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Analysis of multigenerational families with thoracic aortic aneurysms and dissections due to TGFBR1 or TGFBR2 mutations
  1. V Tran-Fadulu1,
  2. H Pannu1,
  3. D H Kim1,
  4. G W Vick III2,
  5. C M Lonsford1,
  6. A L Lafont1,
  7. C Boccalandro1,
  8. S Smart1,
  9. K L Peterson3,
  10. J Zenger Hain4,
  11. M C Willing5,
  12. J S Coselli2,
  13. S A LeMaire2,
  14. C Ahn1,
  15. P H Byers6,
  16. D M Milewicz1
  1. 1
    Department of Internal Medicine and Department of Neurosurgery, University of Texas Health Science Center at Houston, Texas, USA
  2. 2
    Department of Pediatric Cardiology and Division of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Texas, USA
  3. 3
    Division of Cardiology, University of California, San Diego Medical Center, San Diego, California, USA
  4. 4
    Oakwood Healthcare System, Dearborn, Michigan, USA
  5. 5
    Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA
  6. 6
    Department of Pathology, University of Washington School of Medicine, Seattle, Washington, USA
  1. Correspondence to Dr D M Milewicz, 6431 Fannin, MSB 6.100, Houston, Texas 77030, USA; Dianna.M.Milewicz{at}uth.tmc.edu

Abstract

Background: Mutations in the transforming growth factor β receptor type I and II genes (TGFBR1 and TGFBR2) cause Loeys–Dietz syndrome (LDS), characterised by thoracic aortic aneurysms and dissections (TAAD), aneurysms and dissections of other arteries, craniosynostosis, cleft palate/bifid uvula, hypertelorism, congenital heart defects, arterial tortuosity, and mental retardation. TGFBR2 mutations can also cause TAAD in the absence of features of LDS in large multigenerational families, yet only sporadic LDS cases or parent–child pairs with TGFBR1 mutations have been reported to date.

Methods: The authors identified TGFBR1 missense mutations in multigenerational families with TAAD by DNA sequencing. Clinical features of affected individuals were assessed and compared with clinical features of previously described TGFBR2 families.

Results: Statistical analyses of the clinical features of the TGFBR1 cohort (n = 30) were compared with clinical features of TGFBR2 cohort (n = 77). Significant differences were identified in clinical presentation and survival based on gender in TGFBR1 families but not in TGFBR2 families. In families with TGFBR1 mutations, men died younger than women based on Kaplan–Meier survival curves. In addition, men presented with TAAD and women often presented with dissections and aneurysms of arteries other than the ascending thoracic aorta. The data also suggest that individuals with TGFBR2 mutations are more likely to dissect at aortic diameters <5.0 cm than individuals with TGFBR1 mutations.

Conclusion: This study is the first to demonstrate clinical differences between patients with TGFBR1 and TGFBR2 mutations. These differences are important for the clinical management and outcome of vascular diseases in these patients.

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Footnotes

  • ▸ Additional figures are published online only at http://jmg.bmj.com/content/vol46/issue9

  • Funding Sources which funded these studies: P50HL083794-01 (DMM), RO1 HL62594 (DMM), and UL1 RR024148 (CTSA). DMM is a Doris Duke Distinguished Clinical Scientist. SAL is supported by a Thoracic Surgery Foundation for Research and Education/NHLBI Clinical Scientist Development Award (K08 HL080085).

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

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