOI: 10.1097/hco.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW Thoracic aortic aneurysms and dissections (TAADs) are a major health problem in the Western population. This review summarises recent discoveries in the genetic landscape of TAAD disease, discusses current challenges in clinical practice, and describes the molecular road ahead in TAAD research. Disorders, in which aneurysmal disease is not observed in the thoracic aorta, are not discussed. RECENT FINDINGS Current gene discovery studies have pinpointed about 40 genes associated with TAAD risk, accounting for about 30% of the patients. Importantly, novel genes, and their subsequent functional characterisation, have expanded the knowledge on disease-related pathways providing crucial information on key elements in this disease, and it pinpoints new therapeutic targets. Moreover, current molecular evidence also suggests the existence of less monogenic nature of TAAD disease, in which the presentation of a diseased patient is most likely influenced by a multitude of genetic and environmental factors. SUMMARY CLINICAL PRACTICE/RELEVANCE Ongoing molecular genetic research continues to expand our understanding on the pathomechanisms underlying TAAD disease in order to improve molecular diagnosis, optimise risk stratification, advance therapeutic strategies and facilitate counselling of TAAD patients and their families.
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20
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Genetics of Heritable Thoracic Aortic Disease. CARDIOGENETICS 2022. [DOI: 10.3390/cardiogenetics12010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Genetic testing plays an increasing diagnostic and prognostic role in the management of patients with heritable thoracic aortic disease (HTAD). The identification of a specific variant can establish or confirm the diagnosis of syndromic HTAD, dictate extensive evaluation of the arterial tree in HTAD with known distal vasculature involvement and justify closer follow-up and earlier surgical intervention in HTAD with high risk of dissection of minimal or normal aortic size. Evolving phenotype–genotype correlations lead us towards more precise and individualized management and treatment of patients with HTAD. In this review, we present the latest evidence regarding the role of genetics in patients with HTAD.
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21
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Beyens A, Pottie L, Sips P, Callewaert B. Clinical and Molecular Delineation of Cutis Laxa Syndromes: Paradigms for Homeostasis. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1348:273-309. [PMID: 34807425 DOI: 10.1007/978-3-030-80614-9_13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cutis laxa (CL) syndromes are a large and heterogeneous group of rare connective tissue disorders that share loose redundant skin as a hallmark clinical feature, which reflects dermal elastic fiber fragmentation. Both acquired and congenital-Mendelian- forms exist. Acquired forms are progressive and often preceded by inflammatory triggers in the skin, but may show systemic elastolysis. Mendelian forms are often pleiotropic in nature and classified upon systemic manifestations and mode of inheritance. Though impaired elastogenesis is a common denominator in all Mendelian forms of CL, the underlying gene defects are diverse and affect structural components of the elastic fiber or impair metabolic pathways interfering with cellular trafficking, proline synthesis, or mitochondrial functioning. In this chapter we provide a detailed overview of the clinical and molecular characteristics of the different cutis laxa types and review the latest insights on elastic fiber assembly and homeostasis from both human and animal studies.
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Affiliation(s)
- Aude Beyens
- Center for Medical Genetics Ghent, Department of Dermatology, Department of Biomolecular Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Lore Pottie
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Patrick Sips
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium.
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22
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Prevalence, risk factors, and coronary angiographic profile in patients with tortuous coronary artery. COR ET VASA 2021. [DOI: 10.33678/cor.2021.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Song Y, Lee JK, Lee JO, Kwon B, Seo EJ, Suh DC. Whole Exome Sequencing in Patients with Phenotypically Associated Familial Intracranial Aneurysm. Korean J Radiol 2021; 23:101-111. [PMID: 34668355 PMCID: PMC8743149 DOI: 10.3348/kjr.2021.0467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/17/2021] [Accepted: 08/03/2021] [Indexed: 11/24/2022] Open
Abstract
Objective Familial intracranial aneurysms (FIAs) are found in approximately 6%–20% of patients with intracranial aneurysms (IAs), suggesting that genetic predisposition likely plays a role in its pathogenesis. The aim of this study was to identify possible IA-associated variants using whole exome sequencing (WES) in selected Korean families with FIA. Materials and Methods Among the 26 families in our institutional database with two or more IA-affected first-degree relatives, three families that were genetically enriched (multiple, early onset, or common site involvement within the families) for IA were selected for WES. Filtering strategies, including a family-based approach and knowledge-based prioritization, were applied to derive possible IA-associated variants from the families. A chromosomal microarray was performed to detect relatively large chromosomal abnormalities. Results Thirteen individuals from the three families were sequenced, of whom seven had IAs. We noted three rare, potentially deleterious variants (PLOD3 c.1315G>A, NTM c.968C>T, and CHST14 c.58C>T), which are the most promising candidates among the 11 potential IA-associated variants considering gene-phenotype relationships, gene function, co-segregation, and variant pathogenicity. Microarray analysis did not reveal any significant copy number variants in the families. Conclusion Using WES, we found that rare, potentially deleterious variants in PLOD3, NTM, and CHST14 genes are likely responsible for the subsets of FIAs in a cohort of Korean families.
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Affiliation(s)
- Yunsun Song
- Division of Neurointervention Clinic, Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Keuk Lee
- Asan Institute of Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Ok Lee
- Department of Laboratory Medicine, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Boseong Kwon
- Division of Neurointervention Clinic, Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eul-Ju Seo
- Department of Laboratory Medicine, Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Dae Chul Suh
- Division of Neurointervention Clinic, Department of Radiology, Neurointervention Clinic, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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24
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Lanzer P, Hannan FM, Lanzer JD, Janzen J, Raggi P, Furniss D, Schuchardt M, Thakker R, Fok PW, Saez-Rodriguez J, Millan A, Sato Y, Ferraresi R, Virmani R, St Hilaire C. Medial Arterial Calcification: JACC State-of-the-Art Review. J Am Coll Cardiol 2021; 78:1145-1165. [PMID: 34503684 PMCID: PMC8439554 DOI: 10.1016/j.jacc.2021.06.049] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 01/07/2023]
Abstract
Medial arterial calcification (MAC) is a chronic systemic vascular disorder distinct from atherosclerosis that is frequently but not always associated with diabetes mellitus, chronic kidney disease, and aging. MAC is also a part of more complex phenotypes in numerous less common diseases. The hallmarks of MAC include disseminated and progressive precipitation of calcium phosphate within the medial layer, a prolonged and clinically silent course, and compromise of hemodynamics associated with chronic limb-threatening ischemia. MAC increases the risk of complications during vascular interventions and mitigates their outcomes. With the exception of rare monogenetic defects affecting adenosine triphosphate metabolism, MAC pathogenesis remains unknown, and causal therapy is not available. Implementation of genetics and omics-based approaches in research recognizing the critical importance of calcium phosphate thermodynamics holds promise to unravel MAC molecular pathogenesis and to provide guidance for therapy. The current state of knowledge concerning MAC is reviewed, and future perspectives are outlined.
