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Clinical Sciences
November 2001

The Role of Apoptosis in the Pathogenesis of Fuchs Endothelial Dystrophy of the Cornea

Author Affiliations

From Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, Md (Drs Li, Ashraf, Green, Stark, and O'Brien); and the Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, Md (Drs Shen and Chan). The authors have no proprietary interest in any of the procedures or products mentioned in this article.

Arch Ophthalmol. 2001;119(11):1597-1604. doi:10.1001/archopht.119.11.1597

Objective  To investigate the potential role of apoptosis in the pathogenesis of Fuchs endothelial dystrophy of the cornea.

Methods  Twenty-one corneal buttons from patients with Fuchs dystrophy and 15 control corneas were studied. Apoptosis was assessed by the in situ end-labeling of double-stranded DNA breaks, and by immunohistochemical characterization of cellular markers associated with apoptosis (Fas, FasL, Bcl-2, and Bax). Expression of Bcl-2 and Bax mRNA in the corneal stroma and endothelium was separately analyzed by a semiquantitative reverse transcriptase polymerase chain reaction. Furthermore, cultivated keratocytes generated from diseased corneal buttons and donor rims were exposed to camptothecin, an apoptotic inducer, for 6 and 24 hours. They were then examined for protein and messenger RNA (mRNA) expression of apoptotic regulatory molecules.

Results  DNA fragmentation was seen in the epithelium, stroma, and endothelium in 6 of 7 corneas with Fuchs dystrophy. A statistically significant difference was identified in the expression of Bax and its mRNA in the stroma, but not in the endothelium of Fuchs dystrophy corneas. Following exposure to camptothecin, keratocytes from patients with Fuchs dystrophy responded with an increased level of Bax and a low level of Bcl-2. This trend was distinctively different from the response of normal keratocytes.

Conclusions  The evidence in this study points to a disease-related disturbance in the regulation of apoptosis in Fuchs dystrophy. Our findings suggest that excessive apoptosis may be an important mechanism in the pathogenesis of Fuchs dystrophy.