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Periodontal (formerly type VIII ) Ehlers–Danlos syndrome: Description of 13 novel cases and expansion of the clinical phenotype
Author(s) -
El Chehadeh Salima,
Legrand Anne,
Stoetzel Corinne,
Geoffroy Véronique,
Billon Clarisse,
Adham Salma,
Jeunemaître Xavier,
Jaussaud Roland,
Muller Jean,
Schaefer Elise,
Benistan Karelle,
Gaertner Sébastien,
BlochZupan Agnès,
Courval Aymeric,
Manière MarieCécile,
Petit Catherine,
Bursztejn AnneClaire,
Bal Laurence,
Reyre Anthony,
Chammas Agathe,
Busa Tiffany,
Dollfus Hélène,
Lipsker Dan
Publication year - 2021
Publication title -
clinical genetics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.543
H-Index - 102
eISSN - 1399-0004
pISSN - 0009-9163
DOI - 10.1111/cge.13972
Subject(s) - ehlers–danlos syndrome , medicine , marfan syndrome , aneurysm , phenotype , skin hyperpigmentation , hyperpigmentation , pathology , dermatology , surgery , gene , biology , genetics
Periodontal Ehlers–Danlos syndrome (pEDS) is a rare condition caused by pathogenic variants in the C1R and C1S genes, encoding subunits C1r and C1s of the first component of the classical complement pathway. It is characterized by early‐onset periodontitis with premature tooth loss, pretibial hyperpigmentation and skin fragility. Rare arterial complications have been reported, but venous insufficiency is rarely described. Here we report 13 novel patients carrying heterozygous pathogenic variants in C1R and C1S including three novel C1S variants ( c.962G > C, c.961 T > G and c.961 T > A). In addition to the pEDS phenotype, three patients and one relative displayed widespread venous insufficiency leading to persistent varicose leg ulcers. One patient suffered an intracranial aneurysm with familial vascular complications including thoracic and abdominal aortic aneurysm and dissection and intracranial aneurysm rupture. This work confirms that vascular complications can occur, although they are not frequent, which leads us to propose to carry out a first complete non‐invasive vascular evaluation at the time of the diagnosis in pEDS patients. However, larger case series are needed to improve our understanding of the link between complement pathway activation and connective tissue alterations observed in these patients, and to better assess the frequency, type and consequences of the vascular complications.