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Affiliation(s)
- Peter Lanzer
- Middle German Heart Center-Bitterfeld, Bitterfeld-Wolfen Health Care Center, Bitterfeld, Germany.
| | - Fadil M Hannan
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Jan D Lanzer
- Institute for Computational Biomedicine, Bioquant, Faculty of Medicine, Heidelberg University, Heidelberg, Germany; Department of Internal Medicine II, Heidelberg University Hospital, Heidelberg, Germany; Faculty of Biosciences, Heidelberg University, Heidelberg, Heidelberg, Germany
| | | | - Paolo Raggi
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Dominic Furniss
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Mirjam Schuchardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt Universität Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Rajesh Thakker
- Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Pak-Wing Fok
- Department of Mathematical Sciences, University of Delaware, Newark, Delaware, USA
| | - Julio Saez-Rodriguez
- Institute for Computational Biomedicine, Bioquant, Faculty of Medicine, Heidelberg University, Heidelberg, Germany
| | - Angel Millan
- Institute of Materials Science, University of Zaragoza, Zaragoza, Spain
| | - Yu Sato
- CVPath Institute, Gaithersburg, Maryland, USA
| | | | | | - Cynthia St Hilaire
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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25
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Liang M, Wen H, Li S. Two fetuses in one family of arterial tortuosity syndrome: prenatal ultrasound diagnosis. BMC Pregnancy Childbirth 2021; 21:548. [PMID: 34384376 PMCID: PMC8359025 DOI: 10.1186/s12884-021-03960-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Arterial tortuosity syndrome (ATS) is a rare autosomal recessive connective tissue disorder chiefly characterized by elongated and tortuosity of the large and medium sized arteries and anomalies of the vascular elastic fibers. Here we reported cases of brother about ATS from the same family on the prenatal ultrasound diagnosis. Reports of this case are rare in antenatally and we draw the vessel simulated diagram to display visually. Case presentation Prenatal ultrasound scanning at 29 weeks of gestation of the first fetus showed obvious tortuous and elongated of the aortic arch, ductus arteriosus, left and right pulmonary arteries, carotid and subclavian arteries. Three months after delivery, Contrast-enhanced computed tomography images (CTA) were performed to clearly display vascular abnormalities consistent with prenatal diagnosis of ultrasound. Whole exome sequencing (WES) was performed eight months after birth, two heterozygous variants of SLC2A10 gene was detected in newborn and their father and mother, respectively. Prenatal ultrasound scan at 22 weeks of gestation of the second fetus showed similar cardiovascular imaging. After birth the siblings have facial characteristic features gradually as aging. No surgical intervention was performed in the siblings follow up 19 months. Conclusions The key points of prenatal ultrasound diagnosis of ATS are the elongation and tortuosity of the large and medium sized arteries. Genetic counseling is the process of providing individuals and families with information on the nature, inheritance, and implications of genetic disorders to help them make informed medical and personal decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03960-w.
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Affiliation(s)
- Meiling Liang
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Huaxuan Wen
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China
| | - Shengli Li
- Department of Ultrasound, Affiliated Shenzhen Maternity & Child Healthcare Hospital, Southern Medical University, Shenzhen, 518028, China.
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26
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Boel A, Burger J, Vanhomwegen M, Beyens A, Renard M, Barnhoorn S, Casteleyn C, Reinhardt DP, Descamps B, Vanhove C, van der Pluijm I, Coucke P, Willaert A, Essers J, Callewaert B. Slc2a10 knock-out mice deficient in ascorbic acid synthesis recapitulate aspects of arterial tortuosity syndrome and display mitochondrial respiration defects. Hum Mol Genet 2021; 29:1476-1488. [PMID: 32307537 DOI: 10.1093/hmg/ddaa071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/08/2020] [Accepted: 04/15/2020] [Indexed: 12/19/2022] Open
Abstract
Arterial tortuosity syndrome (ATS) is a recessively inherited connective tissue disorder, mainly characterized by tortuosity and aneurysm formation of the major arteries. ATS is caused by loss-of-function mutations in SLC2A10, encoding the facilitative glucose transporter GLUT10. Former studies implicated GLUT10 in the transport of dehydroascorbic acid, the oxidized form of ascorbic acid (AA). Mouse models carrying homozygous Slc2a10 missense mutations did not recapitulate the human phenotype. Since mice, in contrast to humans, are able to intracellularly synthesize AA, we generated a novel ATS mouse model, deficient for Slc2a10 as well as Gulo, which encodes for L-gulonolactone oxidase, an enzyme catalyzing the final step in AA biosynthesis in mouse. Gulo;Slc2a10 double knock-out mice showed mild phenotypic anomalies, which were absent in single knock-out controls. While Gulo;Slc2a10 double knock-out mice did not fully phenocopy human ATS, histological and immunocytochemical analysis revealed compromised extracellular matrix formation. Transforming growth factor beta signaling remained unaltered, while mitochondrial function was compromised in smooth muscle cells derived from Gulo;Slc2a10 double knock-out mice. Altogether, our data add evidence that ATS is an ascorbate compartmentalization disorder, but additional factors underlying the observed phenotype in humans remain to be determined.
