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Clinical, Diagnostic, and Therapeutic Aspects of the Marfan Syndrome

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Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 802))

Abstract

Marfan syndrome (MFS) is a relatively common and often lethal disease of connective tissue. Medical, surgical and basic research advances over the last two decades have had a major positive impact on the clinical management of MFS patients. Life expectancy has increased significantly, more discriminating diagnostic criteria have been developed, a number of new clinical entities have been recognized, and exciting opportunities for drug-based therapy have emerged. Despite such a remarkable progress, MFS diagnosis remains difficult and aortic disease progression is very heterogeneous and clinical outcome is unpredictable. Ongoing research efforts are therefore exploiting animal models of MFS to identify novel diagnostic and prognostic biomarkers, genetic, epigenetic and environmental modifiers and druggable biological targets.

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References

  1. Pyeritz RE (2000) The Marfan syndrome. Annu Rev Med 51:481–510

    PubMed  CAS  Google Scholar 

  2. Marfan A (1896) Un cas de déformation congénitale des quatre membres plus pronocée aux extrémites charactérisée par l’allongement des os avec uncertain degréd’amincissement. Bull Mem Soc Med Hop 13:220–226

    Google Scholar 

  3. McKusick VA (1955) Heritable disorders of connective tissue. III. The Marfan syndrome. J Chronic Dis 2:609–644

    PubMed  CAS  Google Scholar 

  4. Dietz HC, Cutting CG, Pyeritz RE, Maslen CL, Sakai LY, Corson GM, Puffenberger EG, Hamosh A, Nanthakumar EJ, Curristin SM, Stetten G, Meyers D, Francomano Clair A (1991) Marfan syndrome caused by a recurrent de novo missense mutation in the fibrillin gene. Nature 352:337–339

    PubMed  CAS  Google Scholar 

  5. Lee B, Godfrey M, Vitale E, Hori H, Mattei M-G, Sarfarazi M, Tsipouras P, Ramirez F, Hollister D (1991) Linkage of Marfan syndrome and a phenotypically related disorder are linked to two different fibrillin genes. Nature 352:330–334

    PubMed  CAS  Google Scholar 

  6. Sponseller PD, Erkula G, Skolasky RL, Venuti KD, Dietz HC (2010) Improving clinical recognition of Marfan syndrome. J Bone Joint Surg Am 92:1868–1875

    PubMed  Google Scholar 

  7. Dean JC (2002) Management of Marfan syndrome. Heart 88:97–103

    PubMed  Google Scholar 

  8. Gott VL, Greene PS, Alejo DE, Cameron DE, Naftel DC, Miller DC, Gillinov AM, Laschinger JC, Pyeritz RE (1999) Replacement of the aortic root in patients with Marfan’s syndrome. N Engl J Med 340:1307–1313

    PubMed  CAS  Google Scholar 

  9. Ramirez F, Dietz H (2007) Marfan syndrome: from molecular pathogenesis to clinical treatment. Curr Opin Genet Dev 17:1–7

    Google Scholar 

  10. Geva T, Sanders SP, Diogenes MS, Rockenmacher S, Van Praagh R (1990) Two-dimensional and Doppler echocardiographic and pathologic characteristics of the infantile Marfan syndrome. Am J Cardiol 65:1230–1237

    PubMed  CAS  Google Scholar 

  11. Buntinx IM, Willems PJ, Spitaels SE, Van Reempst PJ, De Paepe AM, Dumon JE (1991) Neonatal Marfan syndrome with congenital arachnodactyly, flexion contractures, and severe cardiac valve insufficiency. J Med Genet 28:267–273

    PubMed  CAS  Google Scholar 

  12. Bresters D, Nikkels PG, Meijboom EJ, Hoorntje TM, Pals G, Beemer FA (1999) Clinical, pathological and molecular genetic findings in a case of neonatal Marfan syndrome. Acta Paediatr 88:98–101

    PubMed  CAS  Google Scholar 

  13. Meijboom LJ, Timmermans J, van Tintelen JP, Nollen GJ, De Backer J, van den Berg MP, Boers GH, Mulder BJ (2005) Evaluation of left ventricular dimensions and function in Marfan’s syndrome without significant valvular regurgitation. Am J Cardiol 95:795–797

    PubMed  Google Scholar 

  14. De Backer JF, Devos D, Segers P, Matthys D, Francois K, Gillebert TC, De Paepe AM, De Sutter J (2006) Primary impairment of left ventricular function in Marfan syndrome. Int J Cardiol 112:353–358

    PubMed  Google Scholar 

  15. Silverman DI, Burton KJ, Gray J, Bosner MS, Kouchoukos NT, Roman MJ, Boxer M, Devereux RB, Tsipouras P (1995) Life expectancy in the Marfan syndrome. Am J Cardiol 75:157–160

    PubMed  CAS  Google Scholar 

  16. van Karnebeek CD, Naeff MS, Mulder BJ, Hennekam RC, Offringa M (2001) Natural history of cardiovascular manifestations in Marfan syndrome. Arch Dis Child 84:129–137

    PubMed  Google Scholar 

  17. Kiotsekoglou A, Sutherland GR, Moggridge JC, Nassiri DK, Camm AJ, Child AH (2009) The unravelling of primary myocardial impairment in Marfan syndrome by modern echocardiography. Heart 95:1561–1566

