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Pterygia Pathogenesis
Corneal Invasion by Matrix Metalloproteinase Expressing Altered Limbal Epithelial Basal Cells
Nicholas Dushku, MD;
Molykutty K. John, PhD;
Gregory S. Schultz, PhD;
Ted W. Reid, PhD
Arch Ophthalmol. 2001;119:695-706.
Objective To assess the potential role of matrix metalloproteinases (MMPs) in
the pathogenesis of pterygia by comparing the immunolocalization patterns
of MMPs in altered limbal basal stem cells, activated fibroblasts, and areas
of elastotic degeneration adjacent to the pterygia.
Methods Nine primary and 1 recurrent pterygia along with normal superior limbal-conjunctival
tissue and cornea were immunostained with mouse monoclonal antibodies specific
for MMP-1, MMP-2, MMP-3, MMP-9, membrane type 1 (MT1)–MMP (MMP-14),
and membrane type 2–MMP (MMP-15).
Results Normal conjunctival, limbal, and corneal cells lacked significant immunostaining
except for cell surface MT1-MMP. In contrast, altered limbal basal epithelial
cells of the 9 primary and 1 recurrent pterygia immunostained for all 6 MMPs.
Activated and altered fibroblasts associated with the pterygia immunostained
primarily for MMP-1. In contrast, stromal areas of elastotic degeneration
(pingueculae) showed variable immunostaining of MMPs.
Conclusions Altered limbal basal epithelial cells (pterygium cells) immunostained
for multiple types of MMPs in contrast to normal conjunctival, limbal, and
corneal cells. The pterygium cells invading over Bowman's layer produce elevated
MMP-1, MMP-2, and MMP-9 expression, which probably are the main MMPs responsible
for the dissolution of Bowman's layer. Pterygium cells may also cause activation
of fibroblasts at the head of the pterygium, leading to the initial cleavage
of fibrillar collagen in Bowman's layer by the production of MMP-1. Altered
fibroblasts in areas of elastotic degeneration (pingueculae) trailing behind
the pterygium constitute a second type of tumor, which is noninvasive.
Clinical Relevance These data of altered MMP expression support the concept that altered
basal limbal epithelial cells play a key role in the formation and migration
of a pterygium.
From the Department of Ophthalmology, Kaiser Permanente Medical Center,
Sacramento, Calif (Dr Dushku); Department of Obstetrics and Gynecology, Institute
for Wound Healing, University of Florida, Gainesville (Drs John and Schultz);
and Departments of Ophthalmology and Visual Sciences, Texas Tech University,
Lubbock (Dr Reid).
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