Fibrillin assemblies: extracellular determinants of
tissue formation and fibrosis
Jacopo Olivieri1, Silvia Smaldone2, Francesco Ramirez2*
The extracellular matrix (ECM) plays a key role in tissue formation, homeostasis and repair, mutations in ECM com-
ponents have catastrophic consequences for organ function and therefore, for the fitness and survival of the
organism. Collagen, fibrillin and elastin polymers represent the architectural scaffolds that impart specific mechanic
properties to tissues and organs. Fibrillin assemblies (microfibrils) have the additional function of distributing, con-
centrating and modulating local transforming growth factor (TGF)-b and bone morphogenetic protein (BMP) sig-
nals that regulate a plethora of cellular activities, including ECM formation and remodeling. Fibrillins also contain
binding sites for integrin receptors, which induce adaptive responses to changes in the extracellular microenviron-
ment by reorganizing the cytoskeleton, controlling gene expression, and releasing and activating matrix-bound
latent TGF-b complexes. Genetic evidence has indicated that fibrillin-1 and fibrillin-2 contribute differently to the
organization and structural properties of non-collagenous architectural scaffolds, which in turn translate into dis-
crete regulatory outcomes of locally released TGF-b and BMP signals. Additionally, the study of congenital dysfunc-
tions of fibrillin-1 has yielded insights into the pathogenesis of acquired connective tissue disorders of the
connective tissue, such as scleroderma. On the one hand, mutations that affect the structure or expression of fibril-
lin-1 perturb microfibril biogenesis, stimulate improper latent TGF-b activation, and give rise to the pleiotropic
manifestations in Marfan syndrome (MFS). On the other hand, mutations located around the integrin-binding site
of fibrillin-1 perturb cell matrix interactions, architectural matrix assembly and extracellular distribution of latent
TGF-b complexes, and lead to the highly restricted fibrotic phenotype of Stiff Skin syndrome. Understanding the
molecular similarities and differences between congenital and acquired forms of skin fibrosis may therefore provide
new therapeutic tools to mitigate or even prevent disease progression in scleroderma and perhaps other fibrotic
The extracellular matrix (ECM) is a highly heteroge-
neous amalgam of morphologically diverse architectural
entities composed of collagenous or elastic polymers,
adaptor proteins and hydrophilic proteoglycans. The
architectural matrix organizes and imparts structural
integrity to individual tissues, in addition to modulating
cell behavior by interacting with cell surface receptors
and soluble growth factors. Primary or secondary dys-
functions in components of the architectural matrix can
therefore interfere with both tissue integrity and cell
performance. Cases in point are the fibrillin assemblies
(microfibrils and elastic fibers), which represent the
non-collagenous scaffolds of the architectural matrix.
The present review focuses on the biology and patho-
physiology of fibrillin assemblies, with a particular
emphasis on recent evidence connecting fibrillin-1 with
the control of TGF-b signaling and tissue fibrosis.
Fibrillin assemblies and interactions
Fibrillins 1 and 2 are ubiquitous glycoproteins that self-
polymerize into filamentous microfibrils with an average
diameter of 10 nm in which individual molecules are
organized in longitudinal head-to-tail arrays and associ-
ate laterally as well [1-4]. Fibrillin microfibrils can addi-
tionally serve as the structural template for tropoelastin
deposition and/or crosslinking during elastic fiber for-
mation. Specific segments of the fibrillins interact in
vitro with numerous extracellular signaling and cell sur-
face molecules, including fibronectin, fibulins, latent
* Correspondence: email@example.com
2Pharmacology and Systems Therapeutics, Mount Sinai School of Medicine,
New York, USA
Full list of author information is available at the end of the article
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
© 2010 Olivieri et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
TGF-b-binding proteins (LTBPs), bone morphogenetic
protein (BMP) pro-peptides, syndecans and integrins.
