Cited by 113Connective tissue disorders researchDermatological and Skeletal DisordersCerebrovascular and genetic disorders

Vascular aspects of the Ehlers-Danlos Syndromes

Malfait, Fransiska·2018·Matrix Biology

Abstract

The Ehlers-Danlos Syndromes comprise a heterogeneous group of rare monogenic conditions that are characterized by joint hypermobility, skin and vascular fragility and generalized connective tissue friability. The latest classification recognizes 13 clinical subtypes, with mutations identified in 19 different genes. Besides defects in fibrillar collagens (collagen types I, III and V), their modifying enzymes (ADAMTS-2, lysylhydroxylase 1 (LH1)), and molecules involved in collagen folding (FKBP22), defects have recently been identified in other constituents of the extracellular matrix (e.g. Tenascin-X, collagen type XII), enzymes involved in glycosaminoglycan biosynthesis (β4GalT7 and β3GalT6), dermatan 4-O-sulfotransferase-1 (D4ST1), dermatan sulfate epimerase (DSE)), (putative) transcription factors (ZNF469, PRDM5), components of the complement pathway (C1r, C1s) and an intracellular Zinc transporter (ZIP13). Easy bruising is, to a variable degree, present in all subtypes of EDS. A variable bleeding tendency, manifesting e.g. as gum bleeding, menometrorraghia, postnatal or peri-operative hemorrhage is observed in many EDS-patients of varying EDS subtypes. Life-threatening arterial aneurysms, dissections and ruptures of medium-sized and large arteries are a hallmark of the vascular subtype of EDS, caused by a molecular defect in collagen type III, an important constituent of blood vessel walls and hollow organs. They may however also occur in other EDS subtypes, especially in classical EDS, caused by defects in type V collagen or, rarely, type I collagen, and in kyphoscoliotic EDS, caused by defects in LH1 or FKBP22. These manifestations of vascular fragility and bleeding are usually attributed to fragility of the blood vessel walls and the perivascular connective tissues, but the molecular pathomechanisms underlying these complications are poorly studied. This review summarizes current knowledge on manifestations of vascular fragility in the different EDS subtypes.

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Crossref · 10.1016/j.matbio.2018.04.013

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Authors
Malfait, F.
Affiliations
Ghent University Hospital (BE)
Corresponding author
Malfait, Fransiska
Venue
Matrix Biology
Publisher
Elsevier BV
Published
2018-10
Volume
71-72
Pages
380-395
ISSN
0945-053X (ISSN-L)
OpenAlex
W2800944293
Cited by
113
References
128
Citations by year
2026: 8 · 2025: 11 · 2024: 15 · 2023: 12 · 2022: 10 · 2021: 14 · 2020: 22 · 2019: 19 · 2018: 2
FWCI
2.00
Type
journal article
Language
en
Open access
closed
Locations
  • Matrix Biology (publishedVersion)
  • PubMed (publishedVersion)
  • Ghent University Academic Bibliography (Ghent University) (submittedVersion)
Funders
Vlaamse regering
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Dermatological and Skeletal Disorders
  • Health Sciences › Medicine › Neurology › Cerebrovascular and genetic disorders
Keywords
Ehlers-Danlos syndrome, vascular fragility, arterial aneurysm, arterial dissection, arterial rupture, bleeding tendency, easy bruising, type III collagen, type V collagen, connective tissue diseases, glycosaminoglycan synthesis
MeSH terms
Collagen, Ehlers-Danlos Syndrome, Extracellular Matrix, Humans, Procollagen-Lysine, 2-Oxoglutarate 5-Dioxygenase, Mutation, Vascular Diseases, Genetic Predisposition to Disease, Tacrolimus Binding Proteins

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