Skip to main content

Abstract

Loeys-Dietz syndrome is an autosomal dominant aortic aneurysm syndrome characterized by multisystemic involvement. The most typical clinical triad includes hypertelorism, bifid uvula or cleft palate and aortic aneurysm with tortuosity. Natural history is significant for aortic dissection at smaller aortic diameter and arterial aneurysms throughout the arterial tree. The genetic cause is heterogeneous and includes mutations in genes encoding for components of the transforming growth factor beta (TGFβ) signalling pathway: TGFBR1, TGFBR2, SMAD3 and TGFB2. Despite the loss of function nature of these mutations, the patient-derived aortic tissues show evidence of increased (rather than decreased) TGFβ signalling. These insights offer new options for therapeutic interventions.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Loeys BL, Chen J, Neptune ER et al (2005) A syndrome of altered cardiovascular, craniofacial, neurocognitive and skeletal development caused by mutations in TGFBR1 or TGFBR2. Nat Genet 37:275–281

    Article  PubMed  CAS  Google Scholar 

  2. Pannu H, Fadulu VT, Chang J et al (2005) Mutations in transforming growth factor-beta receptor type II cause familial thoracic aortic aneurysms and dissections. Circulation 112:513–520

    Article  PubMed  CAS  Google Scholar 

  3. Tran-Fadulu V, Pannu H, Kim DH et al (2009) Analysis of multigenerational families with thoracic aortic aneurysms and dissections due to TGFBR1 or TGFBR2 mutations. J Med Genet 46:607–613

    Article  PubMed  CAS  Google Scholar 

  4. Loeys BL, Schwarze U, Holm T et al (2006) Aneurysm syndromes caused by mutations in the TGF-beta receptor. N Engl J Med 355:788–798

    Article  PubMed  CAS  Google Scholar 

  5. Watanabe Y, Sakai H, Nishimura A et al (2008) Paternal somatic mosaicism of a TGFBR2 mutation transmitting to an affected son with Loeys-Dietz syndrome. Am J Med Genet A 146A:3070–3074

    Article  PubMed  CAS  Google Scholar 

  6. van de Laar IM, Oldenburg RA, Pals G et al (2011) Mutations in SMAD3 cause a syndromic form of aortic aneurysms and dissections with early-onset osteoarthritis. Nat Genet 43:121–126

    Article  PubMed  CAS  Google Scholar 

  7. Lindsay ME, Schepers D, Bolar NA et al (2012) Loss-of-function mutations in TGFB2 cause a syndromic presentation of thoracic aortic aneurysm. Nat Genet 44:922–927

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Campbell IM, Kolodziejska KE, Quach MM et al (2011) TGFBR2 deletion in a 20-month-old female with developmental delay and microcephaly. Am J Med Genet A 155A:1442–1447

    Article  PubMed  CAS  Google Scholar 

  9. Goudie DR, D’Alessandro M, Merriman B et al (2011) Multiple self-healing squamous epithelioma is caused by a disease-specific spectrum of mutations in TGFBR1. Nat Genet 43:365–369

    Article  PubMed  CAS  Google Scholar 

  10. Cardoso S, Robertson SP, Daniel PB (2012) TGFBR1 mutations associated with Loeys-Dietz syndrome are inactivating. J Recept Signal Transduct Res 32:150–155

    Article  PubMed  CAS  Google Scholar 

  11. Williams JA, Loeys BL, Nwakanma LU et al (2007) Early surgical experience with Loeys-Dietz: a new syndrome of aggressive thoracic aortic aneurysm disease. Ann Thorac Surg 83:S757–S63; discussion S85–S90

    Google Scholar 

  12. Eckman PM, Hsich E, Rodriguez ER, Gonzalez-Stawinski GV, Moran R, Taylor DO (2009) Impaired systolic function in Loeys-Dietz syndrome: a novel cardiomyopathy? Circ Heart Fail 2:707–708

    Article  PubMed  Google Scholar 

  13. Kirmani S, Tebben PJ, Lteif AN et al (2010) Germline TGF-beta receptor mutations and skeletal fragility: a report on two patients with Loeys-Dietz syndrome. Am J Med Genet A 152A:1016–1019

    Article  PubMed  Google Scholar 

  14. Mizuguchi T, Collod-Beroud G, Akiyama T et al (2004) Heterozygous TGFBR2 mutations in Marfan syndrome. Nat Genet 36:855–860

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  15. Gutman G, Baris HN, Hirsch R et al (2009) Loeys-Dietz syndrome in pregnancy: a case description and report of a novel mutation. Fetal Diagn Ther 26:35–37