    PubMed  CAS  Google Scholar 

  18. DeVore GR (2002) First-trimester fetal echocardiography: is the future now? Ultrasound Obstet Gynecol 20:6–8

    PubMed  CAS  Google Scholar 

  19. Stadie R, Geipel A, Heep A, Herberg U, Welker B, Gembruch U, Berg C (2007) Prenatal diagnosis of Marfan syndrome. Ultrasound Obstet Gynecol 30:119–121

    PubMed  CAS  Google Scholar 

  20. Lopes KR, Delezoide AL, Baumann C, Vuillard E, Luton D, Chitrit Y, Azancot A (2006) Prenatal Marfan syndrome: report of one case and review of the literature. Prenat Diagn 26:696–699

    PubMed  CAS  Google Scholar 

  21. Geva T, Hegesh J, Frand M (1987) The clinical course and echocardiographic features of Marfan’s syndrome in childhood. Am J Dis Child 141:1179–1182

    PubMed  CAS  Google Scholar 

  22. Nataatmadja M, West M, West J, Summers K, Walker P, Nagata M, Watanabe T (2003) Abnormal extracellular matrix protein transport associated with increased apoptosis of vascular smooth muscle cells in Marfan syndrome and bicuspid aortic valve thoracic aortic aneurysm. Circulation 108(Suppl 1):II329–II334

    PubMed  Google Scholar 

  23. Nagashima H, Sakomura Y, Aoka Y, Uto K, Kameyama K, Ogawa M, Aomi S, Koyanagi H, Ishizuka N, Naruse M, Kawana M, Kasanuki H (2001) Angiotensin II type 2 receptor mediates vascular smooth muscle cell apoptosis in cystic medial degeneration associated with Marfan’s syndrome. Circulation 104:I282–I287

    PubMed  CAS  Google Scholar 

  24. Niwa K, Perloff JK, Bhuta SM, Laks H, Drinkwater DC, Child JS, Miner PD (2001) Structural abnormalities of great arterial walls in congenital heart disease: light and electron microscopic analyses. Circulation 103:393–400

    PubMed  CAS  Google Scholar 

  25. Sohn GH, Jang SY, Moon JR, Yang JH, Sung K, Ki CS, Oh JK, Choe YH, Kim DK (2011) The usefulness of multidetector computed tomographic angiography for the diagnosis of Marfan syndrome by Ghent criteria. Int J Cardiovasc Imaging 27:679–688

    PubMed  Google Scholar 

  26. Nollen GJ, van Schijndel KE, Timmermans J, Groenink M, Barentsz JO, van der Wall EE, Stoker J, Mulder BJ (2002) Pulmonary artery root dilatation in Marfan syndrome: quantitative assessment of an unknown criterion. Heart 87:470–471

    PubMed  CAS  Google Scholar 

  27. Streeten EA, Murphy EA, Pyeritz RE (1987) Pulmonary function in the Marfan syndrome. Chest 91:408–412

    PubMed  CAS  Google Scholar 

  28. Loeys BL, Dietz HC, Braverman AC, Callewaert BL, De Backer J, Devereux RB, Hilhorst-Hofstee Y, Jondeau G, Faivre L, Milewicz DM, Pyeritz RE, Sponseller PD, Wordsworth P, De Paepe AM (2010) The revised Ghent nosology for the Marfan syndrome. J Med Genet 47:476–485

    PubMed  CAS  Google Scholar 

  29. Milewicz DM, Dietz HC, Miller DC (2005) Treatment of aortic disease in patients with Marfan syndrome. Circulation 111:e150–e157

    PubMed  Google Scholar 

  30. Engelfriet PM, Boersma E, Tijssen JG, Bouma BJ, Mulder BJ (2006) Beyond the root: dilatation of the distal aorta in Marfan’s syndrome. Heart 92:1238–1243

    PubMed  CAS  Google Scholar 

  31. Blanchard JF (1999) Epidemiology of abdominal aortic aneurysms. Epidemiol Rev 21:207–221

    PubMed  CAS  Google Scholar 

  32. Antoniou GA, Georgiadis GS, Antoniou SA, Granderath FA, Giannoukas AD, Lazarides MK (2011) Abdominal aortic aneurysm and abdominal wall hernia as manifestations of a connective tissue disorder. J Vasc Surg 54:1175–1181

    PubMed  Google Scholar 

  33. Choke E, Cockerill G, Wilson WR, Sayed S, Dawson J, Loftus I, Thompson MM (2005) A review of biological factors implicated in abdominal aortic aneurysm rupture. Eur J Vasc Endovasc Surg 30:227–244

    PubMed  CAS  Google Scholar 

  34. Longo GM, Xiong W, Greiner TC, Zhao Y, Fiotti N, Baxter BT (2002) Matrix metalloproteinases 2 and 9 work in concert to produce aortic aneurysms. J Clin Invest 110:625–632

    PubMed Central  PubMed  CAS  Google Scholar 

  35. Aoki H, Yoshimura K, Matsuzaki M (2007) Turning back the clock: regression of abdominal aortic aneurysms via pharmacotherapy. J Mol Med (Berl) 85:1077–1088

    Google Scholar 

  36. Humphrey JD, Holzapfel GA (2012) Mechanics, mechanobiology, and modeling of human abdominal aorta and aneurysms. J Biomech 45:805–814

    PubMed Central  PubMed  CAS  Google Scholar 

  37. Loeys B, Nuytinck L, Delvaux I, De Bie S, De Paepe A (2001) Genotype and phenotype analysis of 171 patients referred for molecular study of the fibrillin-1 gene FBN1 because of suspected Marfan syndrome. Arch Intern Med 161:2447–2454

