Skip to main content

The Ehlers-Danlos Syndrome

  • Chapter
  • First Online:
Progress in Heritable Soft Connective Tissue Diseases

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

Abstract

The Ehlers-Danlos Syndromes comprise a heterogeneous group of diseases, which are characterized by fragility of the soft connective tissues and widespread manifestations in skin, ligaments and joints, blood vessels and internal organs. The clinical spectrum varies from mild skin and joint hyperlaxity to severe physical disability and life-threatening vascular complications. The current Villefranche classification recognizes six subtypes, most of which are linked to mutations in one of the genes encoding fibrillar collagen proteins or enzymes involved in post-translational modification of these proteins. Establishing the correct EDS subtype has important implications for genetic counselling and management and is supported by specific biochemical and molecular investigations. Over the last years, the characterisation of several new EDS variants has broadened insights into the molecular pathogenesis of EDS by implicating genetic defects in the biosynthesis of other extracellular matrix molecules, such as proteoglycans and tenascin-X, or genetic defects in molecules involved in intracellular trafficking, secretion and assembly of extracellular matrix proteins.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

ATCS:

Adducted Thumb Clubfoot Syndrome

ECM:

Extracellular Matrix

EDS:

Ehlers-Danlos Syndrome

ER:

Endoplasmic Reticulum

HP:

Hydroxylysylpyridinoline

JHS:

Joint Hypermobility Syndrome

LP:

Lysylpyridinoline

References

  1. Beighton P et al (1998) Ehlers-Danlos syndromes: revised nosology, Villefranche, 1997. Ehlers- Danlos National Foundation (USA) and Ehlers-Danlos Support Group (UK). Am J Med Genet 77(1):31–37

    Article  PubMed  CAS  Google Scholar 

  2. Smith SM, Birk DE (2010) Focus on molecules: collagens V and XI. Exp Eye Res 2012 May; 98(1): 105–106

    Google Scholar 

  3. Andrikopoulos K et al (1995) Targeted mutation in the col5a2 gene reveals a regulatory role for type V collagen during matrix assembly. Nat Genet 9(1):31–36

    Article  PubMed  CAS  Google Scholar 

  4. Toriello HV et al (1996) A translocation interrupts the COL5A1 gene in a patient with Ehlers- Danlos syndrome and hypomelanosis of Ito. Nat Genet 13(3):361–365

    Article  PubMed  CAS  Google Scholar 

  5. Wenstrup RJ et al (1996) A splice-junction mutation in the region of COL5A1 that codes for the carboxyl propeptide of pro alpha 1(V) chains results in the gravis form of the Ehlers-Danlos syndrome (type I). Hum Mol Genet 5(11):1733–1736

    Article  PubMed  CAS  Google Scholar 

  6. De Paepe A et al (1997) Mutations in the COL5A1 gene are causal in the Ehlers-Danlos syndromes I and II. Am J Hum Genet 60(3):547–554

    PubMed Central  PubMed  Google Scholar 

  7. Schwarze U et al (2000) Null alleles of the COL5A1 gene of type V collagen are a cause of the classical forms of Ehlers-Danlos syndrome (types I and II). Am J Hum Genet 66(6):1757–1765

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  8. Wenstrup RJ et al (2000) COL5A1 haploinsufficiency is a common molecular mechanism underlying the classical form of EDS. Am J Hum Genet 66(6):1766–1776

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  9. Malfait F et al (2005) The molecular basis of classic Ehlers-Danlos syndrome: a comprehensive study of biochemical and molecular findings in 48 unrelated patients. Hum Mutat 25(1):28–37

    Article  PubMed  CAS  Google Scholar 

  10. Symoens S et al (2009) COL5A1 signal peptide mutations interfere with protein secretion and cause classic Ehlers-Danlos syndrome. Hum Mutat 30(2):E395–E403

    Article  PubMed  Google Scholar 

  11. Symoens S et al (2011) A novel splice variant in the N-propeptide of COL5A1 causes an EDS phenotype with severe kyphoscoliosis and eye involvement. PLoS One 6(5):e20121

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  12. Symoens S et al (2012) Comprehensive molecular analysis demonstrates type V collagen mutations in over 90% of patients with classic EDS and allows to refine diagnostic criteria. Hum Mutat 33(10):1485–1493

    Article  PubMed  CAS  Google Scholar 

  13. Beighton P, Solomon L, Soskolne CL (1973) Articular mobility in an African population. Ann Rheum Dis 32(5):413–418

    Article  PubMed  CAS  Google Scholar 

  14. Rombaut L et al (2010) Musculoskeletal complaints, physical activity and health-related quality of life among patients with the Ehlers-Danlos syndrome hypermobility type. Disabil Rehabil 32(16):1339–1345

