Pathophysiology and Management of Cardiovascular Manifestations in Marfan and Loeys-Dietz Syndromes

Int Heart J. 2016 May 25;57(3):271-7. doi: 10.1536/ihj.16-094. Epub 2016 May 13.

Abstract

Marfan syndrome (MFS) is an autosomal dominant heritable disorder of connective tissue that affects the cardiovascular, skeletal, ocular, pulmonary, and nervous systems and is usually caused by mutations in the FBN1 gene, which encodes fibrillin-1. MFS is traditionally considered to result from the structural weakness of connective tissue. However, recent investigations on molecular mechanisms indicate that increased transforming growth factor-β (TGF-β) activity plays a crucial role in the pathogenesis of MFS and related disorders, such as Loeys-Dietz syndrome (LDS), which is caused by mutation in TGF-β signaling-related genes. In addition, recent studies show that angiotensin II type 1 receptor (AT1R) signaling enhances cardiovascular pathologies in MFS, and the angiotensin II receptor blocker losartan has the potential to inhibit aortic aneurysm formation. However, the relationship between TGF-β and AT1R signaling pathways remains poorly characterized. In this review, we discuss the recent studies on the molecular mechanisms underlying cardiovascular manifestations of MFS and LDS and the ensuing strategies for management.

Publication types

  • Review

MeSH terms

  • Angiotensin II Type 1 Receptor Blockers / pharmacology
  • Animals
  • Aortic Aneurysm* / etiology
  • Aortic Aneurysm* / metabolism
  • Aortic Aneurysm* / physiopathology
  • Aortic Aneurysm* / prevention & control
  • Disease Management
  • Fibrillin-1 / genetics*
  • Humans
  • Loeys-Dietz Syndrome* / complications
  • Loeys-Dietz Syndrome* / drug therapy
  • Loeys-Dietz Syndrome* / genetics
  • Loeys-Dietz Syndrome* / physiopathology
  • Losartan / pharmacology*
  • Marfan Syndrome* / complications
  • Marfan Syndrome* / drug therapy
  • Marfan Syndrome* / genetics
  • Marfan Syndrome* / physiopathology
  • Signal Transduction / drug effects
  • Signal Transduction / genetics
  • Transforming Growth Factor beta / metabolism*

Substances

  • Angiotensin II Type 1 Receptor Blockers
  • FBN1 protein, human
  • Fibrillin-1
  • Transforming Growth Factor beta
  • Losartan