The multiple molecular interactions of fibrillins are
believed to drive the assembly of morphologically dis-
tinct macroaggregates, which contribute to imparting
the structural integrity to individual tissues and organs
(structural role), and to target TGF-b and BMP com-
plexes to the architectural matrix, which contributes to
instructing the behavior of cells (instructive role) TGF-
bs and BMPs are potent modulators of ECM metabo-
lism, that are under the control of a complex network
of relays and servomechanisms operating within and
outside the cell, and at the cell surface [5-7]. Extracellu-
lar control of local TGF-b and BMP signals - and -in
particular the one that involves fibrillin microfibrils  -
has recently emerged as a critical aspect of tissue forma-
tion, homeostasis and repair . There is however,
significant variability in how fibrillins can bind TGF-b
and BMP complexes, and how fibrillin-bound TGF-b
and BMP complexes can signal to cells.
TGF-b 1, 2 and 3 (hereafter collectively referred
to as TGF-b) are secreted either as a small latent com-
plex (SLC) in which bioactive homodimers are non-
covalently associated with processed pro-peptides
(latency-associated protein; LAP) or as a large latent
complex (LLC) in which the TGF-b-SLC complex is
bound to LTBPs . Association with LAP blocks the
ability of bioactive TGF-b dimers to interact with the
cognate receptors TGFBR1 and TGFBR2, whereas
binding to LTBPs directs TGF-b-SLC sequestration in
the ECM through LTBP-mediated association with
fibronectin fibrils first, and fibrillin assemblies subse-
quently [9,10]. Matrix metalloproteinases (MMPs),
BMP1, thrombospondin-1, small proteoglycans and
integrin receptors are involved in releasing latent TGF-
b from the ECM by modifying LLC structure or
disrupting LAP-mediated latency . Thus, latent
TGF-b complexes bind indirectly to extracellular
microfibrils and as a result, fibrillin-bound TGF-b-LLC
requires a two-step activation process to signal; i.e.:
release from the ECM and LAP dissociation.
BMPs are also secreted and targeted to the ECM as
crosslinked dimers non-covalently associated with the
pro-peptides that can interact in vitro with the N-
termini of fibrillin-1 and -2 [12,13]. In contrast to TGF-
b, however, BMP pro-peptides do not generally confer
latency to the associated dimers, and as a result, BMPs
can readily signal once released from the ECM .
Accordingly, the fibrillins act as storage scaffolds that
distribute, concentrate and confer latency to BMPs,
while soluble antagonists and their modulators are prob-
ably the only extracellular molecules that control the
activity matrix-unbound (free) BMPs. Hence, BMP com-
plexes bind directly to extracellular microfibrils, and
signaling by fibrillin-bound BMPs solely involves the
step of releasing the ligand from the matrix.
Fibrillins 1 and 2 share an Arg-Gly-Asp (RGD)
sequence within a flexible loop in the middle of the
molecules, which favors binding to integrins a5b1and
avb3/6[15-18]; additionally, the N-terminal third of
fibrillin-2 contains a second RGD sequence . An in
vitro model of platelet-derived growth factor-induced
fibroblast migration suggests that the common RGD
sequence of fibrillins induces more lamellipodia and
more widespread remodeling of the leading edge,
whereas the unique RGD motif of fibrillin-2 stimulates
migration with greater directional persistence .
Additionally, evidence indicates that a high affinity
heparin-binding site located immediately next to the
RGD site of fibrillin-1 enhances integrin-mediated cell
adhesion, probably by binding syndecan receptors .
There is reason to believe that the interactions between
fibrillins and cell receptors and between fibrillin and
fibronectin fibrils occur in the pericellular space, where
they probably guide both the early steps of fibrillin poly-
merization and the targeting of growth factors to extra-
cellular microfibrils [9,10,21-26]. Integrins avb5/6/8
can also participate in latent TGF-b release from the
matrix and/or activation through proteolytic and non-
proteolytic mechanisms [27-29]. Thus, pericellular
release of ECM remodeling signals appears to be locally
integrated with microfibril biogenesis and growth factor
targeting to the matrix.
