Increased mRNA expression of decorin in the prolapsing posterior leaflet of the mitral valve.

To improve our understanding of myxomatous degeneration of the valvar tissue as seen in mitral valve prolapse, we have compared the biosynthetic phenotype of the connective tissue cells in myxomatous segments (n=4) resected during surgery with that of homologous segments of normal valves (n=4) harvested in age-matched organ donors. The steady-state level of mRNA for selected extracellular matrix macromolecules and metalloproteinases was assessed by quantitative (internal standard controlled) reverse transcriptase-polymerase chain reaction (RT-PCR). Among the investigated gene products, the decorin mRNA expression was significantly increased in degenerative valve compared with normal tissue (211+/-48 vs. 100+/-70, p<0.02). The level of fibrillin 2 also tended to be increased (194+/-88 vs. 100+/-81, p=0.08). These results suggest that myxomatous valvar tissue is characterized by an overexpression of mRNA for decorin. Owing to the role of this small leucine-rich proteoglycan in the regulation of fibril assembly and stability, this alteration may account for or is a result of a defective organization of the collagen and elastic fibers in this disease and contribute to the intrinsic distensibility and fragility of the myxomatous tissue.