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Test Code MISC2MAYOMFRGP Marfan Syndrome and Related Disorders Multi-Gene Panel, Varies

Useful For

Providing a comprehensive genetic evaluation for patients with a personal or family history suggestive of Marfan syndrome, Loeys-Dietz syndrome, thoracic aortic aneurysm and dissections, or a related disorder

 

Second-tier testing for patients in whom previous targeted gene variant analyses for specific Marfan and related genes were negative

 

Establishing a diagnosis of a Marfan or a related disorder in some cases, allowing for appropriate management and surveillance for aneurysms and other disease features based on the gene involved

 

Identifying variants within genes known to be associated with increased risk for aneurysms and other disease features allowing for predictive testing of at-risk family members

Reporting Name

Marfan and Related Genetic Panel

Specimen Type

Varies


Ordering Guidance


Targeted testing for familial variants (also called site-specific or known mutation testing) is available for the genes on this panel. See FMTT / Familial Mutation, Targeted Testing, Varies.



Shipping Instructions


Specimen preferred to arrive within 96 hours of collection.



Necessary Information


1. Marfan and Related Disorders Patient Information (T636) is strongly recommended, but not required, to be filled out and sent with the specimen. This information aids in providing a more thorough interpretation of test results. Ordering providers are strongly encouraged to complete the form and send it with the specimen.

2. Include physician name and phone number with specimen.

3. Prior Authorization is available for this test. Submit the required form with the specimen.



Specimen Required


Patient Preparation: A previous bone marrow transplant from an allogenic donor will interfere with testing. Call 800-533-1710 for instructions for testing patients who have received a bone marrow transplant.

 

Submit only 1 of the following specimens:

 

Specimen Type: Whole blood

Container/Tube: Lavender top (EDTA)

Specimen Volume: 3 mL

Collection Instructions:

1. Invert several times to mix blood.

2. Send specimen in original tube.

Specimen Stability Information: Ambient (preferred) 4 days/Refrigerated 14 days

 

Specimen Type: Extracted DNA

Container/Tube: 2 mL screw top tube

Specimen Volume: 100 mcL (microliters)

Collection Instructions:

1. The preferred volume is 100 mcL at a concentration of 250 ng/mcL.

2. Include concentration and volume on tube.

Specimen Stability Information: Frozen (preferred)/Ambient/Refrigerated


Specimen Minimum Volume

1 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Varies Varies

Reject Due To

All specimens will be evaluated at Mayo Clinic Laboratories for test suitability.

Clinical Information

Marfan syndrome (MFS) is an autosomal dominant genetic disorder affecting the connective tissue that occurs in approximately 1 to 2 per 10,000 individuals. It is characterized by the presence of skeletal, ocular, and cardiovascular manifestations and is caused by variants in the FBN1 gene. Skeletal findings may include tall stature, chest wall deformity, scoliosis, and joint hypermobility. Lens dislocation (ectopia lentis) is the cardinal ocular feature, and mitral valve prolapse and aortic root dilatation/dissection are the main cardiovascular features. Diagnosis is based on the revised Ghent nosology and genetic testing of FBN1. Management aims to monitor and slow the rate of aortic root dilatation and initiate appropriate medical and/or surgical intervention as needed. Other phenotypes associated with the FBN1 gene include autosomal dominant ectopia lentis (displacement of the lens of the eye), thoracic aortic aneurysm and dissections (TAAD), isolated skeletal features of MFS, MASS phenotype (mitral valve prolapse, aortic diameter increased, stretch marks, skeletal features of MFS), Shprintzen-Goldberg syndrome (Marfanoid-craniosynostosis; premature ossification and closure of sutures of the skull), and autosomal dominant Weill-Marchesani syndrome (short stature, short fingers, ectopia lentis).

 

Loeys-Dietz syndrome (LDS) is an autosomal dominant connective tissue disease with significant overlap with Marfan syndrome but may include involvement of other organ systems and is primarily caused by variants in TGFBR1 and TGFBR2. Features of LDS that are not typical of MFS include craniofacial and neurodevelopmental abnormalities, and arterial tortuosity with increased risk for aneurysm and dissection throughout the arterial tree. Variants of the SMAD3 gene have been reported in families with an LDS-like phenotype with arterial aneurysms and tortuosity and early onset osteoarthritis. Variants of the TGFB3 gene have also been reported in families with an LDS-like phenotype, although these individuals tended to not have arterial tortuosity.

