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The Ehlers-Danlos syndrome is a rare (orphan) disease characterized by the connective tissue dysplasia, fragility of the blood vessels and tissues, and variable clinical pattern. The vascular type of Ehlers-Danlos syndrome, which belongs to Group A according to the classification of 2017, is caused by the mutations in gene of alpha-1 chain of type III collagen COL3A1. The disease is characterized by the high mortality rate of the patients due to the spontaneous ruptures of the vascular walls and hollow viscera. The International Consortium (2017) developed the criteria for the clinical diagnosis of the vascular type of Ehlers – Danlos syndrome. The clinical case of the 16-year-old male patient with vascular type of Ehlers – Danlos syndrome is presented. The molecular genetic testing revealed in the child the previously described pathogenic mutation of splice site p.Gly798_Pro815del of COL3A1 gene associated with the severe course of the disease. In spite of the set of therapy measures aimed at the vascular reinforcement, stimulation and normalization of energy and mineral metabolism, the death occurred in 10 months due to the rupture of the aorta and renal artery. The Conclusion of the forensic medical examination is presented. The results of the care presented indicate that in order to avoid the omission of patients, it is advisable to revise the minimum set of signs required for the clinical diagnosis.

In this report, we present the case of a 3-year-old child with vascular Ehlers-Danlos syndrome (vEDS) previously known as Ehlers-Danlos syndrome type IV. After experiencing a minor traumatic injury to the abdomen, consisting of falling over a bathroom stool on the way to the restroom with a full bladder, the child developed acute abdominal pain. He was found to have an intraperitoneal bladder rupture that was successfully repaired with management techniques tailored to his known diagnosis of vEDS. While tissue fragility and internal organ rupture occurring with minor trauma are known complications of vEDS, this is the first case in the literature of a bladder rupture in a child with vEDS with a confirmed variant in the COL3A1 gene, to our knowledge. This case broadens the clinical presentation of vEDS, demonstrates that children can have life-threatening organ rupture at a young age, and may alert providers to consider this diagnosis when a child presents with bladder rupture.

Vascular Ehlers‐Danlos syndrome (vEDS) is a rare and severe hereditary connective tissue disease arising from a mutation in the type III collagen alpha I chain (COL3A1) gene, with a poor prognosis due to exceptional vascular ruptures and premature death. Herein, starting from a 36‐year‐old Chinese male patient with a complaint of upper abdominal pain, we collected clinical data of and performed a genetic analysis of a total of 20 family members. We identified two closely spaced COL3A1 missense variants in cis, p.Leu734Phe (c.2199_2200TC>AT) and p.Gly741Ser (c.2221G>A), as the cause of vEDS in this family. p.Gly741Ser, a glycine substitution mutation, has been previously reported, whereas p.Leu734Phe, a non‐glycine substitution mutation, is novel. We analysed their independent and combined effects on the COL3A1 level in transfected skin fibroblast cells by means of Western blotting. We found that both variants independently led to a reduced COL3A1 level and, when combined, led to an even more reduced COL3A1 level compared to the wild type. Thus, each missense variant can be independently classified as a pathogenic variant, albeit with a synergetic effect when occurring together. Moreover, our genetic findings provide an explanation for four previous sudden deaths and identified two high‐risk carriers in the family.

Genetic variations of type III collagen may compromise the supportive structures of the female pelvic floor and consequently favor pelvic organ prolapse. The single nucleotide polymorphism G/A rs1800255 located in the coding region for type III collagen (COL3A1) was evaluated as a risk factor for pelvic organ prolapse. A single-center prospective cohort study including women with clinical diagnosis of stage III and IV prolapse (POP group) and prolapse stage 0 or I (control group). Sociodemographic, clinical data and obstetric history were retrieved by physician interview. DNA including the rs1800255 polymorphism was amplified by polymerase chain reaction from blood genomic cells and digested with AluI restriction enzyme for distinction of G and A variants. Qualitative variables were compared using the chi-square and Fisher’s exact tests and unpaired t-test for quantitative variables. After stratification of the groups, risk factors for POP were estimated using odds ratios (ORs) from the binary logistic regression model. A total of 292 women were included, 112 in the POP group and 180 in the control group. There was no significant difference between groups regarding rs1800255. Age and home birth were the only significant risk factors for pelvic organ prolapse. Polymorphism rs1800255 from COL3A1 gene was not a risk factor for pelvic organ prolapse.