    Article  PubMed  Google Scholar 

  15. Rombaut L et al (2011) Impairment and impact of pain in female patients with Ehlers-Danlos syndrome: a comparative study with fibromyalgia and rheumatoid arthritis. Arthritis Rheum 63(7):1979–1987

    Article  PubMed  Google Scholar 

  16. Rombaut L et al (2010) Joint position sense and vibratory perception sense in patients with Ehlers-Danlos syndrome type III (hypermobility type). Clin Rheumatol 29(3):289–295

    Article  PubMed  Google Scholar 

  17. Rombaut L et al (2012) Muscle mass, muscle strength, functional performance, and physical impairment in women with the hypermobility type of Ehlers-Danlos syndrome. Arthritis Care Res (Hoboken) 64(10):1584–1592

    Article  Google Scholar 

  18. Hausser I, Anton-Lamprecht I (1994) Differential ultrastructural aberrations of collagen fibrils in Ehlers- Danlos syndrome types I-IV as a means of diagnostics and classification. Hum Genet 93(4):394–407

    Article  PubMed  CAS  Google Scholar 

  19. Zweers MC et al (2003) Haploinsufficiency of TNXB is associated with hypermobility type of Ehlers-Danlos syndrome. Am J Hum Genet 73(1):214–217

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Schalkwijk J et al (2001) A recessive form of the Ehlers-Danlos syndrome caused by tenascin-X deficiency. N Engl J Med 345(16):1167–1175

    Article  PubMed  CAS  Google Scholar 

  21. Dalgleish R (1998) The human collagen mutation database 1998. Nucleic Acids Res 26(1):253–255

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  22. Schwarze U et al (2001) Haploinsufficiency for one COL3A1 allele of type III procollagen results in a phenotype similar to the vascular form of Ehlers-Danlos syndrome, Ehlers-Danlos syndrome type IV. Am J Hum Genet 69(5):989–1001

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  23. Leistritz DF et al (2011) COL3A1 haploinsufficiency results in a variety of Ehlers-Danlos syndrome type IV with delayed onset of complications and longer life expectancy. Genet Med 13(8):717–722

    Article  PubMed  CAS  Google Scholar 

  24. Palmeri S et al (2003) Neurological presentation of Ehlers-Danlos syndrome type IV in a family with parental mosaicism. Clin Genet 63(6):510–515

    Article  PubMed  CAS  Google Scholar 

  25. Milewicz DM et al (1993) Parental somatic and germ-line mosaicism for a multiexon deletion with unusual endpoints in a type III collagen (COL3A1) allele produces Ehlers-Danlos syndrome type IV in the heterozygous offspring. Am J Hum Genet 53(1):62–70

    PubMed Central  PubMed  CAS  Google Scholar 

  26. Kontusaari S et al (1992) Substitution of aspartate for glycine 1018 in the type III procollagen (COL3A1) gene causes type IV Ehlers-Danlos syndrome: the mutated allele is present in most blood leukocytes of the asymptomatic and mosaic mother. Am J Hum Genet 51(3):497–507

    PubMed Central  PubMed  CAS  Google Scholar 

  27. Richards AJ et al (1992) A single base mutation in the gene for type III collagen (COL3A1) converts glycine 847 to glutamic acid in a family with Ehlers-Danlos syndrome type IV. An unaffected family member is mosaic for the mutation. Hum Genet 89(4):414–418

    Article  PubMed  CAS  Google Scholar 

  28. Pinnell SR et al (1972) A heritable disorder of connective tissue. Hydroxylysine-deficient collagen disease. New Engl J Med 286(19):1013–1020

    Article  PubMed  CAS  Google Scholar 

  29. Yeowell HN, Walker LC, Neumann LM (2005) An Ehlers-Danlos syndrome type VIA patient with cystic malformations of the meninges. Eur J Dermatol 15(5):353–358

    PubMed  CAS  Google Scholar 

  30. Giunta C, Randolph A, Steinmann B (2005) Mutation analysis of the PLOD1 gene: an efficient multistep approach to the molecular diagnosis of the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA). Mol Genet Metab 86(1–2):269–276

    Article  PubMed  CAS  Google Scholar 

  31. Abu A et al (2008) Deleterious mutations in the Zinc-Finger 469 gene cause brittle cornea syndrome. Am J Hum Genet 82(5):1217–1222