    PubMed  CAS  Google Scholar 

  38. Waldmuller S, Muller M, Warnecke H, Rees W, Schols W, Walterbusch G, Ennker J, Scheffold T (2007) Genetic testing in patients with aortic aneurysms/dissections: a novel genotype/phenotype correlation? Eur J Cardiothorac Surg 31:970–975

    PubMed  Google Scholar 

  39. Brown OR, DeMots H, Kloster FE, Roberts A, Menashe VD, Beals RK (1975) Aortic root dilatation and mitral valve prolapse in Marfan’s syndrome: an ECHOCARDIOgraphic study. Circulation 52:651–657

    PubMed  CAS  Google Scholar 

  40. Pyeritz RE, Wappel MA (1983) Mitral valve dysfunction in the Marfan syndrome. Clinical and echocardiographic study of prevalence and natural history. Am J Med 74:797–807

    PubMed  CAS  Google Scholar 

  41. Freed LA, Levy D, Levine RA, Larson MG, Evans JC, Fuller DL, Lehman B, Benjamin EJ (1999) Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 341:1–7

    PubMed  CAS  Google Scholar 

  42. Morse RP, Rockenmacher S, Pyeritz RE, Sanders SP, Bieber FR, Lin A, MacLeod P, Hall B, Graham JM Jr (1990) Diagnosis and management of infantile Marfan syndrome. Pediatrics 86:888–895

    PubMed  CAS  Google Scholar 

  43. Sisk HE, Zahka KG, Pyeritz RE (1983) The Marfan syndrome in early childhood: analysis of 15 patients diagnosed at less than 4 years of age. Am J Cardiol 52:353–358

    PubMed  CAS  Google Scholar 

  44. Ng DK, Chau KW, Black C, Thomas TM, Mak KL, Boxer M (1999) Neonatal Marfan syndrome: a case report. J Paediatr Child Health 35:321–323

    PubMed  CAS  Google Scholar 

  45. Schroeyers P, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H (2001) Minimally invasive video-assisted mitral valve surgery: our lessons after a 4-year experience. Ann Thorac Surg 72:S1050–S1054

    PubMed  CAS  Google Scholar 

  46. Fujiseki Y, Okuno K, Tanaka M, Shimada M, Takahashi M, Kawanishi K (1985) Myocardial involvement in the Marfan syndrome. Jpn Heart J 26:1043–1050

    PubMed  CAS  Google Scholar 

  47. Rybczynski M, Koschyk DH, Aydin MA, Robinson PN, Brinken T, Franzen O, Berger J, Hofmann T, Meinertz T, von Kodolitsch Y (2007) Tissue Doppler imaging identifies myocardial dysfunction in adults with Marfan syndrome. Clin Cardiol 30:19–24

    PubMed  Google Scholar 

  48. Kiotsekoglou A, Bajpai A, Bijnens BH, Kapetanakis V, Athanassopoulos G, Moggridge JC, Mullen MJ, Nassiri DK, Camm J, Sutherland GR, Child AH (2008) Early impairment of left ventricular long-axis systolic function demonstrated by reduced atrioventricular plane displacement in patients with Marfan syndrome. Eur J Echocardiogr 9:605–613

    PubMed  Google Scholar 

  49. Yetman AT, Bornemeier RA, McCrindle BW (2003) Long-term outcome in patients with Marfan syndrome: is aortic dissection the only cause of sudden death? J Am Coll Cardiol 41:329–332

    PubMed  Google Scholar 

  50. Alpendurada F, Wong J, Kiotsekoglou A, Banya W, Child A, Prasad SK, Pennell DJ, Mohiaddin RH (2010) Evidence for Marfan cardiomyopathy. Eur J Heart Fail 12:1085–1091

    PubMed  Google Scholar 

  51. Kahveci G, Erkol A, Yilmaz F (2010) Dilated cardiomyopathy in a patient with Marfan syndrome accompanied by chronic type A aortic dissection and right atrial thrombus. Intern Med 49:2583–2586

    PubMed  Google Scholar 

  52. Jeremy RW, Huang H, Hwa J, McCarron H, Hughes CF, Richards JG (1994) Relation between age, arterial distensibility, and aortic dilatation in the Marfan syndrome. Am J Cardiol 74:369–373

    PubMed  CAS  Google Scholar 

  53. Grahame R, Pyeritz RE (1995) The Marfan syndrome: joint and skin manifestations are prevalent and correlated. Br J Rheumatol 34:126–131

    PubMed  CAS  Google Scholar 

  54. Lundby R, Kirkhus E, Rand-Hendriksen S, Hald J, Pripp AH, Smith HJ (2011) CT of the hips in the investigation of protrusion acetabuli in Marfan syndrome. A case control study. Eur Radiol 21:1485–1491

    PubMed Central  PubMed  Google Scholar 

  55. Le Parc JM, Molcard S, Tubach F (2001) Bone mineral density in Marfan syndrome. Rheumatology (Oxford) 40:358–359

    Google Scholar 

  56. Giampietro PF, Peterson M, Schneider R, Davis JG, Raggio C, Myers E, Burke SW, Boachie-Adjei O, Mueller CM (2003) Assessment of bone mineral density in adults and children with Marfan syndrome. Osteoporos Int 14:559–563

    PubMed  Google Scholar 

  57. Fattori R, Nienaber CA, Descovich B, Ambrosetto P, Reggiani LB, Pepe G, Kaufmann U, Negrini E, von Kodolitsch Y, Gensini GF (1999) Importance of dural ectasia in phenotypic assessment of Marfan’s syndrome. Lancet 354:910–913