Ehlers-Danlos syndrome (EDS) is an inherited connective tissue disorder that is caused by defects in collagen, other extracellular matrix proteins, or associated enzymes. As of 2017, the syndrome comprises 13 subtypes with a significant overlap in features.1 Among them, vascular EDS (vEDS), the most severe subtype in terms of clinical manifestation and mortality, is caused by a mutation of the COL3A1 gene encoding collagen type III alpha 1 chain. With regard to signs and symptoms, in contrast to classical EDS involving flexible joint structures and stretchy cutaneous tissue, vEDS is characterized by translucent skin; fragile arteries, muscles, and internal organs; and sometimes a characteristic facial appearance. We recently encountered a young male patient with advanced chronic kidney disease who needed to start hemodialysis (HD). During his surgeries to form vascular access, his brachial artery (BA) and its branch arteries were unusually friable, which led us to believe that he had profound vascular fragility due to some congenital disorder. Here, we describe a clinical history ending with a vEDS diagnosis and a practical approach to vEDS complicated by end-stage kidney disease (ESKD).

Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder due to its high tendency of arterial and organ rupture. Pulmonary complications in vEDS are rare. We present a young male patient with vEDS who developed severe pulmonary complications and severe rupture of the iliac artery at different stages of his life. Vascular Ehlers-Danlos syndrome was diagnosed based on clinical manifestations and confirmed by the identification of COL3A1 gene mutation. Due to high bleeding tendency and weak cardiopulmonary capacity, conservative treatment was taken for him. To our knowledge, this is the first report of vEDS case in which the patient developed both pulmonary complications and dissection of large arteries. Our report emphasizes the importance of considering vEDS when an adolescent develops unexplained pulmonary cysts with fragility of lung tissues. Genetic counseling and close monitoring should be performed for earlier diagnosis and prevention of severe complications of large arteries. The typical presentations of vEDS were also discussed by means of a review of case reports on vEDS with pulmonary complications.

Background: Vascular Ehlers-Danlos syndrome is a rare inherited connective tissue disease secondary to mutations within the COL3A1 gene. The diagnosis of vascular Ehlers-Danlos syndrome is challenging, and patient selection for genetic testing relies on diagnostic criteria, which have never been evaluated. Methods: All patients seen at a dedicated tertiary referral center for a suspicion of vascular Ehlers-Danlos syndrome between January 2001 and March 2016 were retrospectively included in a diagnostic accuracy study. Major and minor diagnostic criteria of the Villefranche classification were tested for sensitivity, specificity, positive and negative predictive values, according to results of genetic testing. Results: N=519 patients were eligible for analysis dividing into n=384 probands and n=135 relatives. A pathogenic COL3A1 variant was identified in n=165 (31.8%) patients. The Villefranche criteria were met for n=248 patients with a sensitivity of 79% (95% CI, 0.72–0.85) and a negative predictive value of 87% (95% CI, 0.83–0.91). Diagnostic accuracy was highest for symptomatic probands (sensitivity 92%; negative predictive value 95%) with limited specificity (60%). Probands ≤25 years had the worst diagnostic performance. The revised diagnostic Criteria (2017) were less accurate than the Villefranche classification (overall diagnostic odds-ratio, 4.17 versus 7.8; probands diagnostic odds-ratio, 4.04 versus 18.1; and probands ≤25 years diagnostic odds-ratio, 2.36 versus 5.1) mainly due to a lack of sensitivity. Conclusions: The Villefranche criteria provide accurate detection of symptomatic probands in specialized practice but have limited specificity. The revised diagnostic criteria for vascular Ehlers-Danlos syndrome have increased specificity, but its overall performance is poorer. The early clinical diagnosis of probands without family history is not addressed by both diagnostic classifications.

