Circulating transforming growth factor-beta as a prognostic biomarker in Marfan syndrome

Background: Patients with Marfan syndrome (MFS) are at risk for cardiovascular disease. Marfan associated mutations in the FBN1 gene lead to increased transforming growth factor-beta (TGF-beta) activation. The aim of this study was to investigate the role of plasma TGF-beta as a biomarker for progressive aortic root dilatation and dissection.

Methods: Plasma TGF-beta level and aortic root diameter by means of echocardiography were assessed in 99 MFS patients. After 38 months of follow-up measurement of the aortic root was repeated and individual aortic root growth curves were constructed. Clinical events were evaluated. The primary composite endpoint was defined as aortic dissection and prophylactic aortic root replacement.

Results: TGF-beta levels were higher in MFS patients as compared to healthy controls (109 pg/ml versus 54 pg/ml, p <0.001). Higher plasma TGF-beta levels correlated with larger aortic root dimensions (r = 0.26, p = 0.027), previous aortic root surgery (161 pg/ml versus 88 pg/ml, p = 0.007) and faster aortic root growth rate (r = 0.42, p <0.001). During 38 months of follow-up, 17 events were observed (four type B dissections and 13 aortic root replacements). Patients with TGF-beta levels above 140 pg/ml had a 6.5 times higher risk of experiencing the composite endpoint compared to patients with TGF-beta levels below 140 pg/ml (95% CI: 2.1 to 20.1, p = 0.001) with 65% sensitivity and 78% specificity.

Conclusion: Elevated TGF-beta level in patients with Marfan syndrome is correlated with larger aortic root diameters and faster aortic root growth. Level of plasma TGF-beta predicts cardiovascular events and might serve as a prognostic biomarker in MFS. (C) 2013 Elsevier Ireland Ltd. All rights reserved.