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  32. Burkitt Wright EM et al (2011) Mutations in PRDM5 in brittle cornea syndrome identify a pathway regulating extracellular matrix development and maintenance. Am J Hum Genet 88(6):767–777

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  33. Meani N et al (2009) The tumor suppressor PRDM5 regulates Wnt signaling at early stages of zebrafish development. PLoS One 4(1):e4273

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  34. Steinmann B, Royce P, Superti-Furga A (2002) The Ehlers-Danlos syndrome. In: Royce P, Steinmann B (eds) Connective tissue and its heritable disorders. Wiley-Liss, New York, pp 431–523

    Chapter  Google Scholar 

  35. Malfait F et al (2010) Musculocontractural Ehlers-Danlos Syndrome (former EDS type VIB) and adducted thumb clubfoot syndrome (ATCS) represent a single clinical entity caused by mutations in the dermatan-4-sulfotransferase 1 encoding CHST14 gene. Hum Mutat 31(11):1233–1239

    Article  PubMed  CAS  Google Scholar 

  36. Kosho T et al (2010) A new Ehlers-Danlos syndrome with craniofacial characteristics, multiple congenital contractures, progressive joint and skin laxity, and multisystem fragility-related manifestations. Am J Med Genet A 152A(6):1333–1346

    PubMed  Google Scholar 

  37. Miyake N et al (2010) Loss-of-function mutations of CHST14 in a new type of Ehlers-Danlos syndrome. Hum Mutat 31(8):966–974

    Article  PubMed  CAS  Google Scholar 

  38. Shimizu K et al (2011) Delineation of dermatan 4-O-sulfotransferase 1 deficient Ehlers-Danlos syndrome: observation of two additional patients and comprehensive review of 20 reported patients. Am J Med Genet A 155A(8):1949–1958

    Article  PubMed  CAS  Google Scholar 

  39. Quentin E et al (1990) A genetic defect in the biosynthesis of dermatan sulfate proteoglycan: galactosyltransferase I deficiency in fibroblasts from a patient with a progeroid syndrome. Proc Natl Acad Sci U S A 87(4):1342–1346

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  40. Malfait F, Kariminejad A, Van Damme T, Gauche C, Syx D, Merhi-Soussi F, Gulberti S, Symoens S, Vanhauwaert S, Willaert A, Bozorgmehr B, Kariminejad MH, Ebrahimiadib N, Hausser I, Huysseune A, Fournel-Gigleux S, De Paepe A (2013) Defective initiation of glycosaminoglycan synthesis due to B3GALT6 mutations causes a pleiotropic Ehlers-Danlos syndrome-like connective tissue disorder. Am J Hum Genet 2013 May 7 (E-pub ahead of print)

    Google Scholar 

  41. Nakajima M, Mizumoto S, Miyake N, Kogawa R, Iida A, Ito H, Kitoh H, Hirayama A, Mitsubuchi H, Miyazaki O, Kosaki R, Horikawa R, Lai A, Mendoza-Londono R, Dupuis L, Chitayat D, Howard A, Leal GF, Cavalcanti D, Tsurusaki Y, Saitsu H, Watanabe S, Lausch E, Unger S, Bonafé L, Ohashi H, Superti-Furga A, Matsumoto N, Sugahara K, Nishimura G, Ikegawa S (2013) Mutations in B3GALT6, which encodes a glycosaminoglycan linker region enzyme, cause a spectrum of skeletal and connective tissue disorders. Am J Hum Genet 2013 May 7 (E-pub ahead of print)

    Google Scholar 

  42. Giunta C et al (2008) Spondylocheiro dysplastic form of the Ehlers-Danlos syndrome–an autosomal-recessive entity caused by mutations in the zinc transporter gene SLC39A13. Am J Hum Genet 82(6):1290–1305

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  43. Baumann M et al (2012) Mutations in FKBP14 cause a variant of Ehlers-Danlos syndrome with progressive kyphoscoliosis, myopathy, and hearing loss. Am J Hum Genet 90(2):201–216

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  44. Cabral WA et al (2005) Mutations near amino end of alpha 1(I) collagen cause combined OI/EDS by interference with N-propeptide processing. J Biol Chem 280(19):19259–19269

    Article  PubMed  CAS  Google Scholar 

  45. Malfait F, Symoens S, Goemans N, Gyftodimou Y, Holmberg E, López-González V, Mortier G, Nampoothiri S, Petersen MB, De Paepe A (2013) Helical mutations in type I collagen that affect the processing of the amino-propeptide result in an Osteogenesis Imperfecta/Ehlers-Danlos Syndrome overlap syndrome. Orphanet J Rare Dis 8:78

