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Aging and disease    2020, Vol. 11 Issue (3) : 536-546     DOI: 10.14336/AD.2019.0610
Orginal Article |
Cellular and Molecular Biomarkers Indicate Premature Aging in Pseudoxanthoma Elasticum Patients
Tiemann Janina1, Wagner Thomas1, Vanakker Olivier M2, Gils Matthias van2, Cabrera José-Luis Bueno3, Ibold Bettina1, Faust Isabel1, Knabbe Cornelius1, Hendig Doris1,*
1Institut für Laboratoriums- und Transfusionsmedizin, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany
2Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
3Haematology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain
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The molecular processes of aging are very heterogenic and not fully understood. Studies on rare progeria syndromes, which display an accelerated progression of physiological aging, can help to get a better understanding. Pseudoxanthoma elasticum (PXE) caused by mutations in the ATP-binding cassette sub-family C member 6 (ABCC6) gene shares some molecular characteristics with such premature aging diseases. Thus, this is the first study trying to broaden the knowledge of aging processes in PXE patients. In this study, we investigated aging associated biomarkers in primary human dermal fibroblasts and sera from PXE patients compared to healthy controls. Determination of serum concentrations of the aging biomarkers eotaxin-1 (CCL11), growth differentiation factor 11 (GDF11) and insulin-like growth factor 1 (IGF1) showed no significant differences between PXE patients and healthy controls. Insulin-like growth factor binding protein 3 (IGFBP3) showed a significant increase in serum concentrations of PXE patients older than 45 years compared to the appropriate control group. Tissue specific gene expression of GDF11 and IGFBP3 were significantly decreased in fibroblasts from PXE patients compared to normal human dermal fibroblasts (NHDF). IGFBP3 protein concentration in supernatants of fibroblasts from PXE patients were decreased compared to NHDF but did not reach statistical significance due to potential gender specific variations. The minor changes in concentration of circulating aging biomarkers in sera of PXE patients and the significant aberrant tissue specific expression seen for selected factors in PXE fibroblasts, suggests a link between ABCC6 deficiency and accelerated aging processes in affected peripheral tissues of PXE patients.

Keywords pseudoxanthoma elasticum      aging      CCL11      GDF11      IGF1      IGFBP     
Corresponding Authors: Hendig Doris   
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These authors shared first-authorship.

Just Accepted Date: 31 July 2019   Issue Date: 13 May 2020
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Tiemann Janina
Wagner Thomas
Vanakker Olivier M
Gils Matthias van
Cabrera José-Luis Bueno
Ibold Bettina
Faust Isabel
Knabbe Cornelius
Hendig Doris
Cite this article:   
Tiemann Janina,Wagner Thomas,Vanakker Olivier M, et al. Cellular and Molecular Biomarkers Indicate Premature Aging in Pseudoxanthoma Elasticum Patients[J]. Aging and disease, 2020, 11(3): 536-546.
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Sample IDGenderAge1Biopsy sourceABCC6 genotype2Genotype status
PXE patients
P3M amale57Neckc.3421C>T (p.R1141X)c.3883-6G>A (SSM)cht
P128M amale51Neckc.3769_3770insC (p.L1259fsX1277)c.3769_3770insC (p.L1259fsX1277)hm
P255F afemale48Armc.3421C>T (p.R1141X)c.2787+1G>T (SSM)cht
Healthy controls
M57A b
M52A b (AG11482)male52Arm--wt
F48A b
Table 1  Characterization of human dermal fibroblasts from PXE patients and healthy controls.
GeneProtein5´-3´sequenceReference1Annealing temperature (°C)Efficiency
glyceraldehyde-3-phosphate dehydrogenase

β2M beta-2-microglobulin






GDF11 growth differentiation factor 11






IGFBP3 insulin-like growth factor binding protein 3





Table 2  Primer sequences used for quantitative real-time PCR.
Figure 1.  CCL11 protein concentration in sera from PXE patients (grey) and healthy controls (white). Data are shown as Box-Plot with median, 25th and 75th percentile and Tukey whiskers (± 1.5 times interquartile range). Control vs. PXE: ns p>0.05. Cohorts <45 years (n=23) vs. cohorts >45 years (n=22): ##/++ p≤0.01.
Figure 2.  Systemic concentration and local mRNA expression of GDF11. (A) GDF11 protein concentration in sera from PXE patients (grey) and healthy controls (white). Data are shown as Box-Plot with median, 25th and 75th percentile and Tukey whiskers (± 1.5 times interquartile range). (B) Relative GDF11 mRNA-expression of PXE fibroblasts (grey) and NHDF (white). Data are shown as mean ± SEM. Control vs. PXE: *** p ≤0.001. Cohorts <45 years (n=23) vs. cohorts >45 years (n=22): ns p>0.05.
Figure 3.  Systemic IGF1 and IGFBP3 protein concentration in sera from PXE patients (grey) and healthy controls (white). (A) IGF1 serum protein concentrations of PXE patients (grey) and healthy controls (white) (B) IGFBP3 serum protein concentrations of PXE patients (grey) and healthy controls (white) (C) molar IGF1/IGFBP3 ratio of serum protein concentrations of PXE patients (grey) and healthy controls (white). Data are shown as Box-Plot with median, 25th and 75th percentile and Tukey whiskers (± 1.5 times interquartile range). Control vs. PXE: * p≤0.05; ns p>0.05. Cohorts <45 years (n=23) vs. cohorts >45 years (n=22): ns p>0.05.
Figure 4.  Local IGFBP3 mRNA expression and protein concentration. (A) Relative IGFBP3 mRNA expression of PXE fibroblasts (grey) and NHDF (white). (B) IGFBP3 protein concentration in supernatant of PXE fibroblasts (grey) and NHDF (white). Data are shown as mean ± SEM. Control vs. PXE: * p≤0.05; ns p>0.05.
Figure 5.  Male and female specific IGFBP3 mRNA expression and protein concentration. (A) Relative IGFBP3 mRNA expression of female PXE fibroblasts (grey) and NHDF (white). (B) IGFBP3 protein concentration in supernatant of female PXE fibroblasts (grey) and NHDF (white). (C) Relative IGFBP3 mRNA expression of male PXE fibroblasts (grey) and NHDF (white). (D) IGFBP3 protein concentration in supernatant of male PXE fibroblasts (grey) and NHDF (white). Data are shown as mean ± SEM. Control vs. PXE: ** p≤0.01; ns p>0.05.
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