1
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Syx D, Malfait F. Pathogenic mechanisms in genetically defined Ehlers-Danlos syndromes. Trends Mol Med 2024; 30:824-843. [PMID: 39147618 DOI: 10.1016/j.molmed.2024.06.001] [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: 02/14/2024] [Revised: 05/31/2024] [Accepted: 06/03/2024] [Indexed: 08/17/2024]
Abstract
The Ehlers-Danlos syndromes (EDS) are a group of rare heritable connective tissue disorders, common hallmarks of which are skin hyperextensibility, joint hypermobility, and generalized connective tissue fragility. Currently, 13 EDS types are recognized, caused by defects in 20 genes which consequently alter biosynthesis, organization, and/or supramolecular assembly of collagen fibrils in the extracellular matrix (ECM). Molecular analyses on patient samples (mostly dermal fibroblast cultures), combined with studies on animal models, have highlighted that part of EDS pathogenesis can be attributed to impaired cellular dynamics. Although our understanding of the full extent of (extra)cellular consequences is still limited, this narrative review aims to provide a comprehensive overview of our current knowledge on the extracellular, pericellular, and intracellular alterations implicated in EDS pathogenesis.
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Affiliation(s)
- Delfien Syx
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium; Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Fransiska Malfait
- Department of Biomolecular Medicine, Ghent University, Ghent, Belgium; Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
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2
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Virginia F, Giuseppe F, Carlotta L, Andrea C, Daniele M, Silvia P. Is Ehlers-Danlos Syndrome a Neglected Cause of Nosebleeds? EAR, NOSE & THROAT JOURNAL 2024:1455613241246832. [PMID: 38590201 DOI: 10.1177/01455613241246832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Fancello Virginia
- ENT and Audiology Clinic, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Fancello Giuseppe
- Department of Otology and Skull Base Surgery, Gruppo Otologico, Piacenza, Italy
| | - Liberale Carlotta
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Ciorba Andrea
- ENT and Audiology Clinic, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Ferrara, Italy
| | - Monzani Daniele
- Unit of Otorhinolaryngology, Head and Neck Department, University of Verona, Verona, Italy
| | - Palma Silvia
- Otolaryngology and Audiology Unit, University of Modena and Reggio Emilia, Modena, Italy
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Intarak N, Manaspon C, Theerapanon T, Prommanee S, Samaranayake L, Shotelersuk V, Porntaveetus T. Tooth agenesis related to a novel KDF1 variant: A case report and literature review. Oral Dis 2024. [PMID: 38501196 DOI: 10.1111/odi.14930] [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: 01/06/2024] [Revised: 02/19/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
OBJECTIVES To investigate the role of Keratinocyte Differentiation Factor 1 (KDF1) in ectodermal dysplasia (ED) and nonsyndromic tooth agenesis (NSTA) and perform a literature review. METHODS Genome sequencing was used to identify genetic variants in a Thai, NSTA proband and validated through Sanger sequencing. Pathogenicity was assessed using ACMG guidelines, MetaRNN and AlphaMissense. A comprehensive review of KDF1/NSTA cases informed genotype-phenotype analysis of the proband. RESULTS The proband revealed multiple missing teeth, caries and extensive periodontal disease. Deep phenotyping showed no signs of ED beyond tooth agenesis. The identified novel KDF1 variant, p.Ile243Leu, was classified as 'likely pathogenic' by ACMG and predicted as 'detrimental' by MetaRNN and AlphaMissense analyses. A total of 14 reviewed KDF1 cases revealed ED-associated variants (3 variants in 8 patients) clustering in the region of amino acids 251-275, within the DUF4656 domain, while NSTA-causing variants (4 variants in 6 patients) were typically found in amino- or carboxy-termini to this region. KDF1/NSTA cases exhibited an average of 15 missing teeth, with a higher prevalence in the mandible. CONCLUSION This study identifies a novel KDF1 variant-related NSTA in Thai people. The genotype-phenotype correlates suggest a distinctive pattern and tooth agenesis of KDF1-related NSTA.
