Kindler syndrome is an autosomal recessive disorder characterized by skin atrophy and blistering. It results from loss-of-function mutations in the FERMT1 gene encoding the focal adhesion protein, fermitin family homolog-1. How and why deficiency of fermitin family homolog-1 results in skin atrophy and blistering are unclear. In this study, we investigated the epidermal basement membrane and keratinocyte biology abnormalities in Kindler syndrome. We identified altered distribution of several basement membrane proteins, including types IV, VII, and XVII collagens and laminin-332 in Kindler syndrome skin. In addition, reduced immunolabeling intensity of epidermal cell markers such as 1 and ␣6 integrins and cytokeratin 15 was noted. At the cellular level, there was loss of 4 integrin immunolocalization and random distribution of laminin-332 in Kindler syndrome keratinocytes. Of note, active 1 integrin was reduced but overexpression of fermitin family homolog-1 restored integrin activation and partially rescued the Kindler syndrome cellular phenotype. This study provides evidence that fermitin family homolog-1 is implicated in integrin activation and demonstrates that lack of this protein leads to pathological changes be- Kindler syndrome (KS; OMIM 173650) is a rare autosomal recessive disorder characterized by trauma-induced skin blistering, skin atrophy, and poikiloderma.1 KS results from pathogenic mutations in the FERMT1 (formerly KIND1 or C20orf42) gene that encodes fermitin family homolog-1 (FFH1) (formerly kindlin-1 or kindlerin), an actin cytoskeleton and focal adhesion-associated molecule.2,3 FFH1 is mainly expressed in basal keratinocytes. [3][4][5][6] In KS, however, there is often a complete absence of FFH1 protein expression, although some variability may occur. 6 Thus far, 37 different loss-of-function FERMT1 mutations have been identified. 7-9 The mechanism by which these pathogenic FERMT1 mutations result in skin atrophy and blistering, however, remains unclear. Indeed, insight from studies on KS skin and FFH1 has been limited. Ultrastructural and immunohistochemical studies on KS skin have revealed a disrupted and reduplicated cutaneous basement membrane, 4,10 -16 and silencing of FFH1 in HaCaT cells results in reduced cell adhesion, proliferation, and spreading. 17 In addition, cultured KS keratinocytes display decreased cell adhesion and proliferation and exhibit multiple cell polarities