Extracellular matrix components in dilated cardiomyopathy. Immunohistochemical study of endomyocardial biopsy specimens.

Fibrotic change is one of the characteristic features of the heart with idiopathic dilated cardiomyopathy (DCM), but the extracellular matrix components have not been fully clarified. Fibronectin, laminin, and types IV, I and III collagen staining using the avidin-biotin-peroxidase complex method was conducted to study the localization of extracellular matrix components in biopsy specimens obtained from 7 patients with DCM. Fibronectin was observed in the endomysium and perimysium, co-existent with types I and III collagen; it was also distributed nonhomogeneously in the replacement fibrotic lesions. The staining intensity in a section varied substantially from location to location. Laminin surrounded the myocytes and was distributed in the endomysium localized together with type IV collagen, but it was not found in the perimysium. Weak but positive staining was observed in replacement fibrotic lesions in 2 patients. Similarly to laminin, type IV collagen staining was observed around the myocytes and in the endomysium. It was also observed in replacement fibrotic lesions in 4 patients either with or without laminin. Type I collagen, localized together with type III collagen, was distributed in both the endomysium and perimysium. It was also distributed nonhomogeneously in the replacement fibrotic lesions. Similar staining to type I collagen was seen for type III collagen. In summary, all examined components were observed in the fibrotic lesions with no primary deficit of any examined component being demonstrated. The variability of staining intensity and positive fibronectin staining suggests that the phases of fibrotic changes differed substantially from location to location.