Aims-This study was undertaken to confirm the distribution and expression of the molecule CD44 on human corneas under normal and pathological conditions. Methods-Fifty eight corneal buttons from adult patients suVering from various corneal diseases and four normal corneas were included in this study. Frozen sections were stained immunohistochemically with monoclonal antibodies against human CD44 using an APAAP method and observed under a light microscope. Results-In normal corneas CD44 was predominantly expressed on the membranes of basal epithelial cells and on the keratocytes, as well as on the vascular endothelial cells of the corneal limbi, but was not expressed on corneal endothelial cells. Enhanced expression of CD44 was observed on the epithelium of corneas with inflammation and allograft rejection. In a number of abnormal conditions including allograft rejection, corneal trauma, primary and secondary corneal endothelial decompensation the remaining endothelial cells stained positively for CD44. However, in some corneas of keratitis, keratoconus, and dystrophy the endothelium which appeared relatively integral in morphology and amount remained CD44 negative. Conclusions-These results suggest that CD44, the hyaluronate receptor, may play an important role in corneal cell-cell and cell-matrix interactions. Its regulation is closely related to corneal inflammatory reactions. The induction of CD44 on corneal endothelium might play a potential role in compensatory processes when corneal endothelial cells are injured. (Br J Ophthalmol 1997;81:80-84) CD44, the hyaluronate receptor, 1 is a transmembrane glycoprotein which was recognised as a cell adhesion receptor that takes part in cell-cell and cell-matrix interaction such as cell migration, lymphocyte homing and activation, and tumour growth and metastasis.2-4 The main haematopoietic form of CD44 has a molecular weight of 85-95 kDa.5 6 There are some variant CD44 isoforms (CD44v) induced by alternate splicing of multiple exons into the extracellular domain and by diVerent post-translational modifications in diVerent cell types.3 7 CD44 may bind its ligand hyaluronan in response to antigenic stimuli and may participate in the eVector stage of immunological responses, 8 and be capable of binding fibronectin, laminin, and collagen I. 6 9 In corneal disorders such as keratitis and corneal allograft rejection some cell adhesion molecules have been shown to be involved in the pathological processes. [10][11][12][13] However, whether CD44 participates in the processes of corneal diseases is less well known. There have been very few studies of CD44 in human corneas and the existing reports on the distribution of CD44 on corneal tissues diVer. Alho and Underhill reported that CD44 was absent from human corneal epithelium, 14 and Foets and colleagues showed that corneal endothelial cells were negative for CD44, but also reported a 'garland-like' positive pattern of expression in corneal endothelial flat mounts of organ cultured corneas. 15 However, on rabb...