Type VI collagen in healing rabbit corneal wounds

Subsynovial connective tissue is sensitive to surgical interventions in a rabbit model of carpal tunnel syndrome

The most common histological finding in carpal tunnel syndrome (CTS) is non-inflammatory fibrosis and thickening of the subsynovial connective tissue (SSCT) in the tunnel. While the cause of SSCT fibrosis and the relationship of SSCT fibrosis and CTS are unknown, one hypothesis is that SSCT injury causes fibrosis, and that the fibrosis then leads to CTS. We investigated the sensitivity of the SSCT to injuries. Two types of surgical interventions were performed in a rabbit model: A skin incision with tendon laceration and SSCT stretching sufficient to damage the SSCT, and skin incision alone. Twelve weeks after surgery, the rabbit carpal tunnel tissues were studied with immunochemistry for TGF-β receptors 1, 2, and 3, collagen III, and collagen VI. All TGF-β receptors were expressed. The percentages of the TGF-β receptors' expressions were less in the control SSCT fibroblasts than in the fibroblasts from rabbits with surgical interventions. The surgical interventions did not result in any alteration of collagen III expression. However, both surgical interventions resulted in a significant decrease in collagen VI expression compared to the control group. The two surgical interventions achieved similar expression of TGF-β receptors and collagens. Our results provide evidence that the SSCT is sensitive to surgical interventions, even when these are modest. Since SSCT fibrosis is a hallmark of CTS, these data also suggest that such fibrosis could result from relatively minor trauma.

Pathological characteristics of skeletal muscle in Ullrich's disease with collagen VI deficiency

Patients with Ullrich's disease have generalized muscle weakness, multiple contractures of the proximal joints and hyperextensibility of the distal joints. Recently, we found a deficiency of collagen VI protein in skeletal muscle from two patients with Ullrich's disease. In this study, we investigated immunohistochemically the expression of extracellular matrix proteins and various proteins, which are markers for regenerating muscle fibers. Although we have detected the reduction of collagen VI in Ullrich's disease with the two kinds of monoclonal antibodies for the different domains of collagen VI, the remaining immunoreactive material was different between them. This might suggest the presence of incomplete collagen VI protein in the muscle fibers. Furthermore, we found that very small muscle fibers in the patients with Ullrich's disease showed marked expression of desmin, neural cell adhesion molecule and neonatal myosin heavy chain, which is a characteristic finding of regenerating fibers, however, they showed poor expression of developmental myosin heavy chain and thrombomodulin. The present findings suggest that abnormal regeneration or maturation processes are involved in the pathogenesis of dystrophic muscle changes at least in the advanced stage of Ullrich's disease.

Objective assessment of transient corneal haze and its relation to visual performance after photorefractive keratectomy

PURPOSE

Photorefractive keratectomy has the potential to cause transient corneal haze. The purpose of this study was to evaluate the relationship between transient corneal haze as measured by an objective means and high and low contrast visual performance.

METHODS

In a prospective study, 44 eyes of 28 patients were examined preoperatively and at 1, 3, 6, and 12 months after photorefractive keratectomy. Five laser in situ keratomileusis and two intrastromal corneal ring segments (Intacs [KeraVision, Fremont, CA]) were included for comparison, because these procedures are not expected to cause haze. Haze was measured using a prototype objective hazemeter, TSPC-3, a modification of the Nidek EAS-1000. Visual performance was measured using high-contrast visual acuity and the Rabin Small Letter Contrast Test.

RESULTS

Corneal haze was greatest at the 1-month examination and was consistent with a decrease in visual performance on both tests. Corneal haze resolved in 82% of eyes by 10 +/- 4 months after photorefractive keratectomy. However, visual performance had not returned to preoperative levels in 65% and 81% of these eyes on the high-contrast visual acuity test and the Small Letter Contrast Test, respectively. Eyes that underwent laser in situ keratomileusis and Intacs did not develop corneal haze; however, visual decrements were measured.

CONCLUSIONS

As a clinical tool, the TSPC-3 hazemeter objectively measures very subtle changes in haze levels. Corneal haze appears to account for only approximately 50% of visual performance changes in the early healing period after photorefractive keratectomy. Other factors, namely topographic abnormalities, are more likely to be an important cause of persistent visual disturbances.

