title: Reduced elastogenesis: a clue to the arteriosclerosis and emphysematous changes in Schimke immuno-osseous dysplasia?
abstract: BACKGROUND
  Arteriosclerosis and emphysema develop in individuals with Schimke immuno-osseous dysplasia (SIOD), a multisystem disorder caused by biallelic mutations in SMARCAL1 (SWI/SNF-related, matrix-associated, actin-dependent regulator of chromatin, subfamily a-like 1). However, the mechanism by which the vascular and pulmonary disease arises in SIOD remains unknown.
  
  
  METHODS
  We reviewed the records of 65 patients with SMARCAL1 mutations. Molecular and immunohistochemical analyses were conducted on autopsy tissue from 4 SIOD patients.
  
  
  RESULTS
  Thirty-two of 63 patients had signs of arteriosclerosis and 3 of 51 had signs of emphysema. The arteriosclerosis was characterized by intimal and medial hyperplasia, smooth muscle cell hyperplasia and fragmented and disorganized elastin fibers, and the pulmonary disease was characterized by panlobular enlargement of air spaces. Consistent with a cell autonomous disorder, SMARCAL1 was expressed in arterial and lung tissue, and both the aorta and lung of SIOD patients had reduced expression of elastin and alterations in the expression of regulators of elastin gene expression.
  
  
  CONCLUSIONS
  This first comprehensive study of the vascular and pulmonary complications of SIOD shows that these commonly cause morbidity and mortality and might arise from impaired elastogenesis. Additionally, the effect of SMARCAL1 deficiency on elastin expression provides a model for understanding other features of SIOD.
authors.affiliation: Provincial Medical Genetics Program, Department of Medical Genetics, Children's and Women's Health Centre of BC, 4500 Oak Street, Room C234, Vancouver, BC, V6H 3N1, Canada.
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authors.lastname: Wand
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mesh_terms: D000328:Adult; D001161:Arteriosclerosis / Q000235:genetics / Q000503:physiopathology*; D001344:Autopsy; D002648:Child; D002675:Child, Preschool; D004265:DNA Helicases / Q000235:genetics; D004646:Emphysema / Q000235:genetics / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007153:Immunologic Deficiency Syndromes / Q000235:genetics / Q000503:physiopathology*; D008297:Male; D009404:Nephrotic Syndrome / Q000235:genetics / Q000503:physiopathology*; D010009:Osteochondrodysplasias / Q000235:genetics / Q000503:physiopathology*; D000081207:Primary Immunodeficiency Diseases; D011655:Pulmonary Embolism / Q000235:genetics / Q000503:physiopathology*
chemical_list: C412482:SMARCAL1 protein, human; D004265:DNA Helicases