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Affiliation(s)
- Annekatrien Boel
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium.,Ghent-Fertility and Stem cell Team, Department for Reproductive Medicine, Ghent University Hospital, 9000 Ghent, Belgium
| | - Joyce Burger
- Department of Molecular Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Marine Vanhomwegen
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Aude Beyens
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium.,Department of Dermatology, Ghent University Hospital, 9000 Ghent, Belgium
| | - Marjolijn Renard
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Sander Barnhoorn
- Department of Molecular Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Christophe Casteleyn
- Department of Morphology, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium
| | - Dieter P Reinhardt
- Department of Anatomy and Cell Biology, Faculty of Medicine, Faculty of Dentistry, McGill University, H3A 0C7 Montreal, Quebec, Canada
| | - Benedicte Descamps
- Infinity (IBiTech-MEDISIP), Department of Electronics and Information Systems, Ghent University, 9000 Ghent, Belgium
| | - Christian Vanhove
- Infinity (IBiTech-MEDISIP), Department of Electronics and Information Systems, Ghent University, 9000 Ghent, Belgium
| | - Ingrid van der Pluijm
- Department of Molecular Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Vascular Surgery, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Paul Coucke
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Andy Willaert
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
| | - Jeroen Essers
- Department of Molecular Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Clinical Genetics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Vascular Surgery, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands.,Department of Radiation Oncology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Bert Callewaert
- Center for Medical Genetics Ghent, Department of Biomolecular Medicine, Ghent University, 9000 Ghent, Belgium
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27
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Pozzer D, Invernizzi RW, Blaauw B, Cantoni O, Zito E. Ascorbic Acid Route to the Endoplasmic Reticulum: Function and Role in Disease. Antioxid Redox Signal 2021; 34:845-855. [PMID: 31867990 DOI: 10.1089/ars.2019.7912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Significance: Humans cannot synthesize ascorbic acid (AscH2) (vitamin C), so deficiencies in dietary AscH2 cause the life-threatening disease of scurvy and many other diseases. After oral ingestion, plasma AscH2 concentrations are strictly controlled by transporters, which are required for entry into the cell and into intracellular organelles. Recent Advances: Besides its general antioxidant function, AscH2 is a cofactor for endoplasmic reticulum (ER)-localized collagen hydroxylases. Its important role in ER homeostasis is also highlighted by the fact that AscH2 deficiency in auxotrophic species triggers ER stress. Critical Issues: Characterizations of the molecular basis of diseases suggest that intracellular AscH2 deficiency is due not only to limited dietary access but also to its limited intracellular transport and net loss under conditions of intracellular hyperoxidation in the ER. This essay will offer an overview of the different transporters of vitamin C regulating its intracellular concentration, its function inside the ER, and the phenotypes of the diseases that can be triggered by increased depletion of this vitamin in the ER. Future Directions: When considering the benefits of increasing dietary AscH2, it is important to consider pharmacokinetic differences in the bioavailability between orally and intravenously administered AscH2: the latter bypasses intestinal absorption and is, therefore, the only route that can lead to the high plasma concentrations that may provide some health effects, and it is this route that needs to be chosen in clinical trials for those diseases associated with a deficiency of AscH2. Antioxid. Redox Signal. 34, 845-855.
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Affiliation(s)
- Diego Pozzer
- Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Milan, Italy
| | | | - Bert Blaauw
- Department of Biomedical Sciences, University of Padua, Padua, Italy
- Venetian Institute of Molecular Medicine, Padua, Italy
| | - Orazio Cantoni
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino, Italy
| | - Ester Zito
- Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, Milan, Italy
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28
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Boel A, Veszelyi K, Németh CE, Beyens A, Willaert A, Coucke P, Callewaert B, Margittai É. Arterial Tortuosity Syndrome: An Ascorbate Compartmentalization Disorder? Antioxid Redox Signal 2021; 34:875-889. [PMID: 31621376 DOI: 10.1089/ars.2019.7843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Significance: Cardiovascular disorders are the most important cause of morbidity and mortality in the Western world. Monogenic developmental disorders of the heart and vessels are highly valuable to study the physiological and pathological processes in cardiovascular system homeostasis. The arterial tortuosity syndrome (ATS) is a rare, autosomal recessive connective tissue disorder showing lengthening, tortuosity, and stenosis of the large arteries, with a propensity for aneurysm formation. In histopathology, it associates with fragmentation and disorganization of elastic fibers in several tissues, including the arterial wall. ATS is caused by pathogenic variants in SLC2A10 encoding the facilitative glucose transporter (GLUT)10. Critical Issues: Although several hypotheses have been forwarded, the molecular mechanisms linking disrupted GLUT10 activity with arterial malformations are largely unknown. Recent Advances: The vascular and systemic manifestations and natural history of ATS patients have been largely delineated. GLUT10 was identified as an intracellular transporter of dehydroascorbic acid, which contributes to collagen and elastin cross-linking in the endoplasmic reticulum, redox homeostasis in the mitochondria, and global and gene-specific methylation/hydroxymethylation affecting epigenetic regulation in the nucleus. We revise here the current knowledge on ATS and the role of GLUT10 within the compartmentalization of ascorbate in physiological and diseased states. Future Directions: Centralization of clinical, treatment, and outcome data will enable better management for ATS patients. Establishment of representative animal disease models could facilitate the study of pathomechanisms underlying ATS. This might be relevant for other forms of vascular dysplasia, such as isolated aneurysm formation, hypertensive vasculopathy, and neovascularization. Antioxid. Redox Signal. 34, 875-889.
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Affiliation(s)
- Annekatrien Boel
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Krisztina Veszelyi
- Institute of Clinical Experimental Research, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Csilla E Németh
- Department of Medical Chemistry, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
| | - Aude Beyens
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Andy Willaert
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Paul Coucke
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Department of Biomolecular Medicine, Center for Medical Genetics Ghent, Ghent University, Ghent, Belgium
| | - Éva Margittai
- Institute of Clinical Experimental Research, Molecular Biology, and Pathobiochemistry, Semmelweis University, Budapest, Hungary
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29
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Arbustini E, Vengrenyuk Y, Narula J. On the Shades of Coronary Calcium and Plaque Instability. J Am Coll Cardiol 2021; 77:1612-1615. [PMID: 33795034 DOI: 10.1016/j.jacc.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/04/2021] [Accepted: 02/05/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Department of Medical Sciences and Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | | | - Jagat Narula
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
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30
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Alkhaldi A, Momenah T, Alsahari A, Alotay A, Alfonso JJ, Abuzaid A, Alwadai A. Late Outcomes After Pulmonary Arterial Reconstruction in Patients With Arterial Tortuosity Syndrome. Ann Thorac Surg 2021; 113:1569-1574. [PMID: 33811889 DOI: 10.1016/j.athoracsur.2021.03.063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical pulmonary artery reconstruction in patients with Arterial Tortuosity Syndrome (ATS) has excellent outcomes. In this study, we report our late outcomes after more than a decade of experience with such complex interventions. METHODS We conducted a retrospective review of 33 ATS patients who underwent pulmonary artery reconstruction. The mean pre-operative right ventricular/left ventricular pressure (RVp/LVp) ratio was 1.19 ± 0.2. Our surgical approach included either a single-stage complete repair through a median sternotomy (17 patients) or a two-stage repair through sternotomy / left thoracotomy (16 patients), depending on the degree of distal involvement in the left pulmonary artery. RESULTS Median age was 36 months. All patients had distal segmental peripheral pulmonary artery stenosis. Thirty patients (90.1%) were symptomatic before surgery. There was one hospital mortality due to viral pneumonia 78 days after the surgery (in-hospital mortality = 3%). The mean RVp/LVp ratio decreased to 0.31±0.07 early postoperatively (P<0.001), representing a 74% reduction compared with pre-operative values. Follow-up was 100% complete for all hospital survivors (32/33) with a mean follow-up of 70.42±43.32 months (range was 2 to 143 months). There was no late mortality or need for re-intervention (surgical or catheter-based) after hospital discharge. In late postoperative catheterization, the mean RVp/LVp ratio was 0.27±0.05 (P=0.003 compared to early post-operative value). All patients were asymptomatic on their most recent follow-up. CONCLUSIONS A strategy of complete surgical reconstruction of all stenotic pulmonary artery segments in patients with ATS is recommended for sustainable successful outcomes more than a decade later.