    Article  PubMed Central  PubMed  Google Scholar 

  46. Makareeva E et al (2006) Molecular mechanism of alpha 1(I)-osteogenesis imperfecta/Ehlers-Danlos syndrome: unfolding of an N-anchor domain at the N-terminal end of the type I collagen triple helix. J Biol Chem 281(10):6463–6470

    Article  PubMed  CAS  Google Scholar 

  47. Malfait F et al (2004) The natural history, including orofacial features of three patients with Ehlers-Danlos syndrome, dermatosparaxis type (EDS type VIIC). Am J Med Genet A 131(1):18–28

    Article  PubMed  Google Scholar 

  48. Pierard GE, Lapiere M (1976) Skin in dermatosparaxis. Dermal microarchitecture and biomechanical properties. J Invest Dermatol 66(1):2–7

    Article  PubMed  CAS  Google Scholar 

  49. Nusgens BV et al (1992) Evidence for a relationship between Ehlers-Danlos type VII C in humans and bovine dermatosparaxis. Nat Genet 1(3):214–217

    Article  PubMed  CAS  Google Scholar 

  50. Schwarze U et al (2004) Rare autosomal recessive cardiac valvular form of Ehlers-Danlos syndrome results from mutations in the COL1A2 gene that activate the nonsense-mediated RNA decay pathway. Am J Hum Genet 74(5):917–930

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  51. Malfait F et al (2006) Total absence of the alpha2(I) chain of collagen type I causes a rare form of Ehlers-Danlos syndrome with hypermobility and propensity to cardiac valvular problems. J Med Genet 43(7):e36

    Article  PubMed  CAS  Google Scholar 

  52. Nuytinck L et al (2000) Classical Ehlers-Danlos syndrome caused by a mutation in type I collagen. Am J Hum Genet 66(4):1398–1402

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  53. Malfait F et al (2007) Three arginine to cysteine substitutions in the pro-alpha (I)-collagen chain cause Ehlers-Danlos syndrome with a propensity to arterial rupture in early adulthood. Hum Mutat 28(4):387–395

    Article  PubMed  CAS  Google Scholar 

  54. Cabral WA et al (2007) Y-position cysteine substitution in type I collagen (alpha1(I) R888C/p.R1066C) is associated with osteogenesis imperfecta/Ehlers-Danlos syndrome phenotype. Hum Mutat 28(4):396–405

    Article  PubMed  CAS  Google Scholar 

  55. Lund A et al (2008) A novel arginine-to-cysteine substitution in the triple helical region of the alpha1(I) collagen chain in a family with an osteogenesis imperfecta/Ehlers-Danlos phenotype. Clin Genet 73(1):97–101

    Article  PubMed  CAS  Google Scholar 

  56. Gensure RC et al (2005) A novel COL1A1 mutation in infantile cortical hyperostosis (Caffey disease) expands the spectrum of collagen-related disorders. J Clin Invest 115(5):1250–1257

    PubMed Central  PubMed  CAS  Google Scholar 

  57. Rohrbach M et al (2011) Phenotypic variability of the kyphoscoliotic type of Ehlers-Danlos syndrome (EDS VIA): clinical, molecular and biochemical delineation. Orphanet J Rare Dis 6:46

    Article  PubMed Central  PubMed  Google Scholar 

  58. Faber P et al (2007) The successful use of recombinant factor VIIa in a patient with vascular-type Ehlers-Danlos syndrome. Acta Anaesthesiol Scand 51(9):1277–1279

    PubMed  CAS  Google Scholar 

  59. Freeman RK, Swegle J, Sise MJ (1996) The surgical complications of Ehlers-Danlos syndrome. Am Surg 62(10):869–873

    PubMed  CAS  Google Scholar 

  60. Cikrit DF, Miles JH, Silver D (1987) Spontaneous arterial perforation: the Ehlers-Danlos specter. J Vasc Surg 5(2):248–255

    PubMed  CAS  Google Scholar 

  61. Oderich GS et al (2005) The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a 30-year experience. J Vasc Surg 42(1):98–106

    Article  PubMed  Google Scholar 

  62. Pepin M et al (2000) Clinical and genetic features of Ehlers-Danlos syndrome type IV, the vascular type. N Engl J Med 342(10):673–680

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anne De Paepe .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Malfait, F., De Paepe, A. (2014). The Ehlers-Danlos 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_9

Download citation

Publish with us

Policies and ethics