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Affiliation(s)
- Narin Intarak
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Chawan Manaspon
- Biomedical Engineering Institute, Chiang Mai University, Chiang Mai, Thailand
- Biomedical Engineering and Innovation Research Center, Chiang Mai, Thailand
| | - Thanakorn Theerapanon
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Sasiprapa Prommanee
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Lakshman Samaranayake
- Faculty of Dentistry, University of Hong Kong, Hong Kong and Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Vorasuk Shotelersuk
- Center of Excellence for Medical Genomics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Medical Genetics, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Thantrira Porntaveetus
- Center of Excellence in Genomics and Precision Dentistry, Department of Physiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
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4
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Angwin C, Zschocke J, Kammin T, Björck E, Bowen J, Brady AF, Burns H, Cummings C, Gardner R, Ghali N, Gröbner R, Harris J, Higgins M, Johnson D, Lepperdinger U, Milnes D, Pope FM, Sehra R, Kapferer-Seebacher I, Sobey G, Van Dijk FS. Non-oral manifestations in adults with a clinical and molecularly confirmed diagnosis of periodontal Ehlers-Danlos syndrome. Front Genet 2023; 14:1136339. [PMID: 37323685 PMCID: PMC10264792 DOI: 10.3389/fgene.2023.1136339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/03/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction: Periodontal Ehlers-Danlos Syndrome (pEDS) is a rare autosomal dominant type of EDS characterised by severe early-onset periodontitis, lack of attached gingiva, pretibial plaques, joint hypermobility and skin hyperextensibility as per the 2017 International EDS Classification. In 2016, deleterious pathogenic heterozygous variants were identified in C1R and C1S, which encode components of the complement system. Materials and Methods: Individuals with a clinical suspicion of pEDS were clinically and molecularly assessed through the National EDS Service in London and Sheffield and in genetic services in Austria, Sweden and Australia. Transmission electron microscopy and fibroblast studies were performed in a small subset of patients. Results: A total of 21 adults from 12 families were clinically and molecularly diagnosed with pEDS, with C1R variants in all families. The age at molecular diagnosis ranged from 21-73 years (mean 45 years), male: female ratio 5:16. Features of easy bruising (90%), pretibial plaques (81%), skin fragility (71%), joint hypermobility (24%) and vocal changes (38%) were identified as well as leukodystrophy in 89% of those imaged. Discussion: This cohort highlights the clinical features of pEDS in adults and contributes several important additional clinical features as well as novel deleterious variants to current knowledge. Hypothetical pathogenic mechanisms which may help to progress understanding and management of pEDS are also discussed.
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Affiliation(s)
- C. Angwin
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - J. Zschocke
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - T. Kammin
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - E. Björck
- Clinical Genetics, Karolinska University Hospital, Solna, Sweden
| | - J. Bowen
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - A. F. Brady
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - H. Burns
- Department Otolaryngology Head and Neck Surgery, Children’s Health QLD, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - C. Cummings
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - R. Gardner
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - N. Ghali
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
| | - R. Gröbner
- Institute of Human Genetics, Medical University Innsbruck, Innsbruck, Austria
| | - J. Harris
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - M. Higgins
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - D. Johnson
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - U. Lepperdinger
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - D. Milnes
- Clinical Genetics, Genetic Health Queensland, Brisbane, QLD, Australia
| | - F. M. Pope
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Dermatology, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - R. Sehra
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
| | - I. Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - G. Sobey
- National EDS Diagnostic Service, Sheffield Children’s NHS Foundation Trust, Sheffield, United Kingdom
| | - F. S. Van Dijk
- National EDS Service, London North West University Healthcare NHS Trust, London, United Kingdom
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, United Kingdom
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Nakajima K, Suzuki H, Yamamoto M, Yamamoto T, Kawai T, Nakabayashi K, Hata K, Kosaki K, Nakajima H, Sano S, Kubo A. A familial case of periodontal Ehlers-Danlos syndrome lacking skin extensibility and joint hypermobility with a missense mutation in C1R. J Dermatol 2022; 49:714-718. [PMID: 35365885 DOI: 10.1111/1346-8138.16372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 02/09/2022] [Accepted: 03/03/2022] [Indexed: 12/26/2022]
Abstract
Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder first described by Stewart in 1977 that is characterized by severe gingival recession and periodontitis that triggers premature loss of permanent teeth and alveolar bone absorption. It was recently shown that pEDS is caused by a heterozygous missense mutation in C1R or C1S, which encode complement 1 proteases. Here, we report a familial case of pEDS with a novel heterozygous missense mutation, c.674G>C (p.R225P), in C1R (NM_001733.4). The case exhibited pretibial hyperpigmentation and extended periodontitis but neither skin extensibility nor joint hypermobility, suggesting that this mutation will expand the definition of pEDS.