Fibrillin diseases in humans
Heterozygous mutations in fibrillin-1 or fibrillin-2
cause two clinically related disorders of the connective
tissue, MFS (OMIM 154700) and congenital contrac-
tural arachnodactyly (CCA: OMIM 121050) respec-
tively [30,31]. MFS is predominantly characterized by
abnormalities in the ocular, skeletal and cardiovascular
systems. Deficiencies in the cardiovascular system, par-
ticularly development of aortic root dilatation, are the
main cause of mortality and morbidity in affected
patients . The main clinical features of CCA
include joint contractures, crumpled ears and muscu-
loskeletal manifestations; cardiovascular and gastroin-
testinal anomalies are occasionally present in infants
with a severe/lethal form of the disease . On the
one hand, the multiple traits of MFS and CCA under-
score the importance of fibrillin-1 and fibrillin-2
microfibrils in the formation and function of several
organ systems. On the other hand, the distinct pheno-
types of MFS and CCA imply that fibrillin-1 and -2
have discrete functions in spite of participating in the
same architectural assemblies. The functional diversity
of fibrillins -1 and -2 involves both their structural
contribution to microfibril integrity, as the two
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
Page 2 of 8
proteins display temporally distinct expression pat-
terns, and their instructive contribution to cell perfor-
mance, as loss of function mutant mice show discrete
tissue-specific TGF-b and/or BMP-dependent abnorm-
alities (see below) .
Mutations in the human fibrillin-1 gene (FBN1) are
particularly interesting because they are associated with
a wide spectrum of clinical severity in MFS, irrespective
of where they are located in the protein or how much
they reduce gene expression . This apparent lack of
genotype-phenotype correlations also applies to the
occasional FBN1 mutations in patients who do not fulfill
the strict diagnostic criteria of MFS ; these rare
instances include familial ectopia lentis (OMIM 129600),
Shprintzen-Goldberg syndrome (OMIM 182212) and
Weill-Marchesani syndrome (OMIM 608328) [34-36].
By contrast, there is a very strong correlation between
mutations affecting a specific domain of fibrillin-1 and
the unique phenotype of stiff skin syndrome (SSS;
OMIM 184900) . SSS mutations cluster around the
sole integrin-binding RGD sequence of fibrillin-1, and
lead to a highly restricted (as opposed to a systemic)
phenotype that resembles a congenital form of sclero-
derma. The domain-specific nature and unique phenoty-
pic outcome of SSS mutations suggests a different
pathogenetic mechanism from that of MFS. Clinical and
pathogenetic relationships between SSS and scleroderma
are discussed more extensively in the last section of this
Fibrillin mutations in mice
Several mice with mutations in the Fbn1 or Fbn2 gene
have been created that replicate the clinical features of
MFS, SSS and CCA. Mutations in Fbn1 include those
that blunt gene expression and lead in homozygosity to
progressively severe (Fbn1mgR/mgRmice) or neonatal
lethal MFS (Fbn1-/-mice) and those that perturb protein
structure and lead in heterozygosity lead to mild
(Fbn1C1039G/+mice) or subclinical MFS (Fbn1GT-8/+
mice) [38-41]. Loss of fibrillin-2 synthesis in Fbn2-/-
mice is associated with several CCA traits, such as joint
contractures, osteopenia and muscle weakness and atro-
phy, as well as a unique limb patterning defect not seen
in either CCA patients or Fbn1-/-mice, namely digit
fusion (syndactyly) with involvement of either soft or
hard tissue . Lastly, a spontaneous tandem duplica-
tion within Fbn1 is responsible for the phenotype of
tight skin (Tsk/+) mice, which includes myocardial, ske-
letal and pulmonary abnormalities of MFS and fibrotic
features of SSS (see below) .
Characterization of mice harboring mutations in Fbn1
and/or Fbn2 has provided invaluable insights into
microfibril biogenesis and function. The first insight
indicated that fibrillins -1 and -2 perform partially
overlapping structural functions in developing and
mature tissue. This conclusion is based on the findings
that Fbn2 expression is largely restricted to the forming
and remodeling tissues, that fibrillin-2 proteins are bur-
ied within postnatal microfibrils, and that the vascular
phenotype and average survival of Fbn1-/-;Fbn2-/-or
Fbn1-/-;Fbn2-/+mice are significantly more severe than
those of Fbn1-/-or Fbn2-/-mice, [40,42,44,45]. Taken
together, these data imply that fibrillin-2 polymers form
the inner scaffold that supports the deposition and/or
organization of fibrillin-1 polymers, and that continued
and proper deposition of fibrillin-1 is absolutely required
for the postnatal maturation and mechanical compliance
of aortic tissue.
