Background: Mild intrinsic cardiomyopathy in patients with Marfan syndrome (MFS) has consistently been evidenced by independent research groups. So far, little is known about the long-term evolution and pathophysiology of this finding. Methods: To gain more insights into the pathophysiology of MFS-related cardiomyopathy, we performed in-vivo and ex-vivo studies of 11 Fbn1 C1039G/+ mice and 9 wild-type (WT) littermates. Serial ultrasound findings obtained in mice were correlated to the human phenotype. We therefore reassessed left ventricular (LV) function parameters over a 6-y follow-up period in 19 previously reported MFS patients, in whom we documented mild LV dysfunction.
results: Fbn1C1039G/+ mice demonstrated LV contractile dysfunction. Subsequent ex-vivo studies of the myocardium of adult mutant mice revealed upregulation of TGFβ-related pathways and consistent abnormalities of the microfibrillar network, implicating a role for microfibrils in the mechanical properties of the myocardium. Echocardiographic parameters did not indicate clinical significant deterioration of LV function during follow-up in our patient cohort. conclusion: In analogy with what is observed in the majority of MFS patients, the Fbn1 C1039G/+ mouse model demonstrates mild intrinsic LV dysfunction. Both extracellular matrix and molecular alterations are implicated in MFS-related cardiomyopathy. This model may now enable us to study therapeutic interventions on the myocardium in MFS.
M arfan syndrome (MFS, GenBank accession nos. L13923)is an autosomal dominant inherited connective tissue disorder caused by mutations in the fibrillin-1 gene (FBN1) encoding the extracellular matrix protein fibrillin-1. The clinical diagnosis of MFS relies on the identification of characteristic clinical manifestations, mainly occurring in the cardiovascular, musculoskeletal, and ocular system, as summarized in the ''Revised Ghent Nosology'' , and may be supplemented by the identification of a causal FBN1 mutation (1).Cardiovascular involvement in MFS is characterized by progressive dilatation of the ascending aorta at the level of the sinuses of Valsalva, ensuing a risk for type A aortic dissection or -rupture and aortic valve regurgitation (2). Other established cardiovascular manifestations of MFS include mitral valve prolapse and pulmonary artery dilatation. More recently, several independent studies demonstrated the presence ofmostly subclinical-intrinsic cardiomyopathy (CMP) with both left and right ventricular (LV and RV) systolic and diastolic dysfunction in MFS patients (3,4). The current knowledge of MFS-related CMP is based on cross-sectional studies, but little is known about the long-term evolution and pathophysiology of this finding.To unravel the underlying pathophysiology of MFS-related CMP, the knowledge obtained from the study of other MFS manifestations may at least be partly translated to the cardiac phenotype. Upregulation of TGFβ signaling, with activation of the canonical (SMAD2/3) and noncanonical (predominantly ERK1/2) pathways, i...