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Affiliation(s)
- Abdulaziz Alkhaldi
- Department of Pediatric Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
| | - Tarek Momenah
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Atif Alsahari
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdulmajeed Alotay
- Department of Pediatric Cardiology, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Juan J Alfonso
- Department of Cardiac Research, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Ahmad Abuzaid
- Department of Cardiac Anesthesia, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
| | - Abdullah Alwadai
- Department of Pediatric Cardiac Intensive care, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia
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31
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Heinz A. Elastic fibers during aging and disease. Ageing Res Rev 2021; 66:101255. [PMID: 33434682 DOI: 10.1016/j.arr.2021.101255] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/29/2020] [Accepted: 12/30/2020] [Indexed: 02/08/2023]
Abstract
Elastic fibers are essential constituents of the extracellular matrix of higher vertebrates and endow several tissues and organs including lungs, skin and blood vessels with elasticity and resilience. During the human lifespan, elastic fibers are exposed to a variety of enzymatic, chemical and biophysical influences, and accumulate damage due to their low turnover. Aging of elastin and elastic fibers involves enzymatic degradation, oxidative damage, glycation, calcification, aspartic acid racemization, binding of lipids and lipid peroxidation products, carbamylation and mechanical fatigue. These processes can trigger an impairment or loss of elastic fiber function and are associated with severe pathologies. There are different inherited or acquired pathological conditions, which influence the structure and function of elastic fibers and microfibrils predominantly in the cardiorespiratory system and skin. Inherited elastic-fiber pathologies have a direct or indirect impact on elastic-fiber formation due to mutations in the fibrillin genes (fibrillinopathies), in the elastin gene (elastinopathies) or in genes encoding proteins that are associated with microfibrils or elastic fibers. Acquired elastic-fiber pathologies appear age-related or as a result of multiple factors impairing tissue homeostasis. This review gives an overview on the fate of elastic fibers over the human lifespan in health and disease.
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32
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Dealing with kinked and swirled pulmonary vessels: surgical treatment of arterial tortuosity syndrome: a case report. Cardiol Young 2020; 30:1960-1963. [PMID: 32988421 DOI: 10.1017/s1047951120003017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We present the case of a child with arterial tortuosity syndrome, describing the operative findings and our surgical technique to address pulmonary arteries stenosis.
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33
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Beyens A, Boel A, Symoens S, Callewaert B. Cutis laxa: A comprehensive overview of clinical characteristics and pathophysiology. Clin Genet 2020; 99:53-66. [PMID: 33058140 DOI: 10.1111/cge.13865] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 12/20/2022]
Abstract
Cutis laxa (CL) syndromes comprise a rare group of multisystem disorders that share loose redundant skin folds as hallmark clinical feature. CL results from impaired elastic fiber assembly and homeostasis, and the known underlying gene defects affect different extracellular matrix proteins, intracellular trafficking, or cellular metabolism. Due to the underlying clinical and molecular heterogeneity, the diagnostic work-up of CL patients is often challenging. In this review, we provide a practical approach to the broad differential diagnosis of CL syndromes, provide an overview of the molecular pathogenesis of the different subtypes, and suggest general management guidelines.
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Affiliation(s)
- Aude Beyens
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Dermatology, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Annekatrien Boel
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Sofie Symoens
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
| | - Bert Callewaert
- Center for Medical Genetics Ghent, Ghent University Hospital, Ghent, Belgium.,Department of Biomolecular Medicine, Ghent University, Ghent, Belgium
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34
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Michel JB. Phylogenic Determinants of Cardiovascular Frailty, Focus on Hemodynamics and Arterial Smooth Muscle Cells. Physiol Rev 2020; 100:1779-1837. [DOI: 10.1152/physrev.00022.2019] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The evolution of the circulatory system from invertebrates to mammals has involved the passage from an open system to a closed in-parallel system via a closed in-series system, accompanying the increasing complexity and efficiency of life’s biological functions. The archaic heart enables pulsatile motion waves of hemolymph in invertebrates, and the in-series circulation in fish occurs with only an endothelium, whereas mural smooth muscle cells appear later. The present review focuses on evolution of the circulatory system. In particular, we address how and why this evolution took place from a closed, flowing, longitudinal conductance at low pressure to a flowing, highly pressurized and bifurcating arterial compartment. However, although arterial pressure was the latest acquired hemodynamic variable, the general teleonomy of the evolution of species is the differentiation of individual organ function, supported by specific fueling allowing and favoring partial metabolic autonomy. This was achieved via the establishment of an active contractile tone in resistance arteries, which permitted the regulation of blood supply to specific organ activities via its localized function-dependent inhibition (active vasodilation). The global resistance to viscous blood flow is the peripheral increase in frictional forces caused by the tonic change in arterial and arteriolar radius, which backscatter as systemic arterial blood pressure. Consequently, the arterial pressure gradient from circulating blood to the adventitial interstitium generates the unidirectional outward radial advective conductance of plasma solutes across the wall of conductance arteries. This hemodynamic evolution was accompanied by important changes in arterial wall structure, supported by smooth muscle cell functional plasticity, including contractility, matrix synthesis and proliferation, endocytosis and phagocytosis, etc. These adaptive phenotypic shifts are due to epigenetic regulation, mainly related to mechanotransduction. These paradigms actively participate in cardio-arterial pathologies such as atheroma, valve disease, heart failure, aneurysms, hypertension, and physiological aging.