The second insight that has emerged from the studies
of Fbn mutant mice is that the organization of fibrillin-1
and fibrillin-2 polymers within the forming and mature
microfibrils also determines the contextual regulation of
local TGF-b and BMP signals. Vascular and bone find-
ings support this contention. Aortic aneurysm progres-
sion in Fbn1C1039G/+and Fbn1mgR/mgRmice is largely
driven by increased latent TGF-b activation and signal-
ing secondary to loss of TGF-b-LLC sequestration in
the ECM (Figure 1), a molecular phenotype that is repli-
cated in cultured primary smooth muscle cell isolated
from Fbn1 mutant aortas [46,47]. By contrast, improper
TGF-b signaling is not seen in either the aortas or cul-
tured vascular smooth muscle cells from Fbn2-/-mice
[40,47]. Hence, fibrillin-1, but not fibrillin-2, restricts
Figure 1 Hypothetical models of MFS and SSS pathogenesis.
The top drawing depicts the normal wild-type (WT) condition in
which a cell interacts with fibrillin-1 microfibrils through RGD-
mediated integrin binding and through TGF-b signals released from
the fibrillin-1 microfibrils (thin arrows). Mutations in MFS decrease
microfibril deposition/stability and promote excessive TGF-b
signaling (thick arrow). Mutations in stiff skin syndrome perturb
integrin-mediated microfibril deposition and increase matrix-
directed TGF-b signaling (thick arrows).
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
Page 3 of 8
TGF-b activity in the medial layer of the postnatal aorta
by interacting with LTBP components of the LLC. Like-
wise, the unique presence of syndactyly in Fbn2-/-mice
and its apparent association with decreased BMP signal-
ing are strong indications that fibrillin-2, but not fibril-
lin-1, promotes BMP activity in the developing autopods
. Bone remodeling is yet another example of a tis-
sue-specific program in which fibrillin -1 and -2 contri-
bute differently to the extracellular regulation of local
TGF-b and BMP signals [48-50]. Both Fbn1-/-and
Fbn2-/-osteoblast cultures display enhanced TGF-b sig-
naling, which inhibits osteoblast maturation, but only
cultured osteoblasts from Fbn1-/-and Fbn1mgR/mgRmice
exhibit higher than normal BMP activity, which pro-
motes osteoblast maturation [48,49]. As a result, osteo-
blasts deficient for fibrillin-2 fail to mature properly,
and bone formation is impaired in Fbn2-/-mice, whereas
osteoblast maturation and bone formation are largely
unaffected in Fbn1-/-and Fbn1mgR/mgRmice [48,49].
Increased TGF-b signaling, however, upregulates Rankl
production by osteoblasts, with consequent stimulation
of bone resorption by osteoclasts in mice deficient in
either fibrillin-1 or fibrillin-2 deficient mice [49,50]. Col-
lectively, these genetic findings indicate that microfibrils
regulate local TGF-b and BMP signals in a manner that
is stage-, tissue-, ligand- and fibrillin-specific. The
mechanistic basis for this specificity contextual remains
to be determined.
