Clinical features and morphology of collagen fibrils in patients with vascular Ehlers-Danlos based on electron microscopy

Satoko Ishikawa; Shujiro Hayashi; Toshimi Sairenchi; Manabu Miyamoto; Shigemi Yoshihara; Gen Kobashi; Tomomi Yamaguchi; Tomoki Kosho; Ken Igawa

doi:10.3389/fgene.2023.1238209

Clinical features and morphology of collagen fibrils in patients with vascular Ehlers-Danlos based on electron microscopy

Front Genet. 2023 Aug 16:14:1238209. doi: 10.3389/fgene.2023.1238209. eCollection 2023.

Authors

Satoko Ishikawa¹, Shujiro Hayashi¹, Toshimi Sairenchi², Manabu Miyamoto³, Shigemi Yoshihara³, Gen Kobashi⁴, Tomomi Yamaguchi^{5

6

7}, Tomoki Kosho^{5

6

7}, Ken Igawa¹

Affiliations

¹ Department of Dermatology, School of Medicine, Dokkyo Medical University, Tochigi, Japan.
² Medical Science of Nursing, School of Nursing, Dokkyo Medical University, Tochigi, Japan.
³ Department of Pediatrics, School of Medicine, Dokkyo Medical University, Tochigi, Japan.
⁴ Department of Public Health, School of Medicine, Dokkyo Medical University, Tochigi, Japan.
⁵ Department of Medical Genetics, School of Medicine, Shinshu University, Matsumoto, Japan.
⁶ Center for Medical Genetics, Shinshu University Hospital, Matsumoto, Japan.
⁷ Division of Clinical Sequencing, School of Medicine, Shinshu University, Matsumoto, Japan.

Abstract

Background: Vascular-type Ehlers-Danlos syndrome (vEDS) is caused by collagen III deficit resulting from heterogeneous mutations in COL3A1, which occasionally causes sudden death due to arterial/visceral rupture. However, it is difficult to conduct basic research on the pathophysiology of vEDS. Moreover, the number of patients with vEDS is small, limiting the number of available samples. Furthermore, the symptoms of vEDS may vary among family members, even if they share the same mutation. Accordingly, many aspects of the pathology of vEDS remain unknown. Therefore, we investigated the structural abnormalities in collagen fibrils and endoplasmic reticulum (ER) stress in skin samples using electron microscopy as well as their relationship with clinical symptoms in 30 patients with vEDS (vEDS group) and 48 patients without vEDS (disease-negative control group). Methods: Differences between the two groups were evaluated in terms of the sizes of collagen fibrils using coefficient of variation (COV). Results: COV was found to be significantly higher in the vEDS group than in the disease-negative control group, indicating irregularity in the size of collagen fibrils. However, in the vEDS group, some patients had low COV and seldom experienced serious complications and ER stress. Conclusion: ER stress might affect collagen fibril-composing proteins. Moreover, as this stress varies among people based on environmental factors and aging, it may be the underlying cause of varying vEDS symptoms.

Keywords: COL3A1; collagen III; collagen fibril; electron microscopy; endoplasmic reticulum stress; unfolded protein response; vascular Ehlers-Danlos syndrome.

Grants and funding

This study was supported by a grant from Dokkyo Medical University, Project Research Grant (No. 2018-18) and a Japanese Dermatological Association Basic Medical Research grant from Shiseido (DB 2003-03). The funder was not involved in the study design, collection, analysis, interpretation of data, the writing of this article or the decision to submit it for publication.