The suspensory ligament of the lens (zonule of Zinn) centers the ocular lens in the path of light and transmits ciliary muscle forces involved in accommodation. The zonule is a circular cell-free structure that is composed of radially oriented cablelike microfibrils. It extends from the ciliary body to the equatorial region of the lens capsule. Zonule microfibrils are composed primarily of the matrix glycoprotein fibrillin-1.
1 –4 Fibrillin-1 is also a major component of tissue microfibrils, which are especially abundant in association with elastic fibers in skin, arteries, and lung.
3,5 Ectopia lentis, which refers to subluxation of the lens from its centered position, may result from trauma to the zonule or may be caused by dysgenesis or fragility of the zonule as a consequence of inherited disorders. For example, dominantly inherited
FBN1 mutations cause Marfan syndrome (MFS), in which ectopia lentis is a major clinical manifestation.
6 Less commonly, dominantly inherited
FBN1 mutations cause dominantly inherited isolated ectopia lentis (MIM129600), i.e., without other clinical connective tissue manifestations of MFS.
7,8 Recently,
ADAMTSL4 mutations were identified in both recessively inherited isolated ectopia lentis
9 –12 and ectopia lentis et pupillae.
13 Ectopia lentis has also been described in Weill-Marchesani syndrome (MIM277600; MIM608328),
14 which is caused by either
ADAMTS10 15 or
FBN1 mutations,
16 inherited in a recessive or dominant fashion, respectively.
ADAMTS17 mutations were identified in a WMS-like syndrome in which ectopia lentis was also present.
17 These genetic findings suggest that at least three members of the ADAMTS superfamily of secreted proteins are involved in the normal formation, maintenance, or both of the zonule and the abnormalities therein in case of defects in these proteins. Recently, ADAMTSL6, which of all family members is the most similar to ADAMTSL4, was shown to bind directly to fibrillin-1 and to enhance its assembly both in tissue culture and in transgenic mice overexpressing it.
18 Similarly, binding of ADAMTS10 to fibrillin-1 and to fibrillin microfibrils was identified recently, and ADAMTS10 was shown to enhance microfibril biogenesis in vitro.
19 Collectively, these findings led to the hypothesis that ADAMTSL4 functions to promote fibrillin-1 assembly in the genesis, maintenance, or both of the zonular apparatus.