Fibrillin-1 and scleroderma
Tissue fibrosis is traditionally viewed as the pathological
counterpart of physiological wound healing . In
response to insult(s) altering ECM integrity or architec-
ture, activated mesenchymal cells initiate a matrix-
remodeling program in which anabolic and catabolic
activities are tightly balanced. In fibrotic conditions,
such as scleroderma, cell insensitivity to normal regula-
tory signals leads to excessive ECM deposition and ulti-
mately, organ failure [51,52]. Past efforts have mostly
focused on characterizing the molecular mechanisms
responsible for aberrant cell behavior and less attention
has been paid to defining the extracellular determinants
of tissue fibrosis. This situation has rapidly changed
because new evidence from acquired and congenital
forms of human scleroderma and Tsk/+ mice has
implicated dysfunction of fibrillin-1 microfibrils in skin
Widespread tissue fibrosis is the hallmark of systemic
sclerosis (SSc), the most common form of acquired
scleroderma [54,55]. Thickening and hardening of the
skin is progressive, and evolves from the extremities to
the trunk in a centripetal manner that rarely affects the
back. In contrast to other fibrotic disorders, autoimmu-
nity and vasculopathy characteristically precede SSc
fibrosis [56,57]. Skin fibrosis begins near to blood vessels
in the reticular dermis, and is accompanied by a promi-
nent inflammatory infiltrate [58-60]. Fibroblasts
explanted from involved sites show a transiently acti-
vated phenotype characterized by elevated expression of
ECM components, MMP inhibitors (TIMPs) and adhe-
sion molecules, in addition to constitutive TGF-b signal-
ing . Consistent with this last finding, SSc biopsies
display increased activation of the Smad2/3 pathway,
and skin fibrosis is observed in transgenic mice over-
expressing constitutively active TGFBR1 [61,62]. There
is also evidence suggesting that perivascular monocellu-
lar infiltrate may be responsible for exaggerated TGF-b
activity, and that activated SSc fibroblasts may them-
selves augment TGF-b signaling by increasing TGFBR
expression [63,64]. Alteration of LLC storage in the
ECM may also promote the increase in TGF-b signaling
as well. Indeed, SSc fibroblasts secrete and assemble
microfibrils that appear to be unstable, and SSc biopsies
exhibit disorganized fibrillin-1 aggregates and fragmen-
ted elastic fibers throughout the dermis [65-67]. More-
over, FBN1 polymorphisms characterize high SSc
incidence in Choctaw Indians and a smaller cohort of
Japanese patients [68,69]. Lastly, circulating autoantibo-
dies against fibrillin-1 have been described in SSc
patients, that can induce the molecular signature of acti-
vated cells in healthy fibroblasts, apparently through a
TGF-b-dependent mechanism .
As already mentioned, Tsk/+ mice replicate some MFS
features (bone lengthening, cardiac hypertrophy and
lung emphysema) as well as characteristic SSc features
(skin fibrosis with excessive accumulation of collagen I
and microfibrils, and the emergence of circulating auto-
antibodies against topoisomerase I, RNA polymerase I
and fibrillin-1) [71-74]. Additional pathological corre-
lates between the human and mouse phenotypes include
the ability of TGF-b interference to reduce skin thick-
ness, either genetically by pairing the Tsk allele with
Tgfb haploinsufficiency or pharmacological inhibition of
Smad3-mediated transcription in Tsk/+ mice [75,76].
Furthermore, expression of the Tsk protein in mouse
embryonic fibroblasts is accompanied by excessive col-
lagen I deposition along with up-regulation of the
microfibril-associated protein MAPG2, which is over-
expressed in SSc skin [77,78]. There are also key differ-
ences between the two phenotypes. First, Tsk+ mice
lack the microvascular involvement characteristic of SSc
; second, fibrosis is still apparent in immunodeficient
Tsk/+ mice ; and third, the circulating autoantibo-
dies in Tsk/+ mice emerge relatively late compared with
the onset of skin fibrosis . Moreover, the fibrotic
involvement in Tsk/+ mice follows a different pattern
from that in SSc, as skin thickening begins after 2-4
weeks, progresses slowly and is more evident in the
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
Page 4 of 8
interscapular area and is absent from regions devoid of
fascia, such as the ear pinna [81,82]. Lastly, histological
analyses have confirmed the relative normalcy of dermal
thickness and collagen content in Tsk/+ skin, in addition
to attributing the fibrotic phenotype to a marked hyper-
plasia of the loose subdermal connective tissue, which
results in increased tethering of the skin to the underly-
ing muscle layer .