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Abstract
Aortic aneurysms were the primary cause of nearly 10,000 deaths in 2014 according to data from the Centers for Disease Control and may involve segments of the thoracic or abdominal aorta. Thoracic aortic aneurysms and dissections are more commonly associated with an underlying genetic etiology. In the past several decades, in parallel with the burst of new genome sequencing technologies, a number of genetic aortopathies have been identified. These have provided important insights into the molecular mechanisms of aneurysmal disease, but pose challenges in clinical practice as there are limited consensus recommendations at this time. In this review, we aim to address the pathophysiology, clinical presentation, and treatment considerations in the key heritable thoracic aortopathies.
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Affiliation(s)
- Rohan Bhandari
- Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Rajani D Aatre
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Yogendra Kanthi
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA.,Cardiovascular Medicine, Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
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Rohde S, Zafar MA, Ziganshin BA, Elefteriades JA. Thoracic aortic aneurysm gene dictionary. Asian Cardiovasc Thorac Ann 2020; 29:682-696. [PMID: 32689806 DOI: 10.1177/0218492320943800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thoracic aortic aneurysm is typically clinically silent, with a natural history of progressive enlargement until a potentially lethal complication such as rupture or dissection occurs. Underlying genetic predisposition strongly influences the risk of thoracic aortic aneurysm and dissection. Familial cases are more virulent, have a higher rate of aneurysm growth, and occur earlier in life. To date, over 30 genes have been associated with syndromic and non-syndromic thoracic aortic aneurysm and dissection. The causative genes and their specific variants help to predict the disease phenotype, including age at presentation, risk of dissection at small aortic sizes, and risk of other cardiovascular and systemic manifestations. This genetic "dictionary" is already a clinical reality, allowing us to personalize care based on specific causative mutations for a substantial proportion of these patients. Widespread genetic sequencing of thoracic aortic aneurysm and dissection patients has been and continues to be crucial to the rapid expansion of this dictionary and ultimately, the delivery of truly personalized care to every patient.
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Affiliation(s)
- Stefanie Rohde
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.,Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA
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Rodríguez-Capitán J, Macías-Benítez M, Conejo-Muñoz L, Cordero-Aguilar A, López-Salguero R, Pérez-Villardón B. Arterial tortuosity syndrome: a late and unexpected diagnosis and description of a novel likely pathogenic mutation. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:504-506. [PMID: 31786173 DOI: 10.1016/j.rec.2019.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/28/2019] [Indexed: 06/10/2023]
Affiliation(s)
- Jorge Rodríguez-Capitán
- Unidad de Gestión Clínica Área del Corazón, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Universitario Virgen de la Victoria, Málaga, Spain; CIBERCV Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid, Spain.
| | | | - Lourdes Conejo-Muñoz
- Unidad de Cardiología Pediátrica, Unidad de Gestión Clínica de Pediatría-Cardiología, Hospital Materno-Infantil, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Antonio Cordero-Aguilar
- Servicio de Medicina Interna, Hospital Comarcal de Antequera, Área Sanitaria Norte de Málaga, Antequera, Málaga, Spain
| | - Raúl López-Salguero
- Servicio de Medicina Interna, Hospital Comarcal de Antequera, Área Sanitaria Norte de Málaga, Antequera, Málaga, Spain
| | - Beatriz Pérez-Villardón
- Servicio de Medicina Interna, Hospital Comarcal de la Axarquía, Área de Gestión Sanitaria Este Málaga-Axarquía, Vélez-Málaga, Málaga, Spain
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Rodríguez-Capitán J, Macías-Benítez M, Conejo-Muñoz L, Cordero-Aguilar A, López-Salguero R, Pérez-Villardón B. Síndrome de tortuosidad arterial: un diagnóstico tardío e inesperado y la descripción de una nueva mutación probablemente patogénica. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jiang CL, Jen WP, Tsao CY, Chang LC, Chen CH, Lee YC. Glucose transporter 10 modulates adipogenesis via an ascorbic acid-mediated pathway to protect mice against diet-induced metabolic dysregulation. PLoS Genet 2020; 16:e1008823. [PMID: 32453789 PMCID: PMC7274451 DOI: 10.1371/journal.pgen.1008823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 06/05/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
The development of type 2 diabetes mellitus (T2DM) depends on interactions between genetic and environmental factors, and a better understanding of gene-diet interactions in T2DM will be useful for disease prediction and prevention. Ascorbic acid has been proposed to reduce the risk of T2DM. However, the links between ascorbic acid and metabolic consequences are not fully understood. Here, we report that glucose transporter 10 (GLUT10) maintains intracellular levels of ascorbic acid to promote adipogenesis, white adipose tissue (WAT) development and protect mice from high-fat diet (HFD)-induced metabolic dysregulation. We found genetic polymorphisms in SLC2A10 locus are suggestively associated with a T2DM intermediate phenotype in non-diabetic Han Taiwanese. Additionally, mice carrying an orthologous human Glut10G128E variant (Glut10G128E mice) with compromised GLUT10 function have reduced adipogenesis, reduced WAT development and increased susceptibility to HFD-induced metabolic dysregulation. We further demonstrate that GLUT10 is highly expressed in preadipocytes, where it regulates intracellular ascorbic acid levels and adipogenesis. In this context, GLUT10 increases ascorbic acid-dependent DNA demethylation and the expression of key adipogenic genes, Cebpa and Pparg. Together, our data show GLUT10 regulates adipogenesis via ascorbic acid-dependent DNA demethylation to benefit proper WAT development and protect mice against HFD-induced metabolic dysregulation. Our findings suggest that SLC2A10 may be an important HFD-associated susceptibility locus for T2DM. Environmental triggers may amplify genetically determined disease susceptibility, especially for carriers of rare variants with relatively large individual effect sizes, making these polymorphisms highly informative for predicting individualized clinical risk and preventing disease. Since transitions in dietary pattern have greatly contributed to the increased prevalence of obesity and accelerated the spread of the T2DM epidemic worldwide, a better understanding of gene-diet interactions in T2DM will be useful for disease prediction and prevention. Here, we demonstrate that polymorphisms in the gene encoding GLUT10 are associated with a T2DM intermediate phenotype in non-diabetic human subjects. Additionally, mice that carry a GLUT10 rare variant have reduced WAT development and are susceptible for HFD-induced T2DM. We further demonstrate that GLUT10 is highly expressed in preadipocytes, where it regulates intracellular ascorbic acid levels and ascorbic acid-dependent DNA demethylation to control adipogenesis. Preadipocytes carrying the GLUT10 rare variant or with knockdown of GLUT10 expression have reduced the adipogenesis. Thus, we are able to conclude that GLUT10 regulates adipogenesis via ascorbic acid-dependent DNA demethylation to affect WAT development and contribute to the sensitivity of HFD-induced metabolic dysregulation.