    PubMed  CAS  Google Scholar 

  58. Ahn NU, Sponseller PD, Ahn UM, Nallamshetty L, Rose PS, Buchowski JM, Garrett ES, Kuszyk BS, Fishman EK, Zinreich SJ (2000) Dural ectasia in the Marfan syndrome: MR and CT findings and criteria. Genet Med 2:173–179

    PubMed  CAS  Google Scholar 

  59. Sponseller PD, Bhimani M, Solacoff D, Dormans JP (2000) Results of brace treatment of scoliosis in Marfan syndrome. Spine 25:2350–2354

    PubMed  CAS  Google Scholar 

  60. Sponseller PD, Hobbs W, Riley LH 3rd, Pyeritz RE (1995) The thoracolumbar spine in Marfan syndrome. J Bone Joint Surg Am 77:867–876

    PubMed  CAS  Google Scholar 

  61. Vetter U, Mayerhofer R, Lang D, von Bernuth G, Ranke MB, Schmaltz AA (1990) The Marfan syndrome – analysis of growth and cardiovascular manifestation. Eur J Pediatr 149:452–456

    PubMed  CAS  Google Scholar 

  62. Jones KB, Sponseller PD, Erkula G, Sakai L, Ramirez F, Dietz HC 3rd, Kost-Byerly S, Bridwell KH, Sandell L (2007) Symposium on the musculoskeletal aspects of Marfan syndrome: meeting report and state of the science. J Orthop Res 25:413–422

    PubMed  Google Scholar 

  63. Zadeh N, Bernstein JA, Niemi AK, Dugan S, Kwan A, Liang D, Hyland JC, Hoyme HE, Hudgins L, Manning MA (2011) Ectopia lentis as the presenting and primary feature in Marfan syndrome. Am J Med Genet A 155A:2661–2668

    PubMed  Google Scholar 

  64. Nahum Y, Spierer A (2008) Ocular features of Marfan syndrome: diagnosis and management. Isr Med Assoc J 10:179–181

    PubMed  Google Scholar 

  65. Nemet AY, Assia EI, Apple DJ, Barequet IS (2006) Current concepts of ocular manifestations in Marfan syndrome. Surv Ophthalmol 51:561–575

    PubMed  Google Scholar 

  66. De Paepe A, Devereux RB, Dietz HC, Hennekam RC, Pyeritz RE (1996) Revised diagnostic criteria for the Marfan syndrome. Am J Med Genet 62:417–426

    PubMed  Google Scholar 

  67. Lee SY, Ang CL (2003) Results of retinal detachment surgery in Marfan syndrome in Asians. Retina 23:24–29

    PubMed  Google Scholar 

  68. Sharma T, Gopal L, Shanmugam MP, Bhende PS, Agrawal R, Shetty NS, Gopalakrishna M, Rao MK, Balusamy S (2002) Retinal detachment in Marfan syndrome: clinical characteristics and surgical outcome. Retina 22:423–428

    PubMed  Google Scholar 

  69. Tanoue LT (1992) Pulmonary involvement in collagen vascular disease: a review of the pulmonary manifestations of the Marfan syndrome, ankylosing spondylitis, Sjogren’s syndrome, and relapsing polychondritis. J Thorac Imaging 7:62–77

    PubMed  CAS  Google Scholar 

  70. Hall JR, Pyeritz RE, Dudgeon DL, Haller JA Jr (1984) Pneumothorax in the Marfan syndrome: prevalence and therapy. Ann Thorac Surg 37:500–504

    PubMed  CAS  Google Scholar 

  71. Wood JR, Bellamy D, Child AH, Citron KM (1984) Pulmonary disease in patients with Marfan syndrome. Thorax 39:780–784

    PubMed  CAS  Google Scholar 

  72. Dwyer EM Jr, Troncale F (1965) Spontaneous pneumothorax and pulmonary disease in the Marfan syndrome. Report of two cases and review of the literature. Ann Intern Med 62:1285–1292

    PubMed  Google Scholar 

  73. Karpman C, Aughenbaugh GL, Ryu JH (2011) Pneumothorax and bullae in Marfan syndrome. Respiration 82:219–224

    PubMed  Google Scholar 

  74. Cipriano GF, Peres PA, Cipriano G Jr, Arena R, Carvalho AC (2010) Safety and cardiovascular behavior during pulmonary function in patients with Marfan syndrome. Clin Genet 78:57–65

    PubMed  CAS  Google Scholar 

  75. Ledoux M, Beauchet A, Fermanian C, Boileau C, Jondeau G, Saiag P (2011) A case-control study of cutaneous signs in adult patients with Marfan disease: diagnostic value of striae. J Am Acad Dermatol 64:290–295

    PubMed  Google Scholar 

  76. Judge DP, Dietz H (2005) Marfan’s syndrome. Lancet 366:1965–1976

    PubMed Central  PubMed  CAS  Google Scholar 

  77. Faivre L, Collod-Beroud G, Ades L, Arbustini E, Child A, Callewaert B, Loeys B, Binquet C, Gautier E, Mayer K, Arslan-Kirchner M, Grasso M, Beroud C, Hamroun D, Bonithon-Kopp C, Plauchu H, Robinson P, De Backer J, Coucke P, Francke U, Bouchot O, Wolf J, Stheneur C, Hanna N, Detaint D, De Paepe A, Boileau C, Jondeau G (2011) The new Ghent criteria for Marfan syndrome: what do they change? Clin Genet 81:433–442

