The Proteins of Keratoconus: a Literature Review Exploring Their Contribution to the Pathophysiology of the Disease (original) (raw)

Molecular and Histopathological Changes Associated with Keratoconus

BioMed Research International, 2017

Keratoconus (KC) is a corneal thinning disorder that leads to loss of visual acuity through ectasia, opacity, and irregular astigmatism. It is one of the leading indicators for corneal transplantation in the Western countries. KC usually starts at puberty and progresses until the third or fourth decade; however its progression differs among patients. In the keratoconic cornea, all layers except the endothelium have been shown to have histopathological structural changes. Despite numerous studies in the last several decades, the mechanisms of KC development and progression remain unclear. Both genetic and environmental factors may contribute to the pathogenesis of KC. Many previous articles have reviewed the genetic aspects of KC, but in this review we summarize the histopathological features of different layers of cornea and discuss the differentially expressed proteins in the KC-affected cornea. This summary will help emphasize the major molecular defects in KC and identify additional research areas related to KC, potentially opening up possibilities for novel methods of KC prevention and therapeutic intervention.

The pathogenesis of keratoconus

Eye, 2013

Keratoconus (KC) is a common degenerative condition that frequently results in visual loss with an onset typically in early adulthood. It is the single most common reason for keratoplasty in the developed world. The cause and underlying pathological mechanism are unknown, but both environmental and genetic factors are thought to contribute to the development of the disease. Various strategies have been employed to address the gap in our understanding of this complex disease, with the expectation that over time more sophisticated therapies will be developed. In this review we summarise our current knowledge of the aetiology and risk factors associated with KC.

Role of biochemical factors in the pathogenesis of keratoconus

Acta Biochimica Polonica, 2014

Keratoconus (KC) is a corneal disease associated with structural abnormalities in the corneal epithelium, Bowman's layer and stroma and altered concentration of tear components. KC corneas show a different pattern of collagen lamellae than their normal counterparts. Also, a reduction of several collagen types in KC epithelium and stroma was observed. Altered expression and/or activity of lysyl oxidase, a critical enzyme of the biogenesis of connective tissue detected in KC corneas, may weaken covalent bonds between collagen and elastin fibrils, what may lead to biomechanical deterioration of the cornea. Increased activity of matrix metalloproteinases observed in KC may induce the degradation of the extracellular matrix causing damage to the cornea. Oxidative and nitrative stress play an important role in KC pathogenesis and KC corneas are characterized by the disturbed lipid peroxidation and nitric oxide pathways. Malfunctioning of these pathways may lead to accumulation of thei...

Genomic strategies to understand causes of keratoconus

Molecular Genetics and Genomics

com thinning, which results in the conical shape of the cornea. These structural changes in the corneal layers induce optical aberrations, leading to a loss of visual acuity due to distorted blurred vision, which is caused by irregular astigmatism, and high myopia (Rabinowitz 1998). Although KTCN is sometimes referred to as a corneal dystrophy, it is not included in International Classification of Corneal Dystrophies (IC3D) (Weiss et al. 2008) and should be distinguished from this group of corneal diseases. However, co-occurrence of KTCN with many types of corneal dystrophies, including Avellino and Fuchs dystrophies (Igarashi et al. 2003; Salouti et al. 2010; Wilson et al. 2014), may indicate that common molecular mechanisms in the pathogenesis of these disorders are involved. Among the general population, the estimated frequency of KTCN is 1 in 2,000 individuals (Rabinowitz 1998), although up-to-date data are not available. The prevalence of KTCN may be different according to patient ethnic origin (Gokhale 2013). The reported prevalence of the disease may also vary depending upon the different diagnostic tests used in the particular studies. The early KTCN or forme fruste KTCN are not detectable at the slit lamp during the anterior segment examination, and in these cases, assessment of the corneal topographic pattern is required to obtain the accurate diagnosis (Saad and Gatinel 2010). The first symptoms of KTCN usually appear during the second decade or early in the third decade of life. The pathogenic features of KTCN may be observed in different layers of the cornea (Fig. 1) (Sherwin and Brookes 2004). These abnormalities include changes in morphology of epithelial cells (Sykakis et al. 2012), deposition of iron particles in the epithelial basement membrane, breaks in Bowman's layer (Rabinowitz 1998), and thinning of stroma correlating with loss of collagen lamellae, altered collagen fibril orientation, and decreased keratocytes density (Patey et al.