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Affiliation(s)
- Kimiko Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Hisato Suzuki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Mayuko Yamamoto
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tetsuya Yamamoto
- Department of Oral and Maxillofacial Surgery, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tomoko Kawai
- Department of Maternal-Fetal Biology, National Reseasch Institute for Child Health and Development, Tokyo, Japan
| | - Kazuhiko Nakabayashi
- Department of Maternal-Fetal Biology, National Reseasch Institute for Child Health and Development, Tokyo, Japan
| | - Kenichiro Hata
- Department of Maternal-Fetal Biology, National Reseasch Institute for Child Health and Development, Tokyo, Japan
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Nakajima
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Shigetoshi Sano
- Department of Dermatology, Kochi Medical School, Kochi University, Kochi, Japan
| | - Akiharu Kubo
- Division of Dermatology, Department of Internal Related, Kobe University Graduate School of Medicine, Kobe, Japan.,Department of Dermatology, Keio University School of Medicine, Tokyo, Japan
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C1r Upregulates Production of Matrix Metalloproteinase-13 and Promotes Invasion of Cutaneous Squamous Cell Carcinoma. J Invest Dermatol 2021; 142:1478-1488.e9. [PMID: 34756877 DOI: 10.1016/j.jid.2021.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 12/14/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the most common metastatic skin cancer with increasing incidence worldwide. Previous studies have demonstrated the role of complement system in cSCC progression. In this study we have investigated the mechanistic role of serine protease C1r, a component of the classical pathway of complement system, in cSCC. Knockout of C1r in cSCC cells using CRISPR/Cas9 resulted in significant decrease in their proliferation, migration, and invasion through collagen type I compared to wild type cSCC cells. Knockout of C1r suppressed growth and vascularization of cSCC xenograft tumors, and promoted apoptosis of tumor cells in vivo. mRNA-seq analysis after C1r knockdown revealed significantly regulated GO terms Cell-matrix adhesion, Extracellular matrix component, Basement membrane, Metalloendopeptidase activity and KEGG pathway Extracellular matrix-receptor interaction. Among the significantly regulated genes were invasion-associated matrix metalloproteinases MMP1, MMP13, MMP10, and MMP12. Knockout of C1r resulted in decreased production of MMP-1, MMP-13, MMP-10, and MMP-12 by cSCC cells in culture. Knockout of C1r inhibited expression of MMP-13 by tumor cells, suppressed invasion, and reduced the amount of degraded collagen in vivo in xenografts. These results provide evidence for the role of C1r in promoting the invasion of cSCC cells by increasing MMP production.
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7
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Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RA. Hypermobile Ehlers-Danlos syndromes: Complex phenotypes, challenging diagnoses, and poorly understood causes. Dev Dyn 2021; 250:318-344. [PMID: 32629534 PMCID: PMC7785693 DOI: 10.1002/dvdy.220] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/24/2020] [Accepted: 06/28/2020] [Indexed: 12/14/2022] Open
Abstract
The Ehlers-Danlos syndromes (EDS) are a group of heritable, connective tissue disorders characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. There is phenotypic and genetic variation among the 13 subtypes. The initial genetic findings on EDS were related to alterations in fibrillar collagen, but the elucidation of the molecular basis of many of the subtypes revealed several genes not involved in collagen biosynthesis or structure. However, the genetic basis of the hypermobile type of EDS (hEDS) is still unknown. hEDS is the most common type of EDS and involves generalized joint hypermobility, musculoskeletal manifestations, and mild skin involvement along with the presence of several comorbid conditions. Variability in the spectrum and severity of symptoms and progression of patient phenotype likely depend on age, gender, lifestyle, and expression domains of the EDS genes during development and postnatal life. In this review, we summarize the current molecular, genetic, epidemiologic, and pathogenetic findings related to EDS with a focus on the hypermobile type.