 

TAAD is a genetic condition primarily involving dilatation and dissection of the thoracic aorta but may also include aneurysm and dissection of other arteries. TAAD has a highly variable age of onset and presentation and may involve additional features such as congenital heart defects and other features of connective tissue disease or smooth muscle abnormalities depending on the causative gene. The gene most commonly involved in familial TAAD is ACTA2. For other genes also implicated in TAAD, refer to the table below.

 

The COL3A1 gene causes Ehlers Danlos syndrome, vascular type (type IV), an autosomal dominant connective tissue disease with characteristic facial features, thin, translucent skin, easy bruising, and arterial, intestinal, and uterine fragility. Arterial rupture may be preceded by aneurysm or dissection or may occur spontaneously. The COL5A1 and COL5A2 genes cause Ehlers Danlos syndrome, classic type (type I and type II), an autosomal dominant connective tissue disorder characterized by skin hyperextensibility, widened atrophic scars, joint hypermobility, smooth, velvety skin, and easy bruising. The FLNA gene causes FLNA-related periventricular nodular heterotopia (PVNH), an X-linked neuronal migration disorder where the majority of affected individuals are female. This condition is characterized by seizures, hyperflexible joints, and cardiac findings, which include thoracic aortic aneurysm and dissection. Some individuals show clinical overlap with EDS.

 

Autosomal dominant variants of the FBN2 gene are known to cause congenital contractural arachnodactyly (CCA), which has several overlapping features with Marfan syndrome, including dolichostenomelia, scoliosis, pectus deformity, arachnodactyly, and a risk for thoracic aortic aneurysm.

 

Variants of the CBS gene cause homocystinuria an autosomal recessive disorder of amino acid metabolism with clinical overlap with Marfan syndrome; including lens dislocation and skeletal abnormalities, as well as increased risk for abnormal blood clotting.

 

Variants in the SKI gene cause Shprintzen-Goldberg syndrome (SGS), an autosomal dominant condition with overlap with LDS and MFS. Distinguishing features of SGS include hypotonia and intellectual disability. Aortic root dilatation is less frequent in SGS than in LDS or MFS, but, when present, it can be severe.

 

Homozygous and compound heterozygous loss of function variants in the SLC2A10 gene have been described in arterial tortuosity syndrome, a condition characterized by generalized tortuosity and elongation of all major arteries in addition to other connective tissue disease features.

 

Variants in the NOTCH1 gene cause aortic valve disease, with individuals displaying a range of aortic valve abnormalities and severe valve calcification.

 

Genes included in Marfan Syndrome and Related Disorders Multi-Gene Panel:

Gene

Protein

Inheritance

Known association

ACTA2

Actin, alpha-2, smooth muscle, aorta

AD

TAAD

CBS

Cystathionine beta-synthase

AR

Homocystinuria

COL3A1

Collagen, type III, alpha-1

AD

Ehlers-Danlos syndrome, vascular type (EDS type IV)

COL5A1

Collagen, type V alpha-1

AD

Ehlers-Danlos Syndrome, Classic Type (EDS type I, EDS type II)

COL5A2

Collagen, type V alpha-2

AD

Ehlers-Danlos Syndrome, Classic Type (EDS type I, EDS type II)

FBN1

Fibrillin 1

AD

Marfan syndrome/TAAD/Ectopia Lentis/ MASS phenotype/Shprintzen-Goldberg syndrome/Weill-Marchesani syndrome

FBN2

Fibrillin 2

AD

Congenital Contractural Arachnodactyly

FLNA

Filamin A

X-linked

Ehlers-Danlos syndrome and periventricular nodular heterotopia/X-linked cardiac valvular dysplasia/ otopalatodigital spectrum disorders/TAAD

MFAP5

Microfibril-associated protein 5

AD

TAAD

MYH11

Myosin, heavy chain 11, smooth muscle

AD

TAAD

MYLK

Myosin light chain kinase

AD

TAAD

NOTCH1

Notch, drosophila, homolog of, 1

AD

Aortic valve disease/Adams-Oliver Syndrome

PRKG1

Protein kinase, cGMP-dependent, type 1

AD

TAAD

SKI

V-SKI avian sarcoma viral oncogene homolog

AD

Shprintzen-Goldberg syndrome

SLC2A10

Solute carrier family 2 (facilitated glucose transporter), member 10

AR

Arterial Tortuosity syndrome/TAAD (Autosomal Recessive)