In this paper, we describe the case of a 29-year-old Caucasian male who was reported dead in his home. In 2010, a diagnosis of acrogeria, Gottron type was obtained by genetic analysis of a COL3A1 gene mutation. External examination showed typical characteristics of acrogeria, Gottron type. Autopsy showed a full-thickness laceration in the inferior vena cava wall, which caused hemorrhage and death. Samples of inferior vena cava were processed by Masson trichrome staining, which revealed a reduction in vessel wall thickness and a decrease in the amount of elastic fibers. An antibody reaction with BCL-2 was intensely positive. Our case is extremely rare in the medical field and in the world of scientific literature, both because the patient had a variant of acrogeria, Gottron type and because of the cause of death, which is not typical of Ehlers-Danlos syndrome. To the best of our knowledge, this very rare event has not previously been reported in the international scientific literature.

Ehlers-Danlos Syndrome comprises a heterogeneous group of heritable connective tissue disorders resulting from various gene mutations. We present an unusual case of vascular Ehlers-Danlos Syndrome with distinctive physical characteristics and a cardiomyopathy with features suggesting isolated left ventricular non-compaction. The cardiac features represent the first report of a cardiomyopathy associated with a mutation in the COL3A1 gene. This case also illustrates the multi-system nature of Ehlers-Danlos Syndrome and the complexity of managing patients with the vascular subtype.

Vascular Ehlers-Danlos syndrome (EDS IV) is a rare genetic disorder characterized by an alteration in the COL3A1 gene which encodes type III collagen. It is the most common type of collagen in vessels of medium size and certain organs such as the intestines and the uterus. The alteration of this type of collagen produces aneurisms and ruptures of vessels and organs. A high level of clinical suspicion is required for diagnosis. It is a complex disease whose management requires a multidisciplinary team to treat the different complications that may occur. We report the case of a 50-year-old man diagnosed with EDS IV detected incidentally after hemothorax secondary to a coughing spell.

Vascular Ehlers-Danlos syndrome (EDS IV ) is a rare genetic disorder characterised by an alteration in the COL3A1 gene which encodes type III collagen. It is the most common type of collagen in vessels of medium size and certain organs such as the intestines and the uterus. The alteration of this type of collagen produces aneurisms and ruptures of vessels and organs. A high level of clinical suspicion is required for diagnosis. It is a complex disease whose management requires a multidisciplinary team to treat the different complications that may occur. We report the case of a 50-year-old man diagnosed with EDS IV detected incidentally after haemothorax secondary to a coughing spell.

Rationale: Vascular Ehlers–Danlos syndrome (vEDS) is a rare autosomal dominant inherited collagen disorder caused by defects or deficiency of pro-alpha 1 chain of type III procollagen encoded by COL3A1. vEDS is characterized not only by soft tissue manifestations including hyperextensibility of skin and joint hypermobility but also by early mortality due to rupture of arteries or vital organs. Although pulmonary complications are not common, vEDS cases complicated by pneumothorax, hemothorax, or intrapulmonary hematoma have been reported. When a patient initially presents only with pulmonary complications, it is not easy for clinicians to suspect vEDS. Patient concerns: We report a case of an 18-year-old high school student, with a past history of cryptorchidism, presenting with recurrent pneumothorax. Diagnoses: Routine laboratory findings were unremarkable. Chest high resolution computed tomographic scan showed age-unmatched hyperinflation of both lungs, atypical cystic changes and multifocal ground glass opacities scattered in both lower lobes. His slender body shape, hyperflexible joints, and hyperextensible skin provided clue to suspicion of a possible connective tissue disorder. Interventions: The histological examination of the lung lesions showed excessive capillary proliferation in the pulmonary interstitium and pleura allowing the diagnosis of pulmonary capillary hemangiomatosis (PCH)-like foci. Genetic study revealed COL3A1 gene splicing site mutation confirming his diagnosis as vEDS. Outcomes: Although his diagnosis vEDS is notorious for fatal vascular complication, there was no evidence of such complication at presentation. Fortunately, he has been followed up for 10 months without pulmonary or vascular complications. Lessons: To the best of our knowledge, both cryptorchidism and PCH-like foci have never been reported yet as complications of vEDS, suggesting our case might be a new variant of this condition. This case emphasizes the importance of comprehensive physical examination and history-taking, and the clinical suspicion of a possible connective tissue disorder when we encounter cases with atypical presentation and/or unique chest radiologic findings especially in young patients.