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Affiliation(s)
- Cortney Gensemer
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Randall Burks
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
| | - Steven Kautz
- Department of Health Sciences and Research, Medical University of South Carolina, Charleston, South Carolina
| | - Daniel P. Judge
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Mark Lavallee
- Department of Family Medicine, Wellspan Health, York, Pennsylvania
| | - Russell A. Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, South Carolina
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Nakamura T, Yamashita M, Ikegami K, Suzuki M, Yanagita M, Kitagaki J, Kitamura M, Murakami S. Autophagy facilitates type I collagen synthesis in periodontal ligament cells. Sci Rep 2021; 11:1291. [PMID: 33446772 PMCID: PMC7809284 DOI: 10.1038/s41598-020-80275-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 12/18/2020] [Indexed: 12/12/2022] Open
Abstract
Autophagy is a lysosomal protein degradation system in which the cell self-digests its intracellular protein components and organelles. Defects in autophagy contribute to the pathogenesis of age-related chronic diseases, such as myocardial infarction and rheumatoid arthritis, through defects in the extracellular matrix (ECM). However, little is known about autophagy in periodontal diseases characterised by the breakdown of periodontal tissue. Tooth-supportive periodontal ligament (PDL) tissue contains PDL cells that produce various ECM proteins such as collagen to maintain homeostasis in periodontal tissue. In this study, we aimed to clarify the physiological role of autophagy in periodontal tissue. We found that autophagy regulated type I collagen synthesis by elimination of misfolded proteins in human PDL (HPDL) cells. Inhibition of autophagy by E-64d and pepstatin A (PSA) or siATG5 treatment suppressed collagen production in HPDL cells at mRNA and protein levels. Immunoelectron microscopy revealed collagen fragments in autolysosomes. Accumulation of misfolded collagen in HPDL cells was confirmed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis. E-64d and PSA treatment suppressed and rapamycin treatment accelerated the hard tissue-forming ability of HPDL cells. Our findings suggest that autophagy is a crucial regulatory process that facilitates type I collagen synthesis and partly regulates osteoblastic differentiation of PDL cells.
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Affiliation(s)
- Tomomi Nakamura
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Motozo Yamashita
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Kuniko Ikegami
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Mio Suzuki
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Manabu Yanagita
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jirouta Kitagaki
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masahiro Kitamura
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shinya Murakami
- Department of Periodontology, Graduate School of Dentistry, Osaka University, 1-8, Yamadaoka, Suita, Osaka, 565-0871, Japan
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Wang W, Liu Q, Wang Y, Piao H, Li B, Zhu Z, Li D, Wang T, Xu R, Liu K. Verification of hub genes in the expression profile of aortic dissection. PLoS One 2019; 14:e0224922. [PMID: 31751374 PMCID: PMC6872142 DOI: 10.1371/journal.pone.0224922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 10/24/2019] [Indexed: 12/29/2022] Open
Abstract
Background To assess the mRNA expression profile and explore the hub mRNAs and potential molecular mechanisms in the pathogenesis of human thoracic aortic dissection (TAD). Methodology mRNA microarray expression signatures of TAD tissues (n = 6) and non-TAD tissues (NT; n = 6) were analyzed by an Arraystar human mRNA microarray. Real-time PCR (qRT-PCR) was used to validate the results of the mRNA microarray. Bioinformatic tools, including Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analysis, were utilized. Protein-protein interaction (PPI) networks were constructed based on data from the STRING database. Molecular Complex Detection (MCODE) and cytoHubba analyses were used to predict the strongest hub gene and pathway. Results The top 10 hub genes were CDK1, CDC20, CCNB2, CCNB1, MAD2L1, AURKA, C3AR1, NCAPG, CXCL12 and ASPM, which were identified from the PPI network. Module analysis revealed that TAD was associated with the cell cycle, oocyte meiosis, the p53 signaling pathway, and progesterone-mediated oocyte maturation. The qRT-PCR results showed that the expression of all hub genes was significantly increased in TAD samples (p < 0.05). Immunostaining of Ki-67 and CDK1 showed a high proliferation state and high expression in TAD, respectively. Conclusions CDK1 could be used as a potential diagnostic biomarker and therapeutic target of TAD.