Differential expression of two exons of the alpha1(XI) collagen gene (Col11a1) in the mouse embryo

The amino terminal domain of collagen XI has a unique structure, which is believed to participate in the regulation of matrix assembly. Interestingly, several distinct isoforms of the amino terminal domain of alpha1(XI) and alpha2(XI) collagen chains exist as a result of alternative splicing. Here we report the analysis of the alternative splicing pattern of the mouse alpha1(XI) collagen gene (Col11a1). Like other vertebrate species, the mutually exclusive expression of exons 6A and 6B of Col11a1 results in the inclusion in the alpha1 chain of either an acidic peptide (pI 3.14) or a basic peptide (pI 11.66). Expression of these two exons was monitored in several tissues of the 16.5-day mouse embryo by in situ hybridization and immunohistochemistry, with exon-specific cDNA probes and peptide-specific antibodies, respectively. The results documented that isoforms containing the exon 6B-encoded peptide accumulate predominantly in the vertebrae, skeletal muscles and intestinal epithelium. By contrast, exon 6A products were found to be most abundant in the smooth muscle cells of the intestine, aorta and lung. The results using in situ hybridization confirmed those using immunohistochemistry. Albeit correlative, the evidence suggests distinct contributions of the two peptides to the differential assembly of tissue-specific matrices.

Histologic Changes and Wound Healing Response Following 10-Pulse Noncontact Holmium:YAG Laser Thermal Keratoplasty

BACKGROUND

Noncontact holmium:YAG laser thermal keratoplasty (Ho:YAG LTK) is a promising new technology for correction of hyperopia and astigmatism. We studied the acute histologic changes and wound healing response following Ho:YAG LTK performed with treatment parameters encompassing those used in clinical studies.

METHODS

We performed 10-pulse noncontact Ho:YAG LTK on three human corneas 1 day before their removal at penetrating keratoplasty and on six New Zealand white rabbit corneas followed for up to 3 months. Tissues were studied with light and transmission electron microscopy and immunohistochemistry.

RESULTS

The amount of acute tissue injury increased according to the pulse radiant energy. In human corneas, changes in the irradiated zones included epithelial cell injury and death, loss of fine filamentous structure in Bowman's layer, disruption of stromal lamellae, and keratocyte injury and death. In the rabbit corneas, similar acute changes were noted. By 3 weeks, epithelial hyperplasia and stromal contraction were present. Wound healing in the rabbits included repair of the epithelial attachment complex, keratocyte activation, synthesis of type I collagen, partial restoration of stromal keratan sulfate and type VI collagen, and retrocorneal membrane formation.

CONCLUSIONS

Noncontact Ho:YAG LTK produces acute epithelial and stromal tissue changes and in rabbit corneas stimulates a brisk wound healing response.

Immunohistochemical analysis of unsutured and sutured corneal wound healing

In the unsutured partial thickness penetrating wounds of the cornea, the epithelium migrates over the wounded stromal surface prior to the onset of stromal regeneration. To determine the possible affects of the epithelial ingrowth on the organization of the stromal scar tissues, the healing of unsutured and sutured wounds was compared immunohistochemically. Immunostaining patterns for fibronectin, types III, VI and VII collagen, keratan sulfate proteoglycan (KSPG), and intermediate filament-associated protein (IFAP 130) in fibroblasts, were analyzed in unsutured and adjacent sutured keratotomy wounds in monkeys, at 2-9 weeks after surgery. At 2-4 weeks, fibronectin, type III and type VI collagen showed a lamellar interweaving pattern across unsutured wounds that was absent in sutured wounds. Type VII collagen was detected along the entire depth of regenerated stroma in unsutured wounds, but not in sutured wounds indicating that the epithelium had formerly been present in the regenerated stroma in unsutured wounds. Fibroblasts in both types of wounds expressed IFAP 130, but staining was more pronounced in sutured wounds. At 5-9 weeks, cellular re-activation, as judged from the expression for IFAP 130, was concomitant with a loss of lamellar interweaving with fibronectin, type III and type VI collagen across unsutured wounds, and proceeded in a posterior to anterior direction. In contrast, in sutured wounds, lamellar interweaving was established in anterior to posterior direction. At all postoperative times, unsutured and sutured wounds showed minimal staining for KSPG in the anterior scar.(ABSTRACT TRUNCATED AT 250 WORDS)

Quantitative analysis of immunogold labellings of collagen types I, III, IV and VI in healthy and pathological human corneas

BACKGROUND

We studied the distribution of collagen types I, III, IV and VI in one healthy human cornea and in seven pathological human corneas, in which the disorders were three cases of pseudophakic bullous keratopathy (two severe, one moderate) and one case each of stage IV keratoconus, chronic ulcer, vascularized cornea and disciform keratitis.