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Affiliation(s)
- Chung-Lin Jiang
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Wei-Ping Jen
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Chang-Yu Tsao
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
| | - Li-Ching Chang
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chien-Hsiun Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yi-Ching Lee
- Institute of Cellular and Organismic Biology, Academia Sinica, Taipei, Taiwan
- * E-mail:
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40
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Warring SK, Castillo R, Klaas K, Taggart N, Fischer PR. Visual Diagnosis: A Case of Stretchy Skin and Vascular Abnormalities. Pediatr Rev 2020; 41:e16-e20. [PMID: 32358036 DOI: 10.1542/pir.2017-0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Kelsey Klaas
- Department of General Pediatric and Adolescent Medicine, and
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41
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The Genetics of Thoracic Aortic Aneurysms and Dissection: A Clinical Perspective. Biomolecules 2020; 10:biom10020182. [PMID: 31991693 PMCID: PMC7072177 DOI: 10.3390/biom10020182] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/14/2020] [Accepted: 01/16/2020] [Indexed: 12/13/2022] Open
Abstract
Thoracic aortic aneurysm and dissection (TAAD) affects many patients globally and has high mortality rates if undetected. Once thought to be solely a degenerative disease that afflicted the aorta due to high pressure and biomechanical stress, extensive investigation of the heritability and natural history of TAAD has shown a clear genetic basis for the disease. Here, we review both the cellular mechanisms and clinical manifestations of syndromic and non-syndromic TAAD. We particularly focus on genes that have been linked to dissection at diameters <5.0 cm, the current lower bound for surgical intervention. Genetic screening tests to identify patients with TAAD associated mutations that place them at high risk for dissection are also discussed.
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Faggion Vinholo T, Brownstein AJ, Ziganshin BA, Zafar MA, Kuivaniemi H, Body SC, Bale AE, Elefteriades JA. Genes Associated with Thoracic Aortic Aneurysm and Dissection: 2019 Update and Clinical Implications. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2019; 7:99-107. [PMID: 31842235 PMCID: PMC6914358 DOI: 10.1055/s-0039-3400233] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thoracic aortic aneurysm is a typically silent disease characterized by a lethal natural history. Since the discovery of the familial nature of thoracic aortic aneurysm and dissection (TAAD) almost 2 decades ago, our understanding of the genetics of this disorder has undergone a transformative amplification. To date, at least 37 TAAD-causing genes have been identified and an estimated 30% of the patients with familial nonsyndromic TAAD harbor a pathogenic mutation in one of these genes. In this review, we present our yearly update summarizing the genes associated with TAAD and the ensuing clinical implications for surgical intervention. Molecular genetics will continue to bolster this burgeoning catalog of culprit genes, enabling the provision of personalized aortic care.
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Affiliation(s)
- Thais Faggion Vinholo
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Adam J Brownstein
- Department of Medicine, Johns Hopkins Hospital and Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Bulat A Ziganshin
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.,Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
| | - Mohammad A Zafar
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
| | - Helena Kuivaniemi
- Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, and Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Simon C Body
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Allen E Bale
- Department of Genetics, Yale School of Medicine, New Haven, Connecticut
| | - John A Elefteriades
- Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
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Abstract
PURPOSE OF REVIEW To review the literature and provide a summary of management of syndromic and nonsyndromic aortopathies. RECENT FINDINGS The number of newly identified genetic causes for aortopathies have continued to increase over the past 10 years. The number of reported individuals with most hereditary aneurysm genes is small but increasing with more publications focusing describing the natural history caused by each gene. SUMMARY Aortopathy can present as an isolated finding or present as part of a larger genetic syndrome. Advances in genetic testing technology has shed light on the increasing importance of molecular diagnostics in the evaluation and management of patients with hereditary aortic disease. Molecular diagnostics and family phenotyping can aide in the diagnosis and management of pediatric patients with aortic disease.
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Affiliation(s)
| | - Rocio T Moran
- Division of Genetics and Genomics, The MetroHealth System, Cleveland, Ohio, USA
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Lizák B, Szarka A, Kim Y, Choi KS, Németh CE, Marcolongo P, Benedetti A, Bánhegyi G, Margittai É. Glucose Transport and Transporters in the Endomembranes. Int J Mol Sci 2019; 20:ijms20235898. [PMID: 31771288 PMCID: PMC6929180 DOI: 10.3390/ijms20235898] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/16/2019] [Accepted: 11/21/2019] [Indexed: 12/18/2022] Open
Abstract
Glucose is a basic nutrient in most of the creatures; its transport through biological membranes is an absolute requirement of life. This role is fulfilled by glucose transporters, mediating the transport of glucose by facilitated diffusion or by secondary active transport. GLUT (glucose transporter) or SLC2A (Solute carrier 2A) families represent the main glucose transporters in mammalian cells, originally described as plasma membrane transporters. Glucose transport through intracellular membranes has not been elucidated yet; however, glucose is formed in the lumen of various organelles. The glucose-6-phosphatase system catalyzing the last common step of gluconeogenesis and glycogenolysis generates glucose within the lumen of the endoplasmic reticulum. Posttranslational processing of the oligosaccharide moiety of glycoproteins also results in intraluminal glucose formation in the endoplasmic reticulum (ER) and Golgi. Autophagic degradation of polysaccharides, glycoproteins, and glycolipids leads to glucose accumulation in lysosomes. Despite the obvious necessity, the mechanism of glucose transport and the molecular nature of mediating proteins in the endomembranes have been hardly elucidated for the last few years. However, recent studies revealed the intracellular localization and functional features of some glucose transporters; the aim of the present paper was to summarize the collected knowledge.