    Article  PubMed  Google Scholar 

  16. Rodrigues VJ, Elsayed S, Loeys BL, Dietz HC, Yousem DM (2009) Neuroradiologic manifestations of Loeys-Dietz syndrome type 1. AJNR Am J Neuroradiol 30:1614–1619

    Article  PubMed  CAS  Google Scholar 

  17. Wischmeijer A, Van Laer L, Tortora G et al (2013) First report of thoracic aortic aneurysm in infancy in a family with aneurysms-osteoarthritis syndrome due to a novel SMAD3 mutation: further delineation of the clinical phenotype. Am J Med Genet A 161A:1028–1035

    Google Scholar 

  18. Regalado ES, Guo DC, Villamizar C et al (2011) Exome sequencing identifies SMAD3 mutations as a cause of familial thoracic aortic aneurysm and dissection with intracranial and other arterial aneurysms. Circ Res 109:680–686

    Article  PubMed  CAS  Google Scholar 

  19. van de Laar IM, van der Linde D, Oei EH et al (2012) Phenotypic spectrum of the SMAD3-related aneurysms-osteoarthritis syndrome. J Med Genet 49:47–57

    Article  PubMed  Google Scholar 

  20. van der Linde D, van de Laar IMBM, Bertoli-Avella AM et al (2012) Cardiovascular phenotype of the recently discovered aneurysms-osteoarthritis syndrome (AOS) caused by SMAD3 mutations. J Am Coll Cardiol 60:397–403

    Google Scholar 

  21. Loeys BL, Dietz HC, Braverman AC et al (2010) The revised Ghent nosology for the Marfan syndrome. J Med Genet 47:476–485

    Article  PubMed  CAS  Google Scholar 

  22. Beighton P, De Paepe A, Steinmann B, Tsipouras P, Wenstrup RJ (1998) Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Ehlers-Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK). Am J Med Genet 77:31–37

    Article  PubMed  CAS  Google Scholar 

  23. Schwarze U, Hata R, McKusick VA et al (2004) Rare autosomal recessive cardiac valvular form of Ehlers-Danlos syndrome results from mutations in the COL1A2 gene that activate the nonsense-mediated RNA decay pathway. Am J Hum Genet 74:917–930

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  24. Malfait F, Symoens S, De Backer J et al (2007) Three arginine to cysteine substitutions in the pro-alpha (I)-collagen chain cause Ehlers-Danlos syndrome with a propensity to arterial rupture in early adulthood. Hum Mutat 28:387–395

    Article  PubMed  CAS  Google Scholar 

  25. Pinnell SR, Krane SM, Kenzora JE, Glimcher MJ (1972) A heritable disorder of connective tissue. Hydroxylysine-deficient collagen disease. N Engl J Med 286:1013–1020

    Article  PubMed  CAS  Google Scholar 

  26. Coucke PJ, Willaert A, Wessels MW et al (2006) Mutations in the facilitative glucose transporter GLUT10 alter angiogenesis and cause arterial tortuosity syndrome. Nat Genet 38:452–457

    Article  PubMed  CAS  Google Scholar 

  27. Hucthagowder V, Sausgruber N, Kim KH, Angle B, Marmorstein LY, Urban Z (2006) Fibulin-4: a novel gene for an autosomal recessive cutis laxa syndrome. Am J Hum Genet 78:1075–1080

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  28. Loeys B, Van Maldergem L, Mortier G et al (2002) Homozygosity for a missense mutation in fibulin-5 (FBLN5) results in a severe form of cutis laxa. Hum Mol Genet 11:2113–2118

    Article  PubMed  CAS  Google Scholar 

  29. Doyle AJ, Doyle JJ, Bessling SL et al (2012) Mutations in the TGF-beta repressor SKI cause Shprintzen-Goldberg syndrome with aortic aneurysm. Nat Genet 44(11):1249–1254

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  30. Milewicz DM, Michael K, Fisher N, Coselli JS, Markello T, Biddinger A (1996) Fibrillin-1 (FBN1) mutations in patients with thoracic aortic aneurysms. Circulation 94:2708–2711

    Article  PubMed  CAS  Google Scholar 

  31. Guo DC, Pannu H, Tran-Fadulu V et al (2007) Mutations in smooth muscle alpha-actin (ACTA2) lead to thoracic aortic aneurysms and dissections. Nat Genet 39:1488–1493

    Article  PubMed  CAS  Google Scholar 

  32. Wang L, Guo DC, Cao J et al (2010) Mutations in myosin light chain kinase cause familial aortic dissections. Am J Hum Genet 87:701–707