The discovery of FBN1 mutations in SSS has provided
a more cogent argument for the causal relationship
between altered microfibril biogenesis, increased TGF-b
signaling, and skin fibrosis . SSS is an extremely rare
congenital disease (~40 cases reported to date) that
manifest in infancy or in early childhood with rock-hard
skin bound firmly to the underlying tissues [83,84]. Skin
manifestations are most prominently observed in areas
with abundant fascia, such as the buttocks, thighs, and
shoulder girdle area. However, there is some disagree-
ment about the specific area affected, sometimes being
reported as the dermis and in a few cases as the under-
lying fascia [37,85-87]. It should also be noted that his-
tological studies have rarely assessed hypodermal tissue
because this examination requires more invasive proce-
dures . Early clinical presentation of SSS often
impacts skeletal growth and results in deformities such
as scoliosis, a tiptoe gait, and a narrow thorax that can
ultimately impair pulmonary function and lead to
respiratory distress [84,88]. In most cases, the disease
progresses slowly and is not fatal. Lack of visceral invol-
vement, immunologic abnormalities and vascular distur-
bances differentiate this inherited condition from rare
cases of pediatric SSc [84,89].
In spite of the above considerations, there is reason to
believe that elucidating the molecular underpinning of
skin fibrosis in SSS patients and Tsk/+ mice could yield
general principles of disease progression in SSc. SSS
mutations cluster around the sole integrin (RGD)-
binding site of fibrillin-1, whereas the Tsk mutation gen-
erates longer fibrillin-1 molecules with duplicated RGD
sequences [37,43]. Current evidence indicates that altered
cell-matrix interactions in SSS have multiple negative
effects on ECM assembly, TGF-b activity, cell identity
and integrin signaling . Specifically, perturbed integ-
rin-directed fibrillin-1 assembly in SSS leads to excessive
microfibril deposition and consequently, greater latent
TGF-b concentration and signaling (Figure 1). Increased
TGF-b activity in turn induces keratinocytes to lose their
phenotype and become activated mesenchymal cells
(epithelial to mesenchymal transition; EMT), an observa-
tion in line with keratinocyte contribution to hyper-
trophic scar formation . Additionally, loss of RGD
binding also perturbs microfibril-induced integrin signal-
ing, that normally directs several cellular activities during
skin development (Figure 1). The larger size of fibrillin-1
together with duplicated RGD sequences may trigger the
same cascade of events in the skin of Tsk/+ mice, in addi-
tion to eventuating MFS-like manifestations in other
organ systems by mechanism(s) that influence other
aspects of fibrillin-1 assembly and function [43,91,92]. In
line with this argument, the pathogenesis of reduced
bone mass in Tsk/+ mice differs from that of Fbn1mgR/
mgRmice, as impaired bone formation and increased
bone resorption in the latter [49,93]. The difference are
likely to be accounted for by unopposed elevation of
TGF-b signaling in Tsk/+ bones and by balanced aug-
mentation of both TGF-b and BMP activity in the
Fbn1mgR/mgRcounterparts . Further analyses of Tsk/+
mice and creation of SSS mice promises to elucidate the
pathogenetic contribution of fibrillin-1 microfibrils to
Conclusions and perspectives
Fibrillin assemblies represent a nodal point that inte-
grates the biological network of structural and instruc-
tive information flowing to and from the cell, which
orchestrates tissue formation, homeostasis and repair.
