Comparative therapeutic strategies for preventing aortic rupture in a mouse model of vascular Ehlers-Danlos syndrome

PLoS Genet. 2022 Mar 4;18(3):e1010059. doi: 10.1371/journal.pgen.1010059. eCollection 2022 Mar.

Abstract

Vascular Ehlers-Danlos syndrome is a rare inherited disorder caused by genetic variants in type III collagen. Its prognosis is especially hampered by unpredictable arterial ruptures and there is no therapeutic consensus. We created a knock-in Col3a1+/G182R mouse model and performed a complete genetic, molecular and biochemical characterization. Several therapeutic strategies were also tested. Col3a1+/G182R mice showed a spontaneous mortality caused by thoracic aortic rupture that recapitulates the vascular Ehlers-Danlos syndrome with a lower survival rate in males, thin non-inflammatory arteries and an altered arterial collagen. Transcriptomic analysis of aortas showed upregulation of genes related to inflammation and cell stress response. Compared to water, survival rate of Col3a1+/G182R mice was not affected by beta-blockers (propranolol or celiprolol). Two other vasodilating anti-hypertensive agents (hydralazine, amlodipine) gave opposite results on aortic rupture and mortality rate. There was a spectacular beneficial effect of losartan, reversed by the cessation of its administration, and a marked deleterious effect of exogenous angiotensin II. These results suggest that blockade of the renin angiotensin system should be tested as a first-line medical therapy in patients with vascular Ehlers-Danlos syndrome.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Aortic Rupture* / genetics
  • Aortic Rupture* / prevention & control
  • Arteries
  • Collagen Type III / genetics
  • Disease Models, Animal
  • Ehlers-Danlos Syndrome* / drug therapy
  • Ehlers-Danlos Syndrome* / genetics
  • Humans
  • Male
  • Mice

Substances

  • Collagen Type III

Grants and funding

This work was supported by INSERM (www.inserm.fr); the Fondation pour la Recherche Médicale (https://www.frm.org/), grant “Equipes FRM” 2015, grant number DEQ20150331716; the Agence Nationale pour la Recherche (https://anr.fr/), grant number ANR-14-CE15-0012-02; the Association Française pour les Syndromes d’Ehlers Danlos (AFSED, www.afsed.com) and the Association David (https://associationdavid.org/). A.L. has obtained a 3-year Ph.D grant from Région Ile-de-France and a one-year PhD grant from the Fondation pour la Recherche Médicale (FRM), grant number FDT202001010883. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.