METHODS

Transmission electron microscopy examinations were performed on post-embedding immunogold-labelled sections. The staining was evaluated by gold particle count in the different tissues. The presence or absence of a given antigen was determined by statistical analysis, using a d-value test.

RESULTS

Our results on healthy corneal tissues corroborate the data available from previous studies, except for collagen type VI, which we found to be absent in Bowman's layer. In pathological corneas with a collagenous layer posterior to Descemet's membrane, collagen types I, III and especially IV were detected in this collagenous layer. Collagen types I, III and VI were detected in the anterior healed stroma of other pathological corneas, except for the keratoconus cornea, in which intense collagen III staining was observed.

CONCLUSION

The presence of collagen types I and III in the posterior collagenous layer of our pseudophakic bullous keratopathy corneas suggests that this layer corresponds to scar tissue secreted by stimulated endothelial cells.

Wound healing in response to keratorefractive surgery

Over one million Americans have undergone refractive keratoplasty since the introduction of radial keratotomy into the United States in 1978. There are now a number of alternative techniques available for reshaping the corneal surface to alter ocular refractive errors. Numerous technologic advances in the past decade now enable us to perform these procedures in a safer and more reliable fashion. The ability to control precisely the refractive outcome, however, continues to elude us and appears to be limited, in part, by interindividual variability in the wound healing response. Presently, we review the corneal wound healing response to various keratorefractive approaches and suggest some interventional strategies which might enable us to modulate more precisely our refractive results.

Decreased type VI collagen gene expression in cultured Werner's syndrome fibroblasts

Gene expression of collagens VI, I, and III in Werner's syndrome was studied by measuring messenger RNA (mRNA) and protein production levels in four fibroblast strains from patients with Werner's syndrome and comparing them with age-matched healthy subjects. Levels of type VI collagen mRNA were decreased in all Werner's syndrome fibroblast strains and the decreases were in parallel in all three chains (alpha 1, alpha 2, and alpha 3) of type VI collagen. A coordinate increase of the alpha 1(I) and alpha 1(III) collagen mRNA levels was observed in three of the four Werner's syndrome fibroblast strains. However, no qualitative abnormality of these mRNA transcripts in Werner's syndrome fibroblasts were found by Northern blot analysis. Changes in type VI and type I collagen mRNA correlated well with production levels of corresponding proteins, as determined by immunologic assays. These data suggest that there are changes in expression of multiple connective tissue constituents in Werner's syndrome fibroblasts.

Immunohistochemical localization of collagen types I and VI in human skin wounds

A total of 74 human skin wounds were investigated and collagen types I and VI were localized in the wound area by immunohistochemistry. Collagen type I appeared in the form of ramifying string-like structures after approximately 5-6 days, but positive reactions in the form of a spot-like staining around isolated fibroblasts also occurred in a skin wound aged 4 days. Collagen VI was detectable after a post-infliction interval of at least 3 days showing a strongly positive reacting network associated with fibroblasts in the wound area. Both collagens appeared almost constantly after a wound age of 6-7 days and could also be found in wounds aged a few months. Therefore, although a positive reaction for collagen type I in the form of string-like and ramifying structures around wound fibroblasts indicates a wound age of at least 5-6 days, a spot-like positive staining for collagen type I cannot exclude a wound age of at least 4 days. A positive staining for collagen type VI represents a post-infliction time of 3 days or more. The almost constant appearance of these collagen types suggests that negative results in a sufficient number of specimens indicate a wound age of less than 6-7 days, but cannot completely exclude longer post-infliction intervals. Since collagen type I and VI are also found in the granulation/scar tissue of lesions with advanced wound age, the immunohistochemical analysis of these proteins provides no further information for an age determination of older skin wounds.

Wound healing of the ocular surface

Wound healing is a complex, long-lasting regulatory sequence that involves expression of a number of genes, which are active during the individual's development. Some of the phenomena differ from normal tissue turnover and growth only quantitatively. This article reviews the current data on corneal wound healing, with particular reference to mesenchymal matrix proteins and their integrin receptors, to growth factors and to proteolytic enzymes. Some inflammatory mediators are also discussed. The theoretical basis for therapeutic interventions is also discussed briefly, in the light of present knowledge.