A total of 192 broiler chicks were used to evaluate the influence of dietary α-lipoic acid (ALA) on growth performance, carcass characteristics and meat quality of broiler chickens with the purpose of developing a strategy to prevent the occurrence of pale, soft, and exudative (PSE) meat and to improve the meat quality of broilers. At 22 d of age, birds were allocated to 4 ALA treatments (0, 400, 800, and 1200 ppm). The results showed that dietary ALA significantly decreased average feed intake (AFI), average daily gain (ADG), final live body weight (BW) and carcass weight (p

Vascular type of Ehlers-Danlos syndrome (EDS), also known as EDS type IV (NIM#130050) is a life-threatening autosomal dominant inherited disorder of connective tissue, caused by mutations of the COL3A1 gene. Vascular EDS causes severe fragility of connective tissues with arterial and intestinal ruptures and complications of surgical and radiological treatment, and is of particular importance to medical professionals of many specialties: surgeons, internists, radiologists, and obstetricians. An accurate diagnosis may help in the management of visceral complications. In addition, when a family is faced with new information concerning a positive genetic test for vascular EDS, it is crucial that follow-up care for the family include comprehensive genetic counseling. After the genetic diagnosis of a COL3A1 mutation, various medical specialists, including the clinical geneticists must cooperate to perform genetic counseling and to provide a system of long-term follow up for individuals with vascular EDS.

Eighty-four castrated boars including Laiwu Black (LW) (weight 30-90 kg, n=6) and Lulai Black (LL) (weight 40-100 kg, n=6) were used to study the developmental changes of collagen type III alpha 1 (Col3a1) mRNA expression in the muscle and their association with intramuscular collagen (IMC). The muscle total RNA was extracted to determine the abundance of Col3a1 mRNA using relative quantitative RT-PCR with beta-actin mRNA as the internal standard. The results indicated that the developmental patterns of muscle Col3a1 mRNA in LW and LL pigs were similar. The abundance of Col3a1 mRNA increased with body weight, but decreased a little at 70 kg and 80 kg phases for LW and LL, respectively. On the whole, the expression level of Col3a1 mRNA in muscle of LW was higher than that of LL (P

A 17-year-old teen was hospitalized with bilateral pneumothorax. After the bilateral lungs were expanded using catheter tubes, he fully recovered and he was discharged from our hospital. He had a history of colon perforation. Ehlers-Danlos syndrome (EDS) was suspected due to the combination of colon perforation and pneumothorax, and EDS type IV was confirmed after a genetic study identified a c.1511g>a mutation in the COL3A1 gene. This is the first report of bilateral pneumothorax caused by EDS type IV. Clinicians should consider EDS type IV in the differential diagnosis for bilateral pneumothorax in conjunction with distinct previous histories and radiological findings.