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Affiliation(s)
- Beáta Lizák
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, 1094 Budapest, Hungary; (B.L.); (C.E.N.); (G.B.)
| | - András Szarka
- Laboratory of Biochemistry and Molecular Biology, Department of Applied Biotechnology and Food Science, Budapest University of Technology and Economics, 1111 Budapest, Hungary;
| | - Yejin Kim
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (Y.K.); (K.-s.C.)
| | - Kyu-sung Choi
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (Y.K.); (K.-s.C.)
| | - Csilla E. Németh
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, 1094 Budapest, Hungary; (B.L.); (C.E.N.); (G.B.)
| | - Paola Marcolongo
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (P.M.); (A.B.)
| | - Angelo Benedetti
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (P.M.); (A.B.)
| | - Gábor Bánhegyi
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, 1094 Budapest, Hungary; (B.L.); (C.E.N.); (G.B.)
| | - Éva Margittai
- Institute of Translational Medicine, Semmelweis University, 1094 Budapest, Hungary; (Y.K.); (K.-s.C.)
- Correspondence: ; Tel.: +36-459-1500 (ext. 60311); Fax: +36-1-2662615
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Moon I, Jin KN, Kim HL, Suh HJ, Lim WH, Seo JB, Kim SH, Zo JH, Kim MA. Association of arterial stiffness with aortic calcification and tortuosity. Medicine (Baltimore) 2019; 98:e16802. [PMID: 31415390 PMCID: PMC6831173 DOI: 10.1097/md.0000000000016802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ± 10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (β = 0.37, P < .001), hypertension (β = 0.19, P = .003), diabetes mellitus (β = 0.12, P = .045), smoking (β = 0.17, P = .016), and estimated glomerular filtration rate (β = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (β = 0.34, P < .001), body mass index (β = -0.19, P = .018), and diabetes mellitus (β = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.
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Affiliation(s)
| | - Kwang Nam Jin
- Department of Radiology, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
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Michel JB, Jondeau G, Milewicz DM. From genetics to response to injury: vascular smooth muscle cells in aneurysms and dissections of the ascending aorta. Cardiovasc Res 2019; 114:578-589. [PMID: 29360940 DOI: 10.1093/cvr/cvy006] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Abstract
Vascular smooth muscle cells (vSMCs) play a crucial role in both the pathogenesis of Aneurysms and Dissections of the ascending thoracic aorta (TAAD) in humans and in the associated adaptive compensatory responses, since thrombosis and inflammatory processes are absent in the majority of cases. Aneurysms and dissections share numerous characteristics, including aetiologies and histopathological alterations: vSMC disappearance, medial areas of mucoid degeneration, and extracellular matrix (ECM) breakdown. Three aetiologies predominate in TAAD in humans: (i) genetic causes in heritable familial forms, (ii) an association with bicuspid aortic valves, and (iii) a sporadic degenerative form linked to the aortic aging process. Genetic forms include mutations in vSMC genes encoding for molecules of the ECM or the TGF-β pathways, or participating in vSMC tone. On the other hand, aneurysms and dissections, whatever their aetiologies, are characterized by an increase in wall permeability leading to transmural advection of plasma proteins which could interact with vSMCs and ECM components. In this context, blood-borne plasminogen appears to play an important role, because its outward convection through the wall is increased in TAAD, and it could be converted to active plasmin at the vSMC membrane. Active plasmin can induce vSMC disappearance, proteolysis of adhesive proteins, activation of MMPs and release of TGF-β from its ECM storage sites. Conversely, vSMCs could respond to aneurysmal biomechanical and proteolytic injury by an epigenetic phenotypic switch, including constitutional overexpression and nuclear translocation of Smad2 and an increase in antiprotease and ECM protein synthesis. In contrast, such an epigenetic phenomenon is not observed in dissections. In this context, dysfunction of proteins involved in vSMC tone are interesting to study, particularly in interaction with plasma protein transport through the wall and TGF-β activation, to establish the relationship between these dysfunctions and ECM proteolysis.
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Affiliation(s)
- Jean-Baptiste Michel
- UMR 1148, Laboratory for Translational Vascular Science, Inserm and Paris 7- Denis Diderot University, Xavier Bichat Hospital, 75018 Paris, France
| | - Guillaume Jondeau
- UMR 1148, Laboratory for Translational Vascular Science, Inserm and Paris 7- Denis Diderot University, Xavier Bichat Hospital, 75018 Paris, France.,Cardiology Department, National Reference Center for Marfan Syndrome and Related Diseases, APHP Hopital Bichat, 75018 Paris
| | - Dianna M Milewicz
- Division of Medical Genetics, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA
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Ciurică S, Lopez-Sublet M, Loeys BL, Radhouani I, Natarajan N, Vikkula M, Maas AH, Adlam D, Persu A. Arterial Tortuosity. Hypertension 2019; 73:951-960. [DOI: 10.1161/hypertensionaha.118.11647] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Simina Ciurică
- From the Cardiology Department, Marie Curie Civil Hospital, CHU Charleroi, Lodelinsart, Belgium (S.C.)
| | - Marilucy Lopez-Sublet
- Department of Internal Medicine, ESH Hypertension Excellence Centre (M.L.-S.), CHU Avicenne, AP-HP, Bobigny, France
| | - Bart L. Loeys
- Cardiogenetics, Center for Medical Genetics, University of Antwerp/Antwerp University Hospital, Belgium (B.L.L.)
| | | | - Nalin Natarajan
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, United Kingdom (N.N., D.A.)