    PubMed  Google Scholar 

  78. Sheikhzadeh S, Kade C, Keyser B, Stuhrmann M, Arslan-Kirchner M, Rybczynski M, Bernhardt A, Habermann C, Hillebrand M, Mir T, Robinson P, Berger J, Detter C, Blankenberg S, Schmidtke J, von Kodolitsch Y (2011) Analysis of phenotype and genotype information for the diagnosis of Marfan syndrome. Clin Genet 82(3):240–247

    PubMed  Google Scholar 

  79. Maron BJ, Chaitman BR, Ackerman MJ, Bayes de Luna A, Corrado D, Crosson JE, Deal BJ, Driscoll DJ, 3rd Estes NA, Araujo CG, Liang DH, Mitten MJ, Myerburg RJ, Pelliccia A, Thompson PD, Towbin JA, Van Camp SP (2004) Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation 109:2807–2816

    PubMed  Google Scholar 

  80. Gersony DR, McClaughlin MA, Jin Z, Gersony WM (2007) The effect of β-blocker therapy on clinical outcome in patients with Marfan's syndrome: a meta-analysis. Int J Cardiol 114:303–308

    PubMed  Google Scholar 

  81. Ladouceur M, Fermanian C, Lupoglazoff JM, Edouard T, Dulac Y, Acar P, Magnier S, Jondeau G (2007) Effect of β-blockade on ascending aortic dilatation in children with the Marfan syndrome. Am J Cardiol 99:406–409

    PubMed  CAS  Google Scholar 

  82. Salim MA, Alpert BS, Ward JC, Pyeritz RE (1994) Effect of β-adrenergic blockade on aortic root rate of dilation in the Marfan syndrome. Am J Cardiol 74:629–633

    PubMed  CAS  Google Scholar 

  83. Selamet Tierney ES, Feingold B, Printz BF, Park SC, Graham D, Kleinman CS, Mahnke CB, Timchak DM, Neches WH, Gersony WM (2007) β-blocker therapy does not alter the rate of aortic root dilation in pediatric patients with Marfan syndrome. J Pediatr 150:77–82

    PubMed  CAS  Google Scholar 

  84. Rossi-Foulkes R, Roman MJ, Rosen SE, Kramer-Fox R, Ehlers KH, O’Loughlin JE, Davis JG, Devereux RB (1999) Phenotypic features and impact of β blocker or calcium antagonist therapy on aortic lumen size in the Marfan syndrome. Am J Cardiol 83:1364–1368

    PubMed  CAS  Google Scholar 

  85. Williams A, Kenny D, Wilson D, Fagenello G, Nelson M, Dunstan F, Cockcroft J, Stuart G, Fraser AG (2012) Effects of atenolol, perindopril and verapamil on haemodynamic and vascular function in Marfan syndrome – a randomised, double-blind, crossover trial. Eur J Clin Invest 42(8):891–899

    PubMed  CAS  Google Scholar 

  86. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, Bolger A, Cabell CH, Takahashi M, Baltimore RS, Newburger JW, Strom BL, Tani LY, Gerber M, Bonow RO, Pallasch T, Shulman ST, Rowley AH, Burns JC, Ferrieri P, Gardner T, Goff D, Durack DT (2007) Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 116:1736–1754

    PubMed  Google Scholar 

  87. 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

    PubMed Central  PubMed  CAS  Google Scholar 

  88. Lacro RV, Dietz HC, Wruck LM, Bradley TJ, Colan SD, Devereux RB, Klein GL, Li JS, Minich LL, Paridon SM, Pearson GD, Printz BF, Pyeritz RE, Radojewski E, Roman MJ, Saul JP, Stylianou MP, Mahony L (2007) Rationale and design of a randomized clinical trial of β-blocker therapy (atenolol) versus angiotensin II receptor blocker therapy (losartan) in individuals with Marfan syndrome. Am Heart J 154:624–631

    PubMed Central  PubMed  CAS  Google Scholar 

  89. Gambarin FI, Favalli V, Serio A, Regazzi M, Pasotti M, Klersy C, Dore R, Mannarino S, Vigano M, Odero A, Amato S, Tavazzi L, Arbustini E (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 10:354–362

    Google Scholar 

  90. Detaint D, Aegerter P, Tubach F, Hoffman I, Plauchu H, Dulac Y, Faivre LO, Delrue MA, Collignon P, Odent S, Tchitchinadze M, Bouffard C, Arnoult F, Gautier M, Boileau C, Jondeau G (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

    PubMed  Google Scholar 

  91. 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

    PubMed Central  PubMed  Google Scholar 

  92. Yetman AT, Bornemeier RA, McCrindle BW (2005) Usefulness of enalapril versus propranolol or atenolol for prevention of aortic dilation in patients with the Marfan syndrome. Am J Cardiol 95:1125–1127

    PubMed  CAS  Google Scholar 

  93. Pereira L, Konstantinos A, Tian J, Lee SY, Keene DR, Ono R, Reinhardt DP, Sakai LY, Jensen-Biery N, Bunton T, Dietz HC, Ramirez F (1997) Targeting of the gene coding fibrillin-1 recapitulates the vascular phenotype of Marfan syndrome in the mouse. Nat Genet 17:218–222

