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van Dijk FS, Ghali N, Chandratheva A. Ehlers-Danlos syndromes: importance of defining the type. Pract Neurol 2024; 24:90-97. [PMID: 38160052 DOI: 10.1136/pn-2023-003703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 01/03/2024]
Abstract
Ehlers-Danlos syndromes (EDS) is an umbrella term describing 14 types, of which 13 are rare and monogenic, with overlapping features of joint hypermobility, skin, and vascular fragility, and generalised connective tissue friability. Hypermobile EDS currently has no identified genetic cause. Most of the rare monogenic EDS types can have neurological features, which are often part of major or minor diagnostic criteria for each type. This review aims to highlight the neurological features and other key characteristics of these EDS types. This should improve recognition of these features, enabling more timely consideration and confirmation or exclusion through genetic testing. In practice, many healthcare professionals still refer to patients as having 'EDS'. However, the different EDS types have distinct clinical features as well as different underlying genetic causes and pathogenic mechanisms, and each requires bespoke management and surveillance. Defining the EDS type is therefore crucial, as EDS is not in itself a diagnosis.
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Affiliation(s)
- Fleur S van Dijk
- National EDS Service London, London North West University Healthcare NHS Trust, Harrow, London, UK
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, UK
| | - Neeti Ghali
- National EDS Service London, London North West University Healthcare NHS Trust, Harrow, London, UK
- Department of Metabolism, Digestion and Reproduction, Section of Genetics and Genomics, Imperial College London, London, UK
| | - Arvind Chandratheva
- National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Bowen JM, Hernandez M, Johnson DS, Green C, Kammin T, Baker D, Keigwin S, Makino S, Taylor N, Watson O, Wheeldon NM, Sobey GJ. Diagnosis and management of vascular Ehlers-Danlos syndrome: Experience of the UK national diagnostic service, Sheffield. Eur J Hum Genet 2023; 31:749-760. [PMID: 36977837 PMCID: PMC10326011 DOI: 10.1038/s41431-023-01343-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/08/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
The UK National Diagnostic Service for Ehlers-Danlos Syndromes (EDS) was established in 2009 for the rare types of EDS. Vascular EDS (vEDS) is an inherited connective tissue disorder caused by pathogenic variants in the COL3A1 gene. Associated tissue fragility affects multiple organ systems, increasing the risk of blood vessel dissection and rupture, with potentially fatal consequences. The diagnosis of vEDS has improved with advances in genetic testing, however this is most often suspected following an acute event. We provide data on the clinical features of vEDS for 180 patients (full cohort) seen in our service with confirmed molecular diagnoses. Increased awareness of this rare condition will prompt genetic testing essential to confirm the diagnosis. Outcomes are improved by early diagnosis followed by appropriate management. Fragile connective tissues make invasive procedures potentially dangerous, particularly in an emergency setting. Lifestyle advice from a young age can help acceptance and understanding of the diagnosis and inform choices. There is currently limited evidence for the use of drug therapy to reduce vascular events. We report on the incidence of vascular events in 126 patients (statistical analysis cohort) in our care and the use of medication. Our retrospective data showed that those patients on a long-term angiotensin II receptor blocker and/or beta-blocker had fewer vascular events than those not on cardiac medication who received the same lifestyle and emergency care advice.
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Affiliation(s)
- Jessica M Bowen
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospital NHS Foundation Trust, OPD2 Department, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Monica Hernandez
- Health Economics and Decision Science, ScHARR, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Diana S Johnson
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospital NHS Foundation Trust, OPD2 Department, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Claire Green
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospital NHS Foundation Trust, OPD2 Department, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Tammy Kammin
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospital NHS Foundation Trust, OPD2 Department, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Duncan Baker
- Sheffield Diagnostic Genetics Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Sylvia Keigwin
- Sheffield Diagnostic Genetics Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Seiko Makino
- Sheffield Diagnostic Genetics Service, Sheffield Children's Hospital NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Naomi Taylor
- South Yorkshire Regional Inherited Cardiac Conditions Service, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Oliver Watson
- South Yorkshire Regional Inherited Cardiac Conditions Service, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Nigel M Wheeldon
- South Yorkshire Regional Inherited Cardiac Conditions Service, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Glenda J Sobey
- Ehlers-Danlos Syndrome National Diagnostic Service, Sheffield Children's Hospital NHS Foundation Trust, OPD2 Department, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
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Congenital Defects in a Patient Carrying a Novel Homozygous AEBP1 Variant: Further Expansion of the Phenotypic Spectrum of Ehlers-Danlos Syndrome Classical-like Type 2? Genes (Basel) 2022; 13:genes13122358. [PMID: 36553625 PMCID: PMC9777638 DOI: 10.3390/genes13122358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
In 2018, a new clinical subtype, caused by biallelic variants in the AEBP1 gene, encoding the ACLP protein, was added to the current nosological classification of the Ehlers-Danlos Syndromes (EDS). This new phenotype, provisionally termed EDS classical-like type 2 (clEDS2), has not yet been fully characterized, as only nine cases have been reported to date. Here we describe a patient, homozygous for a novel AEBP1 pathogenic variant (NM_001129.5 c.2123_2124delTG (p.Val708AlafsTer5)), whose phenotype is reminiscent of classical EDS but also includes previously unreported multiple congenital malformations. Furthermore, we briefly summarize the current principal clinical manifestations of clEDS2 and the molecular evidence surrounding the role of AEBP1 in the context of extracellular matrix homeostasis and connective tissue development. Although a different coexisting etiology for the multiple congenital malformations of our patient cannot be formally excluded, the emerging role of ACLP in TGF-β and WNT pathways may explain their occurrence and the phenotypical variability of clEDS2.
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