title: Autosomal dominant inheritance of a predisposition to thoracic aortic aneurysms and dissections and intracranial saccular aneurysms.
abstract: A genetic predisposition for thoracic aortic aneurysms and dissections (TAAD) can be inherited in an autosomal dominant manner with decreased penetrance and variable expression. Four genes identified to date for familial TAAD account for approximately 20% of the heritable predisposition. In a cohort of 514 families with two or more members with presumed autosomal dominant TAAD, 48 (9.3%) families have one or more members who were at 50% risk to inherit the presumptive gene causing TAAD had an intracranial vascular event. In these families, gender is significantly associated with disease presentation (P < 0.001), with intracranial events being more common in women (65.4%) while TAAD events occurred more in men (64.2%,). Twenty-nine of these families had intracranial aneurysms (ICA) that could not be designated as saccular or fusiform due to incomplete data. TGFBR1, TGFBR2, and ACTA2 mutations were found in 4 families with TAAD and predominantly fusiform ICAs. In 15 families, of which 14 tested negative for 3 known TAAD genes, 17 family members who were at risk for inheriting TAAD had saccular ICAs. In 2 families, women who harbored the genetic mutation causing TAAD had ICAs. In 2 additional families, intracranial, thoracic and abdominal aortic aneurysms were observed. This study documents the autosomal dominant inheritance of TAADs with saccular ICAs, a previously recognized association that has not been adequately characterized as heritable. In these families, routine cerebral and aortic imaging for at risk members could prevent cerebral hemorrhages and aortic dissections.
authors.affiliation: Department of Internal Medicine and Neurosurgery, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Regalado
authors.forename: Sarah
authors.initials: S
authors.lastname: Medrek
authors.forename: Van
authors.initials: V
authors.lastname: Tran-Fadulu
authors.forename: Dong-Chuan
authors.initials: DC
authors.lastname: Guo
authors.forename: Hariyadarshi
authors.initials: H
authors.lastname: Pannu
authors.forename: Hossein
authors.initials: H
authors.lastname: Golabbakhsh
authors.forename: Suzanne
authors.initials: S
authors.lastname: Smart
authors.forename: Julia H
authors.initials: JH
authors.lastname: Chen
authors.forename: Sanjay
authors.initials: S
authors.lastname: Shete
authors.forename: Dong H
authors.initials: DH
authors.lastname: Kim
authors.forename: Ralph
authors.initials: R
authors.lastname: Stern
authors.forename: Alan C
authors.initials: AC
authors.lastname: Braverman
authors.forename: Dianna M
authors.initials: DM
authors.lastname: Milewicz
mesh_terms: D000784:Aortic Dissection / Q000235:genetics*; D017545:Aortic Aneurysm, Thoracic / Q000235:genetics*; D001483:Base Sequence; D015331:Cohort Studies; D005260:Female; D020022:Genetic Predisposition to Disease; D005838:Genotype; D006801:Humans; D002532:Intracranial Aneurysm / Q000235:genetics*; D008297:Male; D010375:Pedigree; D018125:Receptors, Transforming Growth Factor beta / Q000235:genetics; D012444:Saccule and Utricle / Q000098:blood supply; D017422:Sequence Analysis, DNA; D013896:Thoracic Diseases / Q000235:genetics
chemical_list: D018125:Receptors, Transforming Growth Factor beta