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Affiliation(s)
- Weitie Wang
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Qing Liu
- Graduate School of Medicine and Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yong Wang
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Hulin Piao
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bo Li
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Zhicheng Zhu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Dan Li
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Tiance Wang
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Rihao Xu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
| | - Kexiang Liu
- Department of Cardiovascular Surgery, Second Hospital of Jilin University, Changchun, Jilin, China
- * E-mail:
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10
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Wu J, Yang J, Zhao J, Wu J, Zhang X, Leung WK, Sun W. A Chinese family with periodontal Ehlers-Danlos syndrome associated with missense mutation in the C1R gene. J Clin Periodontol 2019; 45:1311-1318. [PMID: 30025171 DOI: 10.1111/jcpe.12988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 12/14/2022]
Abstract
AIM We report a rare case of the periodontal Ehlers-Danlos syndrome (pEDS) associated with severe periodontitis and tooth loss in a Chinese family. MATERIAL AND METHODS The proband complained of gingival bleeding and mobility, which were also reported in his mother, and maternal uncle and his maternal grandmother and great-grandfather in the past. All family members underwent oral, physical, dermatological, and genetic examinations. RESULTS Oral manifestation of family members affected with pEDS presented severe periodontitis with multiple or total tooth loss. The proband displayed unique clinical manifestations including a characteristic facial appearance and thin, translucent skin with easily visible venous patterns on feet. Whole-exome sequencing identified missense mutation c.265T>C in C1R in all affected family members tested and frameshift mutation c.1322delG in COL3A1 in the proband alone. None of the unaffected members showed any marked oral, physical, dermatological, or genetic findings. CONCLUSION We reported an extremely rare case of pEDS with a missense mutation in C1R in a Chinese family, with coexistence C1R and COL3A1 mutations in the proband who was suspected to suffer from vascular EDS as well. To our knowledge, this is the first case of coexistence of two forms of EDS in a single individual.
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Affiliation(s)
- Juan Wu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Yang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jie Zhao
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingrong Wu
- Department of Pathology, Nanjing Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Xuan Zhang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wai Keung Leung
- Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Weibin Sun
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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11
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Seo GH, Kim YM, Ghang B, Kim GH, Lee BH. Ehlers-Danlos syndrome VIII with novel C1R variant accompanying white matter changes. ACTA ACUST UNITED AC 2019. [DOI: 10.5734/jgm.2019.16.1.43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Go Hun Seo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon-Myung Kim
- Department of Pediatrics, Jeju National University School of Medicine, Jeju, Korea
| | - Byeongzu Ghang
- Department of Rheumatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gu-Hwan Kim
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Beom Hee Lee
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Medical Genetics Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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12
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George SMC, Vandersteen A, Nigar E, Ferguson DJP, Topham EJ, Pope FM. Two patients with Ehlers-Danlos syndrome type VIII with unexpected hoarseness. Clin Exp Dermatol 2018; 41:771-4. [PMID: 27663155 DOI: 10.1111/ced.12911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2015] [Indexed: 11/30/2022]
Abstract
Ehlers-Danlos syndrome (EDS) encompasses a genetically and clinically heterogeneous group of connective tissue disorders, characterized by joint hypermobility, skin hyperextensibility and tissue fragility. It is a rare condition, and inheritance is either autosomal dominant or recessive. Previously grouped into 11 different subtypes, with increasing knowledge of the underlying molecular defects, it was reclassified in 1997 into 6 major groups, with type VIII excluded from this classification. Type VIII EDS is a very rare subtype, characterized by severe, early-onset periodontitis, skin fragility and abnormal scarring. Voice abnormalities have occasionally been described in other forms of the condition, and may be due to defects in the collagen of the vocal ligament. We report two cases of patients with EDS type VIII and hoarseness.
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Affiliation(s)
- S M C George
- Department of Dermatology, Eastbourne District General Hospital, Eastbourne, UK.