    PubMed  CAS  Google Scholar 

  94. Bunton TE, Biery NJ, Gayraud B, Ramirez F, Dietz HC (2001) Phenotypic modulation of vascular smooth muscle cells contributes to elastolysis in a mouse model of Marfan syndrome. Circ Res 88:37–43

    PubMed  CAS  Google Scholar 

  95. Xiong W, Knispel R, Dietz HC, Ramirez F, Baxter B (2008) T. Doxycycline delays aneurysm rupture in a mouse model of Marfan syndrome. J Vasc Surg 47:166–172

    PubMed  Google Scholar 

  96. Chung A, Yang HHC, Radomski MW, van Breemen C (2008) Long-Term doxycycline is more effective than Atenolol to prevent thoracic aortic aneurysm in Marfan syndrome through the inhibition of matrix metalloproteinase-2 and -9. Circ Res 102:e73–e85

    PubMed  CAS  Google Scholar 

  97. McLoughlin D, McGuinness J, Byrne J, Terzo E, Huuskonen V, McAllister H, Black A, Kearney S, Kay E, Hill AD, Dietz HC, Redmond JM (2011) Pravastatin reduces Marfan aortic dilation. Circulation 124:S168–S173

    PubMed  CAS  Google Scholar 

  98. Xiong W, Meisinger T, Knispel R, Worth JM, Baxter BT (2012) MMP-2 regulates Erk1/2 phosphorylation and aortic dilatation in Marfan syndrome. Circ Res 110:e92–e101

    PubMed  CAS  Google Scholar 

  99. Booms P, Ney A, Barthel F, Moroy G, Counsell D, Gille C, Guo G, Pregla R, Mundlos S, Alix AJ, Robinson PN (2006) A fibrillin-1-fragment containing the elastin-binding-protein GxxPG consensus sequence upregulates matrix metalloproteinase-1: biochemical and computational analysis. J Mol Cell Cardiol 40:234–246

    PubMed  CAS  Google Scholar 

  100. Radonic T, de Witte P, Groenink M, de Waard V, Lutter R, van Eijk M, Jansen M, Timmermans J, Kempers M, Scholte AJ, Hilhorst-Hofstee Y, van den Berg MP, van Tintelen JP, Pals G, Baars MJ, Mulder BJ, Zwinderman AH (2012) Inflammation aggravates disease severity in Marfan syndrome patients. PLoS One 7:e32963

    PubMed Central  PubMed  CAS  Google Scholar 

  101. Segura AM, Luna RE, Horiba K, Stetler-Stevenson WG, McAllister HA Jr, Willerson JT, Ferrans VJ (1998) Immunohistochemistry of matrix metalloproteinases and their inhibitors in thoracic aortic aneurysms and aortic valves of patients with Marfan’s syndrome. Circulation 98:II331–II338

    PubMed  CAS  Google Scholar 

  102. Lindeman JH, Abdul-Hussien H, van Bockel JH, Wolterbeek R, Kleemann R (2009) Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm: doxycycline selectively depletes aortic wall neutrophils and cytotoxic T cells. Circulation 119:2209–2216

    PubMed  CAS  Google Scholar 

  103. Abdul-Hussien H, Hanemaaijer R, Verheijen JH, van Bockel JH, Geelkerken RH, Lindeman JH (2009) Doxycycline therapy for abdominal aneurysm: improved proteolytic balance through reduced neutrophil content. J Vasc Surg 49:741–749

    PubMed  Google Scholar 

  104. Canadas V, Vilacosta I, Bruna I, Fuster V (2010) Marfan syndrome. Part 2: treatment and management of patients. Nat Rev Cardiol 7:266–276

    PubMed  CAS  Google Scholar 

  105. Patel ND, Weiss ES, Alejo DE, Nwakanma LU, Williams JA, Dietz HC, Spevak PJ, Gott VL, Vricella LA, Cameron DE (2008) Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures. Ann Thorac Surg 85:2003–2011

    PubMed  Google Scholar 

  106. Volguina IV, Miller DC, Lemaire SA, Palmero LC, Wang XL, Connolly HM, Sundt TM 3rd, Bavaria JE, Dietz HC, Milewicz DM, Coselli JS (2009) Valve-sparing and valve-replacing techniques for aortic root replacement in patients with Marfan syndrome: analysis of early outcome. J Thorac Cardiovasc Surg 137:641–649

    PubMed  Google Scholar 

  107. Ramirez F, Sakai LY (2009) Biogenesis and function of fibrillin assemblies. Cell Tissue Res 339:71–82

    PubMed Central  PubMed  Google Scholar 

  108. Faivre L, Collod-Beroud G, Loeys BL, Child A, Binquet C, Gautier E, Callewaert B, Arbustini E, Mayer K, Arslan-Kirchner M, Kiotsekoglou A, Comeglio P, Marziliano N, Dietz HC, Halliday D, Beroud C, Bonithon-Kopp C, Claustres M, Muti C, Plauchu H, Robinson PN, Ades LC, Biggin A, Benetts B, Brett M, Holman KJ, De Backer J, Coucke P, Francke U, De Paepe A, Jondeau G, Boileau C (2007) Effect of mutation type and location on clinical outcome in 1,013 probands with Marfan syndrome or related phenotypes and FBN1 mutations: an international study. Am J Hum Genet 81:454–466

    PubMed Central  PubMed  CAS  Google Scholar 

  109. Ramirez F, Rifkin DB (2009) Extracellular microfibrils: contextual platforms for TGFβ and BMP signaling. Curr Opin Cell Biol 21:616–622

