An Overview of Investigational and Experimental Drug Treatment Strategies for Marfan Syndrome

Violette Deleeuw, 1 Adelbert De Clercq, 1 Julie De Backer, 1, 2 Patrick Sips 1 1Center for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Ghent, 9000, Belgium; 2Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent, 9000, BelgiumCorrespondence: Patrick SipsCenter for Medical Genetics, Department of Biomolecular Medicine, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, BelgiumTel +32 9 332 13 45Email Patrick.Sips@Ugent.beAbstract: Marfan syndrome (MFS) is a heritable connective tissue disorder caused by pathogenic variants in the gene coding for the extracellular matrix protein fibrillin-1. While the disease affects multiple organ systems, the most life-threatening manifestations are aortic aneurysms leading to dissection and rupture. Other cardiovascular complications, including mitral valve prolapse, primary cardiomyopathy, and arrhythmia, also occur more frequently in patients with MFS. The standard medical care relies on cardiovascular imaging at regular intervals, along with pharmacological treatment with β-adrenergic receptor blockers aimed at reducing the aortic growth rate. When aortic dilatation reaches a threshold associated with increased risk of dissection, prophylactic surgical aortic replacement is performed. Although current clinical management has significantly improved the life expectancy of patients with MFS, no cure is available and fatal complications still occur, underscoring the need for new treatment options. In recent years, preclinical studies have identified a number of potentially promising therapeutic targets. Nevertheless, the translation of these results into clinical practice has remained challenging. In this review, we present an overview of the currently available knowledge regarding the underlying pathophysiological processes associated with MFS cardiovascular pathology. We then summarize the treatment options that have been developed based on this knowledge and are currently in different stages of preclinical or clinical development, provide a critical review of the limitations of current studies and highlight potential opportunities for future research.Keywords: thoracic aortic aneurysm and dissection, rare genetic disease, pharmacological treatment, pathophysiology, preclinical research