Genetics and clinical characteristics of keratoconus

Acta dermatovenerologica Alpina, Pannonica, et Adriatica, 2010

Keratoconus (KC) is a bilateral, non-inflammatory, and progredient corneal ectasia that mostly occurs as a sporadic disorder, but it has long been recognized that a significant minority of patients also exhibit a family history. In recent years several candidate genes such as VSX1 and SOD1 have been proposed, and some disease-causing mutations have been identified. Lately research has also focused on collagen genes, especially those that are differentially expressed in KC cornea. Alterations in COL4A3 and COL4A4 genes may be responsible for decreases in collagen types I and III, a feature often detected in KC. To investigate the role of all four genes in 113 Slovenian patients with sporadic or familial keratoconus, DNA extraction, polymerase chain reaction amplification, and sequencing of both genes were performed. No disease-causing mutations were found, but two previously identified single nucleotide polymorphisms were identified (A128A and 627+23G>A) in the VSX1 gene. D326Y in...

Further evaluation of differential expression of keratoconus candidate genes in human corneas

PeerJ, 2020

Background: Keratoconus (KTCN) is a progressive eye disease, characterized by changes in the shape and thickness of the cornea that results in loss of visual acuity. While numerous KTCN candidate genes have been identified, the genetic etiology of the disease remains undetermined. To further investigate and verify the contribution of particular genetic factors to KTCN, we assessed 45 candidate genes previously indicated as involved in KTCN etiology based on transcriptomic and genomic data. Methods: The RealTime ready Custom Panel, covering 45 KTCN candidate genes and two reference transcripts, has been designed. Then, the expression profiles have been assessed using the RT-qPCR assay in six KTCN and six non-KTCN human corneas, obtained from individuals undergoing a penetrating keratoplasty procedure. Results: In total, 35 genes exhibiting differential expression between KTCN and non-KTCN corneas have been identified. Among these genes were ones linked to the extracellular matrix formation, including collagen synthesis or the TGF-β, Hippo, and Wnt signaling pathways. The most downregulated transcripts in KTCN corneas were CTGF, TGFB3, ZNF469, COL5A2, SMAD7, and SPARC, while TGFBI and SLC4A11 were the most upregulated ones. Hierarchical clustering of expression profiles demonstrated almost clear separation between KTCN and non-KTCN corneas. The gene expression levels determined using RT-qPCR showed a strong correlation with previous RNA sequencing (RNA-Seq) results. Conclusions: A strong correlation between RT-qPCR and earlier RNA-Seq data confirms the possible involvement of genes from collagen synthesis and the TGF-β, Hippo, and Wnt signaling pathways in KTCN etiology. Our data also revealed altered expression of several genes, such as LOX, SPARC, and ZNF469, in which single nucleotide variants have been frequently identified in KTCN. These findings further highlight the heterogeneous nature of KTCN.

Differential epithelial and stromal protein profiles in keratoconus and normal human corneas

Experimental Eye Research, 2011

The purpose of the study was to identify epithelial and stromal proteins that exhibit up-or down-regulation in keratoconus (KC) vs. normal human corneas. Because previous proteomic studies utilized whole human corneas or epithelium alone, thereby diluted the specificity of the proteome of each tissue, we selectively analyzed the epithelium and stromal proteins. Individual preparations of epithelial and stromal proteins from KC and age-matched normal corneas were analyzed by two independent methods, i.e., a shotgun proteomic using a Nano-Electrospray Ionization Liquid Chromatography Tandem Mass Spectrometry [Nano-ESI-LC-MS (MS) 2 ] and two-dimensional-difference gel electrophoresis (2D-DIGE) coupled with mass spectrometric methods. The label-free Nano-ESI-LC-MS (MS) 2 method identified 104 epithelial and 44 stromal proteins from both normal and KC corneas, and also quantified relative changes in levels of selected proteins, in both the tissues using spectral counts in a proteomic dataset. Relative to normal corneal epithelial proteins, six KC epithelial proteins (lamin-A/C, keratin type I cytoskeletal 14, tubulin beta chain, heat shock cognate 71 kDa protein, keratin type I cytoskeletal 16 and protein S100-A4) exhibited upregulation and five proteins (transketolase, pyruvate kinase, 14-3-3 sigma isoform, phosphoglycerate kinase 1, and NADPH dehydrogenase (quinone) 1) showed down-regulation. A similar relative analysis showed that three KC stromal proteins (decorin, vimentin and keratocan) were up-regulated and five stromal proteins (TGF-betaig h3 (Bigh3), serotransferrin, MAM domain-containing protein 2 and isoforms 2C2A of collagen alpha-2[VI] chain) were down-regulated. The 2D-DIGE-mass spectrometry followed by Decyder software analysis showed that relative to normal corneas, the KC corneal epithelium exhibited upregulation of four proteins (serum albumin, keratin 5, L-lactate dehydrogenase and annexin A8) and downregulation of four proteins (FTH1 [Ferritin heavy chain protein 1], calpain small subunit 1, heat shock protein beta 1 and annexin A2). A similar relative analysis of stroma by this method also showed upregulation of aldehyde dehydrogenase 3A1 (ALDH3A1), keratin 12, apolipoprotein A-IV precursor, haptoglobin precursor, prolipoprotein and lipoprotein Gln in KC corneas. Together, the results suggested that the Nano-ESI-LC-MS(MS) 2 method was superior than the 2D-DIGE method as it identified a greater number of proteins with altered levels in KC corneas. Further, the epithelial and stromal structural proteins of KC corneas exhibited altered levels compared to normal corneas, suggesting that they are affected due to structural remodeling during KC development and progression. Additionally, because several epithelial and stromal enzymes exhibited up-or down-regulation in the KC corneas relative to normal corneas, the two layers of KC corneas were under metabolic stress to adjust their remodeling.