Such an integrated view of the molecular interactions
within fibrillin assemblies and between them and the
resident cells has expanded our understanding of the
roles of the architectural matrix substantially, in addi-
tion to providing new means to test evidence-based
therapies in conditions characterized by primary or sec-
ondary defects in fibrillin assemblies. In this light, TGF-
b immediately emerged as the first network component
to be targeted by pharmacological interventions aimed
at improving aortic aneurysm progression in MFS. The
strategy was based on the prior knowledge that blockade
of angiotensin II receptor I (AT1R) activity reduces
excessive TGF-b signaling in experimental renal and
cardiac fibrosis [94,95]. within accordance with this pre-
diction, losartan treatment was shown to restore aortic
wall architecture in Fbn1C1039G/+mice and to mitigate
aortic root dilation in a small cohort of children with
severe MFS [46,96]. A more recent study has confirmed
the efficacy of losartan treatment in improving aortic
wall degeneration in Fbn1mgR/mgRmice, a more severe
model of MFS than the Fbn1C1039G/+mouse, even
though the regimen showed no beneficial impact to
counteract bone loss . These findings, together with
evidence suggesting that some individuals may not
respond to losartan as effectively as others [97,98],
strongly argue for a multifaceted treatment strategy in
MFS and perhaps, in related disorders of the connective
tissue. Indeed, in vivo data have demonstrated that
broad inhibition of tyrosinekinases is a more efficient
strategy to control tissue fibrosis than using specific
receptor inhibitors [99-101]. Likewise, in vivo and ex
vivo lines of evidence have implicated additional
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
Page 5 of 8
contributors to vascular disease onset and/or progres-
sion in MFS. First, studies of Fbn1-/-aortas and vascular
SMC suggest that stress responses triggered by a struc-
turally deficient matrix and mediated by ROS through
the Ras/mitogen-acivated protein kinase signaling path-
way participate in Smad2/3 activation independently of
TGF-b . Second, improved aortic wall architecture
in Fbn1 mutant mice systemically treated with doxycy-
cline implies that improper MMP activity (and conceiva-
bly TIMP activity as well) exacerbates TGFb-driven
aneurysm progression in MFS [102,103]. Third, para-
doxical increase of TGFb signaling in the Loeys-Dietz
syndrome (LDS; OMIM-609192), which is caused by
heterozygous loss-of-function mutations in TGFBR1 or
TGFBR2 , points to the potential impairment of
TGFb auto-regulation, compensatory mechanisms and/
or alternative signaling cascades [30,32]. Lastly, domain-
specific mutations in SSS correlate perturbations in
ECM assembly and cell-matrix communication with
triggering a wide array of signals that stimulate and sus-
tain fibrosis . TGF-b and EMT antagonism on the
one hand, and integrin agonism on the other, have
therefore emerged as therapeutic strategies to be tested
alone or in mutant mice that model human SSS .
Moreover, the recent report that lymphatic and blood
endothelial cells participate in fibrillin-1 deposition in
human skin raises the intriguing possibility of a micro-
vascular origin of dermal fibrosis in SSS . It is
therefore safe to conclude that the study of SSS patients
and mice will benefit our understanding of SSc patho-
genesis, despite the noted differences in clinical presen-
tation and natural history between these two diseases.
List of abbreviations
CCA: congenital contractural arachnodactyly; ECM: extracellular matrix; EMT:
epithelial-to-mesenchymal transition; FBN and Fbn: human and mouse
fibrillin genes, respectively; LAP: latency associated protein; LDS: Loeys-Dietz
syndrome; LLC: large latent complex; LTBP: latent TGFb-associated protein;
MFS: Marfan syndrome; MMP: matrix metalloproteinase; SSc: Systemic
Sclerosis; SSS: Stiff Skin syndrome; TGFBR: TGFb receptor; Tsk: tight skin
We thank all the members of our laboratories for many stimulating
discussions, and Ms. K Johnson for organizing the manuscript. Our work was
funded by grants from the National Institutes of Health (AR049698, AR42044
and AR055806) and the Scleroderma Foundation.
1Scienze Mediche e Chirurgiche, Sezione Clinica Medica, Universita’
Politecnica delle Marche, Ancona, Italy.2Pharmacology and Systems
Therapeutics, Mount Sinai School of Medicine, New York, USA.
JO, SS and FR drafted the manuscript. FR was responsible for its design and
coordination. All authors read and approved the final product.
The authors declare that they have no competing interests.
Received: 15 September 2010 Accepted: 2 December 2010
Published: 2 December 2010
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Cite this article as: Olivieri et al.: Fibrillin assemblies: extracellular
determinants of tissue formation and fibrosis. Fibrogenesis & Tissue Repair
Olivieri et al. Fibrogenesis & Tissue Repair 2010, 3:24
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