Vascular Elhers-Danlos syndrome (vEDS) is an autosomal dominant genetic vascular disease, affecting the collagen type III, a component in the extracellular matrix of the arterial wall. Patients with vEDS are prone to arterial, intestine or uterine ruptures, which explain the severity of the disease. Mutations in COL3A1, gene encoding for collagen type III are usually heterozygous missense mutations responsible for the substitution of a glycine amino acid for another, which affects the triple helical conformational structure of the collagen type III. Variants of a splice site, deletions/insertions, are also encountered, and more rarely missense mutations not affecting a glycine residue, or alterations responsible for haploinsufficiency. The COL3A1 mutations are almost exclusively private, and a genotype/phenotype correlation has not been clearly studied. We reported the experience of the French reference center for vEDS of 215 patients and found a greater severity of the disease in those with a glycine substitution, or in frame insertion / deletion within the triple helix domain than in other genotypes: responsible variants of haploinsufficiency, missense variants not affecting glycine, or alteration of the N- or C-terminal ends. Furthermore, the phenotype of these last three genotype groups did not combine the complete phenotype described in vEDS especially no gastrointestinal complication. To better understand the alteration of the biomechanical properties of the arterial wall of patients with vEDS we used a new ultrasound technology, ultrafastecho, to visualize and measure the pulse wave velocity (PWV) locally on carotids, over the cardiac cycle. The PWV is a marker of arterial stiffness studied in atherosclerosis, and well known to be an independent risk factor for cardiovascular mortality. We have established normal values ultrafastecho parameters in 102 healthy volunteers and 37 patients with vEDS. This study found no difference in PWV, thus arterial stiffness, in early systole cardiac at diastolic blood pressure. However, in patients with vEDS, weaker stiffening of the arterial wall was observed when blood pressure increases during the cardiac cycle. We continued our explorations by ultrafastecho on a mouse model of vEDS, haploinsufficient for the collagen type III (Col3a1 heterozygous mice). We figured out that Col3a1 heterozygous mice presented the same response profile. Indeed a smaller increase in arterial stiffness while blood pressure was increasing secondary to vasopressor infusion was revealed in the mice compared to the wild mice. In conclusion, alterations of collagen type III in the vEDS affect the biomechanical properties of the arterial wall of the patient, through lower stiffening during the increase of blood pressure over the cardiac cycle. This provides a therapeutic approach for targeting treatment increasing arterial stiffness in vEDS in order to reduce the risk of arterial rupture.; Le syndrome d'Ehlers-Danlos (SEDv) est une maladie artérielle génétique autosomique dominante, affectant le collagène de type III au sein de la matrice extracellulaire de la paroi artérielle notamment. Les patients atteints de SEDv ont une prédisposition aux ruptures artérielles, digestives et utérines qui font toute la sévérité de cette maladie. Les mutations du gène COL3A1 codant pour le collagène de type III sont le plus souvent des mutations hétérozygotes faux-sens, responsables de la substitution d'une glycine par un autre acide aminé, affectant la structure en triple hélice du collagène de type III. Des variants d'un site d'épissage, des insertions-délétions sont également rencontrées, et plus rarement des mutations faux-sens n'affectant pas une glycine, ou des mutations responsables d'haploinsuffisance. Les mutations du COL3A1 sont presque exclusivement privées, et une corrélation entre le phénotype observé et les mutations retrouvées n'a jamais été mise en évidence. Nous avons rapporté l'expérience du centre de référence français du SEDv sur 215 patients, et retrouvé une sévérité de la maladie plus importante chez ceux avec une substitution glycine, ou une insertion/délétion du cadre de lecture dans région de la triple hélice comparativement aux autres génotypes: variants responsables d'haploinsuffisance, variants faux-sens n'affectant pas une glycine, ou les altérations des extrémités N ou C-terminales. Par ailleurs, le phénotype de ces 3 derniers groupes de génotype ne rassemblait pas l'ensemble des symptômes habituellement décrits dans le SEDv et notamment pas de complication digestive. Afin de mieux comprendre l'altération des propriétés biomécaniques de la paroi artérielle des patients atteints de SEDv nous avons utilisé une nouvelle technologie ultrasonore, ultrafastécho, permettant de visualiser et mesurer la vitesse de l'onde de pouls (VOP) localement au niveau carotidien et tout au long du cycle cardiaque. La VOP est un marqueur de rigidité artérielle bien étudié dans l'athérosclérose, et connu pour être un facteur indépendant de mortalité cardiovasculaire. Nous avons établi des valeurs normales des paramètres de l'ultrafastécho chez 102 volontaires sains et analysés 37 patients avec SEDv. Cette étude n'a pas retrouvé de différence de la VOP, donc de rigidité artérielle, en début de systole. En revanche, au cours du cycle cardiaque on a pu observer une moindre rigidification de la paroi artérielle avec l'augmentation de la pression artérielle chez les patients SEDv. Nous avons poursuivi nos explorations par ultrafastécho sur un modèle murin haploinsuffisant pour le collagène de type III (souris Col3a1 hétérozygote) et retrouvé le même profil de réponse. En effet une moindre augmentation de la rigidité artérielle alors que la pression artérielle était augmentée par perfusion de vasopresseur était constatée chez les souris col3a1 hétérozygotes comparativement aux souris sauvages. En conclusion, l'altération du collagène de type III dans le SEDv affecte les propriétés biomécaniques de la paroi artérielle des patients, avec notamment une moindre rigidification lors de l'augmentation de la pression artérielle. Nos travaux ont permis d’affiner la physiopathologie du SEDv, de préciser le phénotype vasculaire par une nouvelle mesure de la VOP et ouvrent des pistes de recherche thérapeutiques d'un traitement augmentant la rigidité artérielle afin de tenter de réduire les risques de ruptures artérielles.