| | - A Vandersteen
- Maritime Medical Genetics Service, Halifax, NS, Canada
| | - E Nigar
- Department of Cellular Pathology, North West London Hospitals NHS Trust, Harrow, UK
| | - D J P Ferguson
- Nuffield Department of Clinical Laboratory Science, Oxford University, John Radcliffe Hospital, Oxford, UK
| | - E J Topham
- Department of Dermatology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - F M Pope
- North West Thames Regional Genetics Centre, North West London Hospitals NHS Trust, Harrow, UK
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Brady AF, Demirdas S, Fournel-Gigleux S, Ghali N, Giunta C, Kapferer-Seebacher I, Kosho T, Mendoza-Londono R, Pope MF, Rohrbach M, Van Damme T, Vandersteen A, van Mourik C, Voermans N, Zschocke J, Malfait F. The Ehlers-Danlos syndromes, rare types. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:70-115. [PMID: 28306225 DOI: 10.1002/ajmg.c.31550] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The Ehlers-Danlos syndromes comprise a clinically and genetically heterogeneous group of heritable connective tissue disorders, which are characterized by joint hypermobility, skin hyperextensibility, and tissue friability. In the Villefranche Nosology, six subtypes were recognized: The classical, hypermobile, vascular, kyphoscoliotic, arthrochalasis, and dermatosparaxis subtypes of EDS. Except for the hypermobile subtype, defects had been identified in fibrillar collagens or in collagen-modifying enzymes. Since 1997, a whole spectrum of novel, clinically overlapping, rare EDS-variants have been delineated and genetic defects have been identified in an array of other extracellular matrix genes. Advances in molecular testing have made it possible to now identify the causative mutation for many patients presenting these phenotypes. The aim of this literature review is to summarize the current knowledge on the rare EDS subtypes and highlight areas for future research. © 2017 Wiley Periodicals, Inc.
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[Ehlers-Danlos syndromes]. Ann Dermatol Venereol 2017; 144:744-758. [PMID: 29032848 DOI: 10.1016/j.annder.2017.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 02/27/2017] [Accepted: 06/12/2017] [Indexed: 11/22/2022]
Abstract
Ehlers-Danlos syndromes (EDS) are a heterogeneous group of inheritable connective tissue disorders characterized by skin hyperextensibility, joint hypermobility and cutaneous fragility with delayed wound healing. Over and above these common features, they differ in the presence or absence of various organ and tissue abnormalities, and differences in genetic causal mechanisms and degree of severity. They are complex and multisystem diseases, with the majority being highly disabling because of major joint problems and neurosensory deficiencies, and in some cases, they may be life-threatening due to associated complications, especially vascular disorders. In 1997, the Villefranche classification defined 6 subtypes of EDS. However, many other new variants have been described over the last years. The "historical" EDS were characterized by abnormalities in fibrillar collagen protein synthesis. More recently, disorders of synthesis and organization of the extracellular matrix have been shown to be responsible for other types of EDS. Thus, many EDS are in fact metabolic diseases related to enzymatic defects. While there is no curative treatment for any type of EDS, early diagnosis is of utmost importance in order to optimize the symptomatic management of patients and to prevent avoidable complications. Patients must be treated and monitored by multidisciplinary teams in highly specialized reference centers. In this article, we present the current state of knowledge on these diseases that continue to be elucidated thanks to new molecular genetic techniques.
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Kapferer-Seebacher I, Lundberg P, Malfait F, Zschocke J. Periodontal manifestations of Ehlers-Danlos syndromes: A systematic review. J Clin Periodontol 2017; 44:1088-1100. [PMID: 28836281 DOI: 10.1111/jcpe.12807] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2017] [Indexed: 11/26/2022]
Abstract
AIM Ehlers-Danlos syndromes (EDS) are a group of inherited connective tissue disorders, characterized by joint hypermobility, skin hyperextensibility, and tissue fragility. Periodontal EDS (pEDS) is a specific EDS subtype caused by heterozygous mutations in complement 1 subunit genes C1R and C1S, with early severe periodontitis as predominant clinical feature. We aimed to systematically assess the spectrum of periodontal abnormalities in all EDS subtypes. MATERIALS AND METHODS An electronic and manual search was conducted in three databases (Medline, LIVIVO, CENTRAL). Publications of all study designs written in English/German without date restriction evaluating periodontal features in EDS were included. RESULTS Thirty articles on pEDS and thirteen articles on other EDS subtypes were analysed. In pEDS, early severe periodontitis (98.4%) and gingival recession (87.1%) are the predominant features. Reports on periodontal manifestations in other EDS subtypes are rare. Described were severe gingival enlargement in dermatosparaxis EDS, and localized periodontal breakdown related to teeth with shortened roots in classical EDS (n = 3, respectively). CONCLUSION Early severe periodontitis is the hallmark of pEDS; there is no evidence that it is part of the clinical phenotype of other EDS subtypes. Stringent analyses of periodontal manifestations in most EDS subtypes are missing. Prospero registration number CRD42017056889.
