The recessive dystrophic form of epidermolysis bullosa (RDEB) is a disorder of incurable skin fragility and blistering caused by mutations in the type VII collagen gene (Col7a1). The absence of type VII collagen production leads to the loss of adhesion at the basement membrane zone due to the absence of anchoring fibrils, which are composed of type VII collagen. We report that wild-type, congenic bone marrow cells homed to damaged skin, produced type VII collagen protein and anchoring fibrils, ameliorated skin fragility, and reduced lethality in the murine model of RDEB generated by targeted Col7a1 disruption. These data provide the first evidence that a population of marrow cells can correct the basement membrane zone defect found in mice with RDEB and offer a potentially valuable approach for treatment of human RDEB and other extracellular matrix disorders.
IntroductionEpidermolysis bullosa represents a family of severe, lifethreatening skin disorders resulting from mutations in genes encoding protein components of the cutaneous basement membrane zone. Although some forms, such as the junctional type, are lethal in the neonatal period, others, such as the dystrophic forms, lead to years of painful skin blistering and mutilating scarring. The most severe form of dystrophic epidermolysis bullosa (the Hallopeau-Siemens type) is caused by recessive mutations in the type VII collagen gene (Col7A1). 1 The recessive dystrophic form of epidermolysis bullosa (RDEB) is characterized by severely diminished type VII collagen (col7) production. 2 The homotrimeric col7 protein is synthesized by fibroblasts and keratinocytes and represents the key component of anchoring fibrils that connect cutaneous basement membrane to the dermal matrix. 3 Severe attenuation of anchoring fibrils in RDEB results in impaired dermal-epidermal cohesion and diminished adhesion of gastrointestinal mucosa at the basement membrane zone. Compromised integrity of the stratifying squamous epithelia leads to increased cutaneous and mucosal sensitivity to mechanical stress and stigmatizing, and to an eventually lethal, clinical phenotype. Children with RDEB develop painful skin and mucosal blistering, mutilating scarring, alopecia, corneal erosions, tooth decay, esophageal strictures, anemia, joint contractures, small epidermal inclusion cysts (milia), nail dystrophy, and fusion of fingers and toes (pseudosyndactyly or "mitten" deformity) by the age of 6 to 8 years. As a result of extreme skin fragility, aberrant tissue repair, and chronic inflammation, RDEB patients develop squamous cell carcinomas in the third decade of life. 4 At this time, there is no therapeutic intervention with proven curative benefit. Palliative measures include complex bandaging of most of the body surface (to protect the skin from the slightest friction, and to prevent infection and excessive loss of body fluid), surgical debridement and analgesia, and nutritional support (using liquid or pureed food by mouth or via percutaneous gastric feeding tube) and analgesia. Faced wit...