SMAD3

Mothers against decapentaplegic, drosophila, homolog of, 3

AD

Loeys-Dietz syndrome/TAAD

SMAD4

Mothers against decapentaplegic, drosophila, homolog of, 4

AD

TAAD/JPS/JPS-HHT

TGFB2

Transforming growth factor, beta-2

AD

TAAD

TGFB3

Transforming growth factor, beta-3

AD

Loeys-Dietz syndrome (Rienhoff syndrome)/TAAD

TGFBR1

Transforming growth factor-beta receptor, type I

AD

Loeys-Dietz syndrome/TAAD

TGFBR2

Transforming growth factor-beta receptor, type II

AD

Loeys-Dietz syndrome/TAAD

Abbreviations: Autosomal dominant (AD), autosomal recessive (AR); thoracic aortic aneurysm and dissection (TAAD); juvenile polyposis syndrome (JPS); juvenile polyposis syndrome-hereditary hemorrhagic telangiectasia (JPS-HHT)

 

Indications for testing include but are not limited to:

-Patients who meet clinical diagnostic criteria (Revised Ghent nosology) for Marfan syndrome

-Patients in whom no specific Marfan or related disorder is evident but for whom there is a clear familial component

-Patients whose family history is consistent with TAAD

-Patients with a personal or family history of thoracic aortic aneurysm and/or dissection or a personal or family history of multiple arterial aneurysms

Reference Values

An interpretive report will be provided.

Interpretation

Evaluation and categorization of variants is performed using the most recent published American College of Medical Genetics and Genomics (ACMG) recommendations as a guideline. Variants are classified based on known, predicted, or possible pathogenicity and reported with interpretive comments detailing their potential or known significance.

 

Multiple in silico evaluation tools may be used to assist in the interpretation of these results. The accuracy of predictions made by in silico evaluation tools is highly dependent upon the data available for a given gene, and predictions made by these tools may change over time. Results from in silico evaluation tools should be interpreted with caution and professional clinical judgment.

Method Description

Next-generation sequencing (NGS) is performed using an Illumina instrument with paired-end reads. The DNA is prepared for NGS using a custom Agilent SureSelect Target Enrichment System. Data is analyzed with a bioinformatics software pipeline for sequence variants and the presence of large intragenic deletions and duplications. Supplemental Sanger sequencing or qPCR may be performed occasionally in regions where NGS is insufficient for data capture or not specific enough to correctly identify a variant. Sanger sequencing or qPCR may also be used for confirmatory testing.(Unpublished Mayo method)

 

Genes analyzed: ACTA2, CBS, COL3A1, COL5A1, COL5A2, FBN1, FBN2, FLNA, MFAP5, MYH11, MYLK, NOTCH1, SKI, SLC2A10, SMAD3, SMAD4, TGFB2, TGFB3, TGFBR1, and TGFBR2.

Day(s) Performed

Monday

Report Available

2 to 4 weeks after prior authorization approved

Performing Laboratory

Mayo Clinic Laboratories in Rochester

CPT Code Information

81410

LOINC Code Information

Test ID Test Order Name Order LOINC Value
MFRGP Marfan and Related Genetic Panel In Process

 

Result ID Test Result Name Result LOINC Value
36650 Gene(s) Evaluated 48018-6
36651 Result Summary 50397-9
36657 Result Details 82939-0
36658 Interpretation 69047-9
36962 Additional Information 48767-8
36963 Method 85069-3
36964 Disclaimer 62364-5
36692 Reviewed by 18771-6

Test Classification

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

Method Name

Custom Sequence Capture and Targeted Next-Generation Sequencing followed by qPCR and/or Polymerase Chain Reaction (PCR) and Supplemental Sanger Sequencing

Prior Authorization

Insurance preauthorization is available for this testing; forms are available.

 

Patient financial assistance may be available to those who qualify. Patients who receive a bill from Mayo Clinic Laboratories will receive information on eligibility and how to apply.

Forms

1. New York Clients-Informed consent is required. Document on the request form or electronic order that a copy is on files:

-Informed Consent for Genetic Testing (T576)

-Informed Consent for Genetic Testing-Spanish (T826)

2. Marfan and Related Disorders Patient Information (T636)

3. Marfan Syndrome and Related Disorders Multi-Gene Panel Prior Authorization Ordering Instructions

4. If not ordering electronically, complete, print, and send a Cardiovascular Test Request Form (T724) with the specimen.

Secondary ID

63029