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Affiliation(s)
- Ines Kapferer-Seebacher
- Department of Operative and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Pernilla Lundberg
- Department of Molecular Periodontology, Umeå University, Umeå, Sweden
| | - Franziska Malfait
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Johannes Zschocke
- Division of Human Genetics, Medical University of Innsbruck, Innsbruck, Austria
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Mitakides J, Tinkle BT. Oral and mandibular manifestations in the Ehlers-Danlos syndromes. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2017; 175:220-225. [PMID: 28192626 DOI: 10.1002/ajmg.c.31541] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) are hereditary disorders that affect the connective tissue and collagen structures in the body. Several types of EDS have been identified. Oral and mandibular structures, which include oral soft tissue, dentition, facial and head pain, and the functioning of the temporomandibular joint (TMJ), are variably affected in the various types of EDS. These various manifestations of EDS have been noted for many years, but newer diagnostic techniques and studies are shedding additional light on the challenges faced by EDS patients in the area of oral and mandibular disorders. Further, the impact of temporomandibular disorder (TMD) on musculoskeletal dysfunction and vice versa, make this an important feature to recognize. Oral and mandibular hypermobility of the TMJ with associated consequences of EDS are noted. These features, diagnostic parameters and treatment procedures are presented. © 2017 Wiley Periodicals, Inc.
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Periodontal Ehlers-Danlos Syndrome Is Caused by Mutations in C1R and C1S, which Encode Subcomponents C1r and C1s of Complement. Am J Hum Genet 2016; 99:1005-1014. [PMID: 27745832 PMCID: PMC5097948 DOI: 10.1016/j.ajhg.2016.08.019] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/26/2016] [Indexed: 12/31/2022] Open
Abstract
Periodontal Ehlers-Danlos syndrome (pEDS) is an autosomal-dominant disorder characterized by early-onset periodontitis leading to premature loss of teeth, joint hypermobility, and mild skin findings. A locus was mapped to an approximately 5.8 Mb region at 12p13.1 but no candidate gene was identified. In an international consortium we recruited 19 independent families comprising 107 individuals with pEDS to identify the locus, characterize the clinical details in those with defined genetic causes, and try to understand the physiological basis of the condition. In 17 of these families, we identified heterozygous missense or in-frame insertion/deletion mutations in C1R (15 families) or C1S (2 families), contiguous genes in the mapped locus that encode subunits C1r and C1s of the first component of the classical complement pathway. These two proteins form a heterotetramer that then combines with six C1q subunits. Pathogenic variants involve the subunit interfaces or inter-domain hinges of C1r and C1s and are associated with intracellular retention and mild endoplasmic reticulum enlargement. Clinical features of affected individuals in these families include rapidly progressing periodontitis with onset in the teens or childhood, a previously unrecognized lack of attached gingiva, pretibial hyperpigmentation, skin and vascular fragility, easy bruising, and variable musculoskeletal symptoms. Our findings open a connection between the inflammatory classical complement pathway and connective tissue homeostasis.
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Zhang L, Yu C, Chang Q, Luo X, Qiu J, Liu S. Comparison of gene expression profiles in aortic dissection and normal human aortic tissues. Biomed Rep 2016; 5:421-427. [PMID: 27699008 PMCID: PMC5038499 DOI: 10.3892/br.2016.740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/06/2016] [Indexed: 12/22/2022] Open
Abstract
The aim of the present study was to compare the gene expression profiles in aortic dissection (AD) and healthy human aortic tissue samples by DNA microarray analysis in order to screen the differential genes. In total, five AD and four healthy aortic specimens were selected; the total RNA was extracted and reverse transcribed into cDNA and in vitro transcribed into aRNA, followed by microarray hybridization for analysis. Thereafter, the transcription levels of six differential genes, myosin light chain kinase (MYLK), polycystin 1, transient receptor potential channel interacting (PKD-1), myosin heavy chain 11 (MYH11), superoxide dismutase 3, extracellular (SOD3), filamin A (FLNA), and transgelin (TAGLN), screened from the expression profiles were quantitatively verified. Compared with the healthy aortic specimens, a total of 1,661 genes in the AD group demonstrated more than 2-fold differential expression, of which 997 genes were upregulated and 664 genes were downregulated. Thereafter, six AD-associated genes that showed downregulation in the microarray assay were selected for quantitatively verifying the gene transcription level using reverse transcription-quantitative polymerase chain reaction (RT-qPCR), which confirmed their downregulation compared with the healthy aortic tissue genes; of the six genes, the expression levels of MYLK, PKD-1, MYH11, SOD3 and TAGLN were significantly downregulated (P<0.05), while the expression of FLNA was not significantly downregulated (P>0.05). Thus, whole genome microarray may be used to screen differentially expressed genes between AD and healthy aortic tissues. When used in combination with RT-qPCR validation, this method may provide novel strategies for investigating AD.