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  33. Zhu L, Vranckx R, Khau Van Kien P et al (2006) Mutations in myosin heavy chain 11 cause a syndrome associating thoracic aortic aneurysm/aortic dissection and patent ductus arteriosus. Nat Genet 38:343–349

    Article  PubMed  CAS  Google Scholar 

  34. Guo DC, Papke CL, Tran-Fadulu V et al (2009) Mutations in smooth muscle alpha-actin (ACTA2) cause coronary artery disease, stroke, and Moyamoya disease, along with thoracic aortic disease. Am J Hum Genet 84:617–627

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  35. Horbelt D, Guo G, Robinson PN, Knaus P (2010) Quantitative analysis of TGFBR2 mutations in Marfan-syndrome-related disorders suggests a correlation between phenotypic severity and Smad signaling activity. J Cell Sci 123:4340–4350

    Article  PubMed  CAS  Google Scholar 

  36. Huang T, David L, Mendoza V et al (2011) TGF-beta signalling is mediated by two autonomously functioning TbetaRI:TbetaRII pairs. EMBO J 30:1263–1276

    Article  PubMed  CAS  Google Scholar 

  37. Lindsay ME, Dietz HC (2011) Lessons on the pathogenesis of aneurysm from heritable conditions. Nature 473:308–316

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  38. Holm TM, Habashi JP, Doyle JJ et al (2011) Noncanonical TGFbeta signaling contributes to aortic aneurysm progression in Marfan syndrome mice. Science 332:358–361

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  39. Neptune ER, Frischmeyer PA, Arking DE et al (2003) Dysregulation of TGF-beta activation contributes to pathogenesis in Marfan syndrome. Nat Genet 33:407–411

    Article  PubMed  CAS  Google Scholar 

  40. Habashi JP, Judge DP, Holm TM et al (2006) Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 312:117–121

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  41. Brooke BS, Habashi JP, Judge DP, Patel N, Loeys B, Dietz HC 3rd (2008) Angiotensin II blockade and aortic-root dilation in Marfan’s syndrome. N Engl J Med 358:2787–2795

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  42. Lacro RV, Dietz HC, Wruck LM et al (2007) Rationale and design of a randomized clinical trial of beta-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J 154:624–631

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  43. Detaint D, Aegerter P, Tubach F et al (2010) Rationale and design of a randomized clinical trial (Marfan Sartan) of angiotensin II receptor blocker therapy versus placebo in individuals with Marfan syndrome. Arch Cardiovasc Dis 103:317–325

    Article  PubMed  Google Scholar 

  44. Gambarin FI, Favalli V, Serio A et al (2009) Rationale and design of a trial evaluating the effects of losartan vs. nebivolol vs. the association of both on the progression of aortic root dilation in Marfan syndrome with FBN1 gene mutations. J Cardiovasc Med (Hagerstown) 10:354–362

    Article  Google Scholar 

  45. Moberg K, De Nobele S, Devos D et al (2012) The Ghent Marfan Trial – a randomized, double-blind placebo controlled trial with losartan in Marfan patients treated with beta-blockers. Int J Cardiol 157:354–358

    Article  PubMed  Google Scholar 

  46. Radonic T, de Witte P, Baars MJ, Zwinderman AH, Mulder BJ, Groenink M (2010) Losartan therapy in adults with Marfan syndrome: study protocol of the multi-center randomized controlled COMPARE trial. Trials 11:3

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  47. Pyeritz RE, Loeys B (2011) The 8th international research symposium on the Marfan syndrome and related conditions. Am J Med Genet A 158A:42–49

    Article  PubMed  Google Scholar 

  48. Patel ND, Arnaoutakis GJ, George TJ et al (2011) Valve-sparing aortic root replacement in Loeys-Dietz syndrome. Ann Thorac Surg 92:556–560, discussion 60-1

    Article  PubMed  Google Scholar 

  49. Augoustides JG, Plappert T, Bavaria JE (2009) Aortic decision-making in the Loeys-Dietz syndrome: aortic root aneurysm and a normal-caliber ascending aorta and aortic arch. J Thorac Cardiovasc Surg 138:502–503

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bart Loeys M.D., Ph.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Van Laer, L., Dietz, H., Loeys, B. (2014). Loeys-Dietz Syndrome. In: Halper, J. (eds) Progress in Heritable Soft Connective Tissue Diseases. Advances in Experimental Medicine and Biology, vol 802. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-7893-1_7

Download citation

Publish with us

Policies and ethics