The COL3A1 Alu insertion is a member of the AluY subfamily. It has been found to be absent in non-human primates and polymorphic in worldwide human populations. The integration of the element into the human genome seems to have preceded the initial migration(s) of anatomically modern humans out of the African continent. Although the insertion has been detected in populations from all the continents, its highest frequency values are located within sub-Saharan Africa. The sequence alignment of the COL3A1 insertion from several African individuals revealed a bi-allelic single nucleotide polymorphism (SNP) at the downstream terminus of the element’s poly-A tract. Once discovered, a selective PCR procedure was designed to determine the frequency of both alleles in 19 worldwide populations. The A-allele in this binary SNP experiences a clinal increase in the eastward direction from Africa to Southeast Asia and Mongolia, reaching fixation in the two latter regions. The T variant, on the other hand, exhibits a westward clinal increase outside of Africa, with its lowest frequency in Asia and achieving fixation in northern Europe. The presence of this internal SNP extends the usefulness provided by the polymorphic Alu insertion (PAI). It is possible that superimposing polymorphisms like this one found in the COL3A1 locus may accentuate signals from genetic drift events allowing for visualization of recent dispersal patterns.

We report a sporadic case of type-IV Ehlers-Danlos Syndrome (EDS) in a woman presenting with a spontaneous carotid-cavernous fistula. This complication was treated successfully by endovascular treatment (EVT) with long-term relief. Analysis of collagens synthesized by the patient''s dermal fibroblasts in culture showed impaired secretion of abnormally slow, electrophoretically migrating type-III collagen, suggesting an underlying defect in the COL3A1 gene. The clinical features of type IV EDS and the outcome of EVT are reviewed.

Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-27T11:30:03Z No. of bitstreams: 0Bitstream added on 2014-05-27T14:43:25Z : No. of bitstreams: 1 2-s2.0-84880335347.pdf: 2379162 bytes, checksum: db53290b788805d40796a665b355e5a3 (MD5) Made available in DSpace on 2014-05-27T11:30:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-07-25 Introduction. Tendon injury is a major cause of lameness and decreased performance in athletic equines. Various therapies for tendonitis have been described; however, none of these therapies results in complete tissue regeneration, and the injury recurrence rate is high even after long recovery periods involving rest and physiotherapy. Methods. A lesion was induced with collagenase gel in the superficial digital flexor tendon in the center portion of the metacarpal region of eight equines of mixed breed. After two weeks, the lesions of the animals in the treated and control groups were treated through the intralesional administration of mesenchymal stem cells derived from adipose tissue (adMSCs) suspended in platelet concentrate (PC) and with phosphate buffered saline (PBS), respectively. Serial ultrasound analyses were performed every two weeks. After 16 weeks of therapy, a biopsy was performed for histopathological, immunohistochemical and gene expression (type I collagen (COL1A1), type III collagen (COL3A1), tenascin-C (TNC), tenomodulin (TNMD), and scleraxis (SCX)) analyses. Results: Differences in the ultrasound and histopathological analyses were observed between the groups. Improved results were reported in the group treated with adMSCs suspended in PC. There was no difference in the gene expression levels observed after the different treatments. The main results observed from the histopathological evaluation of the treated group were as follows: a prevention of the progression of the lesion, a greater organization of collagen fibers, and a decreased inflammatory infiltrate. A lack of progression of the lesion area and its percentage was observed in the ultrasound image, and increased blood flow was measured by Power Doppler. Conclusions: The use of adMSCs combined with PC for the therapy of experimentally induced tendonitis prevented the progression of the tendon lesion, as observed in the ultrasound examination, and resulted in a greater organization and decreased inflammation, as observed in the histopathological evaluation. These data demonstrate the therapeutic potential of this therapy for the treatment of equine tendonitis. © 2013 Carvalho et al.; licensee BioMed Central Ltd. Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Department of Veterinary Clinic School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Department of Animal Reproduction and Veterinary Radiology School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Blood Center Botucatu Medical School São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Department of Veterinary Surgery and Anesthesiology School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Department of Veterinary Clinic School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Department of Animal Reproduction and Veterinary Radiology School of Veterinary Medicine and Animal Science São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo Blood Center Botucatu Medical School São Paulo State University Rubião Junior, 18618-970 Botucatu, São Paulo