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Affiliation(s)
- Liang Zhang
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
| | - Cuntao Yu
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
| | - Qian Chang
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
| | - Xinjin Luo
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
| | - Juntao Qiu
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
| | - Shen Liu
- State Key Laboratory of Cardiovascular Disease, Aortic Surgery Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100037, P.R. China
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Colombi M, Dordoni C, Chiarelli N, Ritelli M. Differential diagnosis and diagnostic flow chart of joint hypermobility syndrome/ehlers-danlos syndrome hypermobility type compared to other heritable connective tissue disorders. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2015; 169C:6-22. [DOI: 10.1002/ajmg.c.31429] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022]
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Verrotti A, Monacelli D, Castagnino M, Villa MP, Parisi P. Ehlers-Danlos syndrome: a cause of epilepsy and periventricular heterotopia. Seizure 2014; 23:819-24. [PMID: 25131162 DOI: 10.1016/j.seizure.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 07/20/2014] [Accepted: 07/23/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Ehlers-Danlos syndrome (EDS) comprises a variety of inherited connective tissue disorders that have been described in association with various neurological features. Until now the neurological symptoms have not been studied in detail; therefore, the aim of this review is to analyze the possible association between EDS, epilepsy and periventricular heterotopia (PH). METHODS We have carried out a critical review of all cases of epilepsy in EDS patients with and without PH. RESULTS Epilepsy is a frequent neurological manifestation of EDS; generally, it is characterized by focal seizures with temporo-parieto-occipital auras and the most common EEG findings epileptiform discharges and slow intermittent rhythm with delta-theta waves. Epilepsy in EDS patients is usually responsive to common antiepileptic therapy; very few cases of drug resistant focal epilepsy requested surgical treatment, with favorable results in terms of outcome. Epilepsy is the most common presenting neurological manifestation associated with PH in EDS patients. Abnormal anatomic circuitries (including heterotopic nodules) could generate epilepsy in patients with PH. CONCLUSION Among the principal neurological manifestations, epilepsy and PH have a considerable importance and can influence the long-term evolution of these patients. We hypothesize that PH may determine the epileptic manifestations in patients with EDS; much remains to be learnt about the relationships between nodules and the epileptic manifestations in EDS syndrome.
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Affiliation(s)
| | | | | | - Maria Pia Villa
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy
| | - Pasquale Parisi
- Child Neurology, NESMOS Department, Chair of Pediatrics, Faculty of Medicine and Psychology, Sapienza University c/o Sant'Andrea Hospital, Via di Grottarossa, 1035-1039, 00189 Rome, Italy.
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Ehlers-Danlos Syndrome Type VIII: A Rare Cause of Leg Ulcers in Young Patients. Case Rep Dermatol Med 2013; 2013:469505. [PMID: 24198978 PMCID: PMC3809367 DOI: 10.1155/2013/469505] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 09/10/2013] [Indexed: 01/08/2023] Open
Abstract
Ehlers-Danlos syndrome type VIII (EDS-VIII) is a very rare autosomal dominant disease characterized by early-onset periodontitis associated with features of Ehlers-Danlos syndrome. We report a 32-year-old man whose chronic leg ulcer led to the diagnosis of EDS-VIII. He had severe periodontitis with complete loss of permanent teeth and skin fragility with thin skin, atrophic scars, and brownish atrophic pretibial plaques. Leg ulcer is not a prominent feature of EDS-VIII. We suggest adding EDS-VIII to the list of rare diseases accounting for chronic leg ulcers, if this case report prompts others to report leg ulcers associated with EDS-VIII.
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