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Background Marfan syndrome (MFS), a congenital connective tissue disorder leading to aortic aneurysm development, is caused by fibrillin-1 ( FBN1 ) gene mutations. Transforming growth factor beta (TGF-β) might play a role in the pathogenesis. It is still a matter of discussion if and how TGF-β up-regulates the intracellular downstream pathway, although TGF-β receptor 3 ( TGFBR3 or Betaglycan) is thought to be involved. We aimed to elucidate the role of TGFBR3 protein in TGF-β signaling in Marfan patients. Methods Dermal fibroblasts of MFS patients with haploinsufficient (HI; n=9) or dominant negative (DN; n=4) FBN1 gene mutations, leading to insufficient or malfunctioning fibrillin-1, respectively, were used. Control cells ( n =10) were from healthy volunteers. We quantified TGFBR3 protein expression by immunofluorescence microscopy and gene expression of FBN1 , TGFB1 , its receptors, and downstream transcriptional target genes by quantitative polymerase chain reaction. Results Betaglycan protein expression in FBN1 mutants pooled was higher than in controls ( P =.004) and in DN higher than in HI ( P =.015). In DN, significantly higher mRNA expression of FBN1 ( P =.014), SMAD7 ( P =.019), HSP47 ( P =.023), and SERPINE1 ( P =.008), but a lower HSPA5 expression ( P =.029), was observed than in HI. A pattern of higher expression was noted for TGFB1 ( P =.059), FN1 ( P =.089), and COL1A1 ( P =.089) in DN as compared to HI. TGFBR3 protein expression in cells, both presence in the endoplasmic reticulum and amount of vesicles per cell, correlated positively with TGFB1 mRNA expression (Rs=0.60, P =.017; Rs=0.55, P =.029; respectively). TGFBR3 gene expression did not differ between groups. Conclusion We demonstrated that activation of TGF-β signaling is higher in patients with a DN than an HI FBN1 gene mutation. Also, TGFBR3 protein expression is increased in the DN group and correlates positively with TGFB1 expression in groups pooled. We suggest that TGFBR3 protein expression is involved in up-regulated TGF-β signaling in MFS patients with a DN FBN1 gene mutation. [ABSTRACT FROM AUTHOR]