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute (M.V.), Université Catholique de Louvain, Brussels, Belgium
| | - Angela H.E.M. Maas
- Department of Cardiology, Radboud University Medical Center Nijmegen, The Netherlands (A.H.E.M.M.)
| | - David Adlam
- Department of Cardiovascular Sciences, University of Leicester and the NIHR Leicester Biomedical Research Centre, United Kingdom (N.N., D.A.)
| | - Alexandre Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium
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Krzyżewski RM, Kliś KM, Kwinta BM, Gackowska M, Gąsowski J. Increased tortuosity of ACA might be associated with increased risk of ACoA aneurysm development and less aneurysm dome size: a computer-aided analysis. Eur Radiol 2019; 29:6309-6318. [PMID: 30989348 PMCID: PMC6795631 DOI: 10.1007/s00330-019-06146-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/31/2019] [Accepted: 03/08/2019] [Indexed: 12/02/2022]
Abstract
Objectives We decided to perform computer-aided analysis of the anterior cerebral artery (ACA) to check for a potential correlation with anterior communicating artery (ACoA) aneurysm presence and growth. Methods We retrospectively analyzed the ACA anatomy of 121 patients with ACoA aneurysms along with 121 age, risk factors, and vessel side-matched control patients without an ACoA aneurysm. We obtained their medical history and digital subtraction angiography (DSA) data from their medical records. For each patient’s DSA, we extracted curve representing the course of their ACA and calculated its relative length (RL), sum of angle metrics (SOAM), triangular index (TI), product of angle distance (PAD), and inflection count metrics (ICM). Results Patients with ACoA aneurysm had significantly higher RL (0.64 ± 0.23 vs. 0.56 ± 0.22; p < 0.01), SOAM (0.27 ± 0.19 vs. 0.18 ± 0.15; p < 0.01), PAD (0.12 ± 0.13 vs. 0.09 ± 0.11; p = 0.02), and TI (0.57 ± 0.14 vs. 0.44 ± 0.15; p < 0.01). In multivariate logistic regression analysis, after adjustment for possible confounders, SOAM (OR, 1.34; 95% CI, 1.12–1.63; p < 0.01) and TI (OR, 1.84; 95% CI, 1.47–2.35; p < 0.01) remained independently associated with higher risk of ACoA aneurysm. Additionally, we found significant negative correlations between TI and aneurysm dome size (R = − 0.194; p = 0.047). Conclusions Increased tortuosity of ACA might increase the risk of ACoA aneurysm development and decrease the risk of aneurysm growth. Key Points • Anterior cerebral artery’s sum of angle metrics is associated with hypertension as well as with history of ischemic stroke and myocardial infarction. • Increased tortuosity of anterior cerebral artery might be associated with anterior communicating artery aneurysm development. • Tortuosity of anterior cerebral artery is negatively correlated with anterior communicating artery aneurysm dome size.
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Affiliation(s)
- Roger M Krzyżewski
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Botaniczna 3 Street, 31-503, Kraków, Poland. .,TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.
| | - Kornelia M Kliś
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland.,Faculty of Computer Science, Electronics and Telecommunications, AGH University of Science and Technology, Kraków, Poland
| | - Borys M Kwinta
- Department of Neurosurgery and Neurotraumatology, Jagiellonian University Medical College, Botaniczna 3 Street, 31-503, Kraków, Poland.,TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland
| | | | - Jerzy Gąsowski
- TENSOR- Team of NeuroSurgery-Oriented Research, Jagiellonian University Medical College, Kraków, Poland.,Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Kraków, Poland
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Decreased Nuclear Ascorbate Accumulation Accompanied with Altered Genomic Methylation Pattern in Fibroblasts from Arterial Tortuosity Syndrome Patients. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:8156592. [PMID: 30800210 PMCID: PMC6360052 DOI: 10.1155/2019/8156592] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
Ascorbate requiring Fe2+/2-oxoglutarate-dependent dioxygenases located in the nucleoplasm have been shown to participate in epigenetic regulation of gene expression via histone and DNA demethylation. Transport of dehydroascorbic acid is impaired in the endomembranes of fibroblasts from arterial tortuosity syndrome (ATS) patients, due to the mutation in the gene coding for glucose transporter GLUT10. We hypothesized that altered nuclear ascorbate concentration might be present in ATS fibroblasts, affecting dioxygenase activity and DNA demethylation. Therefore, our aim was to characterize the subcellular distribution of vitamin C, the global and site-specific changes in 5-methylcytosine and 5-hydroxymethylcytosine levels, and the effect of ascorbate supplementation in control and ATS fibroblast cultures. Diminished nuclear accumulation of ascorbate was found in ATS fibroblasts upon ascorbate or dehydroascorbic acid addition. Analyzing DNA samples of cultured fibroblasts from controls and ATS patients, a lower global 5-hydroxymethylcytosine level was found in ATS fibroblasts, which could not be significantly modified by ascorbate addition. Investigation of the (hydroxy)methylation status of specific regions in six candidate genes related to ascorbate metabolism and function showed that ascorbate addition could stimulate hydroxymethylation and active DNA demethylation at the PPAR-γ gene region in control fibroblasts only. The altered DNA hydroxymethylation patterns in patient cells both at the global level and at specific gene regions accompanied with decreased nuclear accumulation of ascorbate suggests the epigenetic role of vitamin C in the pathomechanism of ATS. The present findings represent the first example for the role of vitamin C transport in epigenetic regulation suggesting that ATS is a compartmentalization disease.
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Abstract
Arterial tortuosity syndrome (ATS) is a rare autosomal recessive disorder caused by mutations in the solute carrier family 2 member 10 (SLC2A10) gene encoding a glucose/ascorbic acid transporter. The clinical features of ATS are mild-to-severe tortuosity of the large and medium arteries throughout the body, accompanied by dysmorphisms and joint laxity. Vascular changes in different parts of the body lead to stenosis and/or aneurysms requiring difficult surgical procedures. Here we present two new patients with ATS from two unrelated families. Patient 1 presented at 10 years of age with headache and typical physical appearance, delicate skeleton, large visible pulsation of the carotid arteries in the neck, and joint laxity. On computed tomography (CT) angiography she had severe tortuosity of the aortal branches and cerebral arteries, but no significant tortuosity of the pulmonary arteries. Two cousins of the girl carried the same homozygous c.254T>C, p.(Leu85Pro) mutation in SLC2A10, however, they additionally had a severe involvement of the pulmonary vessels. Patient 2 was a 9-year-old girl diagnosed with severe tortuosity and stenosis of the pulmonary arteries and progressive myocardiopathy. Her physical appearance was very similar to Patient 1, except that she also had growth retardation. After long-term follow-up by cardiologists, she underwent cardiac surgery abroad, with an unfavorable outcome. Homozygosity for the c.685C>T, p.(Arg229*) mutation in the SLC2A10 gene was detected. Consanguinity was disclosed within both families. Our findings confirm the intrafamilial phenotype variability of ATS. A novel finding is the severe tortuosity of cerebral arteries causing migraine that has not been described before in a child with ATS.
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