title: Immunohistochemistry and electron microscopy of early-onset fuchs corneal dystrophy in three cases with the same L450W COL8A2 mutation.
abstract: OBJECTIVE
  A rare, familial early-onset form of Fuchs corneal dystrophy (FCD) is caused by mutation in the COL8A2 gene. This study describes the aberrant pattern of distribution of collagen type VIII and basement membrane components in Descemet's membrane (DM) and endothelium of three individuals with the same L450W mutation that represent different stages of early-onset FCD.
  
  
  METHODS
  Immunohistochemical studies with bright field, fluorescence, and confocal microscopy characterized the pathology of sectioned corneal buttons with antibodies against COL8A1, COL8A2, COL4, laminin, and fibronectin. A portion of each was processed for electron microscopy.
  
  
  RESULTS
  Histologic examination of pathologic changes in case 1 demonstrated relative preservation of the endothelium, whereas in case 2 much of this layer was atrophic and in case 3 there was complete loss of the endothelium. DM also increased in thickness to 25 mum for case 1, to 31 mum for case 2, and to 38 mum for case 3. Case 1 was the only specimen to reveal shallow warts along the posterior surface of DM, whereas the most advanced specimen, case 3, showed evidence of earlier nodularity that had been buried by the accretion of further extracellular matrix material. The posterior aspect of DM in this specimen had the unusual property of lighter staining relative to the anterior region of DM, laid down earlier in life. Immunocytochemistry revealed increased expression and complex, sharply defined patterns of deposition of collagen VIII, collagen IV, laminin, and fibronectin. Ultrastructurally, the posterior nonbanded layer of DM was intermixed with banded collagen, and the posterior region of DM showed a high density of foci of spindle-shaped structures with intense-staining bands, spaced at approximately 120 nm. Finally, ultrastructural studies of the endothelium in case 1 revealed unusual accumulation of swelling mitochondria. The endothelial cells also had large amounts of abnormal prominent rough endoplasmic reticulum. Type VIII collagen alpha 2 immunogold signal was associated with the highly granular ribosomes of the rough endoplasmic reticulum of these patients.
  
  
  CONCLUSIONS
  Microscopic and electron microscopic examination revealed pathological changes in DM of L450W COL8A2 mutants that were consistent with several-fold increased growth of the extracellular matrix and progressive deposition and synthesis of extracellular material by endothelial cells. As with late-onset FCD, this is accompanied by attenuation and eventual loss of the endothelium itself. Whether the abnormal deposition of collagen, laminin, and fibronectin contributes to the dysfunction and death of the endothelium remains to be determined.
authors.affiliation: Center for Corneal Genetics, Cornea and External Disease Service, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
authors.forename: Cheng
authors.initials: C
authors.lastname: Zhang
authors.forename: W Robert
authors.initials: WR
authors.lastname: Bell
authors.forename: Olof H
authors.initials: OH
authors.lastname: Sundin
authors.forename: Zenaida
authors.initials: Z
authors.lastname: De La Cruz
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Stark
authors.forename: W Richard
authors.initials: WR
authors.lastname: Green
authors.forename: John D
authors.initials: JD
authors.lastname: Gottsch
mesh_terms: D001485:Basement Membrane / Q000378:metabolism / Q000648:ultrastructure; D024102:Collagen Type VIII / Q000235:genetics / Q000378:metabolism* / Q000648:ultrastructure; D003886:Descemet Membrane / Q000378:metabolism / Q000648:ultrastructure; D004728:Endothelium, Corneal / Q000378:metabolism / Q000648:ultrastructure; D005353:Fibronectins / Q000378:metabolism* / Q000648:ultrastructure; D019084:Fluorescent Antibody Technique, Indirect; D005642:Fuchs' Endothelial Dystrophy / Q000235:genetics / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D007797:Laminin / Q000378:metabolism* / Q000648:ultrastructure; D018613:Microscopy, Confocal; D016253:Microscopy, Immunoelectron; D009154:Mutation
chemical_list: C443712:COL8A2 protein, human; D024102:Collagen Type VIII; D005353:Fibronectins; D007797:Laminin