Keratocan Expression Is Increased in the Stroma of Keratoconus Corneas

Molecular Medicine, 2001

Background: Keratoconus is a noninflammatory disease characterized by thinning and scarring of the central portion of the cornea. The etiology is unclear. In this study, we sought to identify mRNAs that are differentially expressed in the stroma of keratoconus corneas in comparison to those of corneas from normal individuals and patients with other corneal diseases. Materials and Methods: Total RNA was isolated from the stromal layer of normal human, keratoconus, and pseudophakic bullous keratopathy corneas. cDNA was synthesized and PCR-select subtractive hybridization experiments were performed. The differentially expressed genes noted were verified by dot blot analysis, cloned, and sequenced. Immunohistochemical staining, in situ hybridization, and/or reverse transcription polymerase chain reaction were used to assess expression of the identified genes at protein

Editorial: Keratoconus - What We Do Not Know

The open ophthalmology journal, 2017

Keratoconus has been recognized and investigated for more than 150 years [1]. Especially over the last decades, there has been intensive translational and clinical research in the field of corneal ectatic diseases, thereby revolutionizing the diagnosis and management of keratoconus. However, despite fundamental advances in understanding the complexity of this entity, the true nature of keratoconus remains merely unknown. Historically, ophthalmologists have described keratoconus as a progressive, non-inflammatory disorder of the cornea, associated with corneal steepening and thinning [1, 2]. The Global Panel on Keratoconus and Ectatic Diseases recently stated that 'abnormal posterior ectasia, abnormal corneal thickness distribution and clinical non-inflammatory corneal thinning are mandatory findings to diagnose keratoconus' [3]. Nevertheless, there is evidence that keratoconus is characterized by marked degradation of the corneal extracellular matrix involving inflammatory features such as increased levels of MMP-9, IL-6, and TNF-α, as well as increased oxidative stress [4, 5]. Moreover patients with keratoconus have increased levels of inflammatory mediators in their tears, as shown in numerous studies [4, 5]. The role of inflammation induced by eye rubbing, which is a proven risk factor for keratoconus development, contact lens wear and ultraviolet irradiation, is another aspect of the inflammatory nature of keratoconus [4].

The keratoconus corneal proteome: Loss of epithelial integrity and stromal degeneration

Journal of Proteomics, 2013

Keratoconus is a thinning corneal dystrophy that begins in the early teenage years and ultimately requires cornea transplantation to restore vision. Here we conducted a highly sensitive mass spectrometric analysis of the epithelium and the stroma from keratoconus and normal donor corneas. We identified a total of 932 and 1,157 proteins in the consolidated data of the epithelium and stroma, respectively. Technical replicates showed strong correlations (≥ 0.88) in levels of all common proteins, indicating very low technical variations in the data. Analysis of the most increased (≥ 1.5 fold) and decreased (≤ 0.8 fold) proteins in the keratoconus corneal epithelial protein extracts identified proteins related to dermal diseases, inflammation, epithelial stratification and mesenchymal changes. Increased proteins included keratins 6A, 16 and vimentin, while the iron transporter lactotransferrin was decreased. The keratoconus stromal proteome suggest endoplasmic reticular stress, oxidative stress and widespread decreases in many extracellular matrix proteoglycan core proteins, lumican and keratocan, collagen types I, III, V and XII. Marked increase in apoptosis and endocytosis-related proteins suggest degenerative changes in keratocytes, the resident cells of the stroma. This is the most comprehensive proteome analysis of the cornea that highlights similarities of keratoconus with other neurodegenerative diseases.