    PubMed Central  PubMed  CAS  Google Scholar 

  110. Tiecke F, Katzke S, Booms P, Robinson PN, Neumann L, Godfrey M, Mathews KR, Scheuner M, Hinkel GK, Brenner RE, Hovels-Gurich HH, Hagemeier C, Fuchs J, Skovby F, Rosenberg T (2001) Classic, atypically severe and neonatal Marfan syndrome: twelve mutations and genotype-phenotype correlations in FBN1 exons 24-40. Eur J Hum Genet 9:13–21

    PubMed  CAS  Google Scholar 

  111. Loeys BL, Gerber EE, Riegert-Johnson D, Iqbal S, Whiteman P, McConnell V, Chillakuri CR, Macaya D, Coucke PJ, De Paepe A, Judge DP, Wigley F, Davis EC, Mardon HJ, Handford P, Keene DR, Sakai LY, Dietz HC (2010) Mutations in fibrillin-1 cause congenital scleroderma: stiff skin syndrome. Sci Transl Med 2:23ra20

    PubMed Central  PubMed  CAS  Google Scholar 

  112. Faivre L, Gorlin RJ, Wirtz MK, Godfrey M, Dagoneau N, Samples JR, Le Merrer M, Collod-Beroud G, Boileau C, Munnich A, Cormier-Daire V (2003) In frame fibrillin-1 gene deletion in autosomal dominant Weill-Marchesani syndrome. J Med Genet 40:34–36

    PubMed  CAS  Google Scholar 

  113. Le Goff C, Mahaut C, Wang LW, Allali S, Abhyankar A, Jensen S, Zylberberg L, Collod-Beroud G, Bonnet D, Alanay Y, Brady AF, Cordier MP, Devriendt K, Genevieve D, Kiper PO, Kitoh H, Krakow D, Lynch SA, Le Merrer M, Megarbane A, Mortier G, Odent S, Polak M, Rohrbach M, Sillence D, Stolte-Dijkstra I, Superti-Furga A, Rimoin DL, Topouchian V, Unger S, Zabel B, Bole-Feysot C, Nitschke P, Handford P, Casanova JL, Boileau C, Apte SS, Munnich A, Cormier-Daire V (2011) Mutations in the TGFβ binding-protein-like domain 5 of FBN1 are responsible for acromicric and geleophysic dysplasias. Am J Hum Genet 89:7–14

    PubMed Central  PubMed  Google Scholar 

  114. Sood S, Eldadah ZA, Krause WL, McIntosh I, Dietz HC (1996) Mutation in fibrillin-1 and the Marfanoid-craniosynostosis (Shprintzen-Goldberg) syndrome. Nat Genet 12:209–211

    PubMed  CAS  Google Scholar 

  115. Ramirez F, Sakai LY, Dietz HC, Rifkin DB (2004) Fibrillin microfibrils: multipurpose extracellular networks in organismal physiology. Physiol Genomics 19:151–154

    PubMed  CAS  Google Scholar 

  116. Hollister DW, Godfrey M, Sakai LY, Pyeritz RE (1990) Immunohistologic abnormalities of the microfibrillar-fiber system in the Marfan syndrome. N Engl J Med 323:152–159

    PubMed  CAS  Google Scholar 

  117. Carta L, Smaldone S, Zilberberg L, Loch D, Dietz HC, Rifkin DB, Ramirez F (2009) p38 MAPK is an early determinant of promiscuous Smad2/3 signaling in the aortas of fibrillin-1 (Fbn1)-null mice. J Biol Chem 284:5630–5636

    PubMed  CAS  Google Scholar 

  118. Habashi JP, Judge D, Holm TM, Cohn RD, Loeys BL, Cooper TK, Myers L, Klein EC, Liu G, Calvi C, Podowski M, Neptune ER, Halushka MK, Bedja D, Garielson K, Rifkin DB, Carta L, Ramirez F, Huso DL, Dietz HC (2006) Losartan, an AT1 antagonist, prevents aortic aneurysm in a mouse model of Marfan syndrome. Science 312:117–121

    PubMed Central  PubMed  CAS  Google Scholar 

  119. Neptune ER, Frischmeyer PA, Arking DE, Myers L, Bunton TE, Gayraud B, Ramirez F, Sakai LY, Dietz HC (2003) Dysregulation of TGFβ activation contributes to pathogenesis in Marfan syndrome. Nat Genet 33:407–411

    PubMed  CAS  Google Scholar 

  120. Isogai Z, Ono RN, Ushiro S, Keene DR, Chen Y, Mazzieri R, Charbonneau NL, Reinhardt DP, Rifkin DB, Sakai LY (2003) Latent transforming growth factor -binding protein 1 interacts with fibrillin and is a microfibril-associated protein. J Biol Chem 278:2750–2757

    PubMed  CAS  Google Scholar 

  121. Sengle G, Charbonneau NL, Ono RN, Sasaki T, Alvarez J, Keene DR, Bachinger HP, Sakai LY (2008) Targeting of bone morphogenetic protein growth factor complexes to fibrillin. J Biol Chem 283:13874–13888

    PubMed  CAS  Google Scholar 

  122. Pereira L, Lee SY, Gayraud B, Andrikopoulos K, Shapiro SD, Bunton T, Jensen Biery N, Dietz HC, Sakai LY, Ramirez F (1999) Pathogenetic sequence for aneurysm revealed in mice underexpressing fibrillin-1. Proc Natl Acad Sci U S A 96:3819–3823