We present a family with 2 female cousins with intracranial aneurysms and type III collagen deficiency. DNA analysis revealed no mutations in the COL3A1 gene, encoding type III collagen, and including the segment encoding the C-propeptide of type III collagen. The 2 patients with low type III collagen production and intracranial aneurysms had inherited different type III collagen alleles. The type III collagen deficiency in this family may results from defects during posttranslational modification or from an altered collagen metabolism.

Item does not contain fulltext This case report describes concurrent splenic peliosis and vascular Ehlers-Danlos syndrome (EDS) in a 59-year-old male patient. After splenic rupture due to peliosis, the complicated postoperative period hinted at the possibility of vascular EDS. This diagnosis was confirmed by genetic testing, which revealed a novel point mutation in the COL3A1 gene, c.2545G-->C, leading to a codon encoding for arginine instead of glycine (p.Gly849Arg). In addition, a histological diagnosis of splenic peliosis could be established.

Ehlers-Danlos syndrome type IV (EDS IV) is caused by mutation within the COL3AI gene, resulting in the disorder of type III procollagen. The diagnosis is confirmed by demonstrating the synthesis of abnormal type III procollagen molecules from cultured dermal fibroblasts or by identifying the mutation in the COL3A1 gene. The authors report a case of EDS IV caused by a novel point mutation in the COL3A1 gene in a 16-yr-old female. Recurrent haemoptysis and cavitary formation of the lung were evidence of pulmonary involvement. However, extrathoracic manifestations of EDS IV were mostly absent. To the best of the authors' knowledge, all previously reported Ehlers-Danlos syndrome IV patients with respiratory disease had the characteristic findings or histories of Ehlers-Danlos syndrome IV. In the present case, connective tissue friability was suspected due to tissue laceration observed in the biopsied lung specimen, and the diagnosis was made beginning from this pivotal finding.

Ehlers-Danlos syndrome (EDS) type IV is a heritable disorder resulting from mutations in the COL3A1 gene that cause deficient production of type III collagen. Clinical manifestations of EDS type IV include hypermobility of small joints, excessive bruisability, thin translucent skin, poor wound healing, bowel rupture, and vascular rupture that is often fatal. A 14-year-old male without a family history of EDS died following multiple bowel and abdominal blood vessel ruptures. Even in areas apart from rupture sites, the bowel wall was thin because of diminished submucosa and muscularis propria. Similarly, the walls of blood vessels in bowel submucosa and elsewhere in the abdomen varied in thickness, and contained frayed and fragmented elastic tissue fibers. Fibroblasts cultured from the patient's skin secreted reduced quantities of type III collagen that was explained by a point mutation in one copy of the COL3A1 gene. EDS type IV should be strongly suspected in any patient with otherwise unexplainable bowel and/or vessel rupture.