Vascular anomalies in lipoid proteinosis (hyalinosis cutis et mucosae): basement membrane components and ultrastructure.
BACKGROUND
In lipoid proteinosis (LP) vascular anomalies represent severe functional defects caused by excessive deposition of basement membrane (BM)-like matrix, particularly around small subepithelial blood vessels.


OBJECTIVE
Correlation of microvascular anomalies in morphology and ultrastructure with extracellular matrix composition and cell interactions for elucidating vascular involvement in LP-pathophysiology.


METHODS
Biopsies from non-related LP-patients were analyzed by indirect immunofluorescence (IIF), electron microscopy (EM), and immune-EM (ImEM).


RESULTS
In LP-skin and mucosa the thickened vessel walls stained strongly for the BM-components type IV collagen, laminin, perlecan, and nidogen (IIF). Integrin alpha6beta4 was regularly collocated with endothelial surface markers such as PECAM (CD31). Ultrastructure (EM) revealed highly ordered matrix deposits around microvessels, with frequently collapsed lumina, functionally compensated by increased vascular density (histology, IIF). Pericytes were trapped between these concentric BM-layers at varying distances towards the periphery (EM), contrasting their regularly close endothelial apposition. Periodic type IV collagen patterns (ImEM) corroborated the multiple BM-leaflet structure and the lack of a common 'fused' endothelial-pericyte BM, seen normally. Presumptive secretory vesicles, abundant in both cell types, implied an equal contribution to BM-synthesis, but also indicated partial loss of endothelial polarity.


CONCLUSIONS
In LP thickened vessel walls, composed of multiple BM, profoundly alter microvascular properties, also by interference with endothelial-pericyte interactions. The increased microvascular density reflects compensatory restoration for disabled function. Most remarkable was the exaggerated secretory activity (also at luminal surfaces) underlining the regulatory key role of extracellular matrix protein 1 (ECM1; mutated in LP) in export or turnover of all major BM-components.
German Cancer Research Center, Division Carcinogenesis and Differentiation, Heidelberg, Germany.
Nicolae
N
Mirancea
Ingrid
I
Hausser
Regina
R
Beck
Dieter
D
Metze
Norbert E
NE
Fusenig
Dirk
D
Breitkreutz
D000328:Adult; D001485:Basement Membrane / Q000473:pathology*; D002196:Capillaries / Q000473:pathology* / Q000648:ultrastructure; D002648:Child; D002675:Child, Preschool; D024141:Collagen Type IV / Q000032:analysis; D042783:Endothelial Cells / Q000502:physiology; D005109:Extracellular Matrix / Q000737:chemistry; D005260:Female; D006801:Humans; D008065:Lipoid Proteinosis of Urbach and Wiethe / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D020286:Pericytes / Q000502:physiology
D024141:Collagen Type IV