    PubMed Central  PubMed  CAS  Google Scholar 

  123. Nistala H, Lee-Arteaga S, Carta L, Cook JR, Smaldone S, Siciliano G, Rifkin AN, Dietz HC, Rifkin DB, Ramirez F (2010) Differential effects of alendronate and losartan therapy on osteopenia and aortic aneurysm in mice with severe Marfan syndrome. Hum Mol Genet 19:4790–4798

    PubMed  CAS  Google Scholar 

  124. Judge DP, Biery N, Keene DR, Geubtner J, Myers L, Huso DL, Sakai LY, Dietz HC (2004) Evidence for a critical contribution of haploinsufficiency in the complex pathogenesis of Marfan syndrome. J Clin Invest 114:172–181

    PubMed Central  PubMed  CAS  Google Scholar 

  125. Lim D-S, Lutucuta S, Bachireddy P, Youker K, Evans A, Entman M, Roberts R, Marian AJ (2001) Angiotensin II blockade reverses myocardial fibrosis in a transgenic mouse model of human hypertrophic cardiomyopathy. Circulation 103:789–791

    PubMed Central  PubMed  CAS  Google Scholar 

  126. Lavoie P, Robitaille G, Agharazii M, Ledbetter S, Lebel M, Lariviere R (2005) Neutralization of transforming growth factor-β attenuates hypertension and prevents renal injury in uremic rats. J Hypertens 23:1895–1903

    PubMed  CAS  Google Scholar 

  127. Naito T, Masaki T, Nikolic-Paterson DJ, Tanji C, Yorioka N, Kohno N (2004) Angiotensin II induces thrombospondin-1 production in human mesangial cells via p38 MAPK and JNK: a mechanism for activation of latent TGF-β1. Am J Physiol Renal Physiol 286:F278–F287

    PubMed  CAS  Google Scholar 

  128. Carta L, Pereira L, Arteaga-Solis E, Lee-Arteaga SY, Lenart B, Starcher B, Merkel CA, Sukoyan M, Kerkis A, Hazeki N, Keene DR, Sakai LY, Ramirez F (2006) Fibrillins 1 and 2 perform partially overlapping functions during aortic development. J Biol Chem 281:8016–8023

    PubMed Central  PubMed  CAS  Google Scholar 

  129. Habashi JP, Doyle JJ, Holm TM, Aziz H, Schoenhoff F, Bedja D, Chen Y, Modiri AN, Judge DP, Dietz HC (2011) Angiotensin II type 2 receptor signaling attenuates aortic aneurysm in mice through ERK antagonism. Science 332:361–365

    PubMed Central  PubMed  CAS  Google Scholar 

  130. Holm TM, Habashi JP, Doyle JJ, Bedja D, Chen Y, van Erp C, Lindsay ME, Kim D, Schoenhoff F, Cohn RD, Loeys BL, Thomas CJ, Patnaik S, Marugan JJ, Judge DP, Dietz HC (2011) Noncanonical TGFβ signaling contributes to aortic aneurysm progression in Marfan syndrome mice. Science 332:358–361

    PubMed Central  PubMed  CAS  Google Scholar 

  131. Cook JR, Nistala H, Ramirez F (2010) Drug-based therapies for vascular disease in Marfan syndrome: from mouse models to human patients. Mt Sinai J Med 77:366–373

    PubMed Central  PubMed  Google Scholar 

  132. Nistala H, Lee-Arteaga S, Smaldone S, Siciliano G, Carta L, Ono RN, Sengle G, Arteaga-Solis E, Levasseur R, Ducy P, Sakai LY, Karsenty G, Ramirez F (2010) Fibrillin-1 and -2 differentially modulate endogenous TGFβ and BMP bioavailability during bone formation. J Cell Biol 190:1107–1121

    PubMed  CAS  Google Scholar 

  133. Alliston T, Piek E, Derynck R (2008) TGFβ family signaling in skeletal development, maintenance and disease. In: Derynck R, Miyazono K (eds) The TGFβ family. Cold Spring Harbor Laboratory Press, Cold Spring Harbor, pp 667–723

    Google Scholar 

  134. Janssens K, ten Dijke P, Janssens S, Van Hul W (2005) Transforming growth factor-β1 to the bone. Endocr Rev 26:743–774

    PubMed  CAS  Google Scholar 

  135. Cook JR, Smaldone S, Cozzolino C, Del Solar M, Lee-Arteaga S, Nistala H, Ramirez F (2012) Generation of Fbn1 conditional null mice implicates the extracellular microfibrils in osteoprogenitor recruitment. Genesis 50(8):635–641

    PubMed Central  PubMed  CAS  Google Scholar 

  136. Gigante A, Chillemi C, Greco F (1999) Changes of elastic fibers in musculoskeletal tissues of Marfan syndrome: a possible mechanism of joint laxity and skeletal overgrowth. J Pediatr Orthop 19:283–288

    PubMed  CAS  Google Scholar 

  137. Kronenberg HM (2007) The role of the perichondrium in fetal bone development. Ann N Y Acad Sci 1116:59–64

    PubMed  CAS  Google Scholar 

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Acknowledgments

Studies from the authors’ laboratory described in the review were supported by grants from the National Institutes of Health (AR-049698, AR-42044 and T32GM007280) and the National Marfan Foundation. We thank Ms. Karen Johnson for organizing the manuscript.

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Correspondence to Francesco Ramirez .

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Cook, J.R., Ramirez, F. (2014). Clinical, Diagnostic, and Therapeutic Aspects of the Marfan 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_6

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