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Wang XX, Zhang L, Lu Y. Advances in the molecular pathogenesis and cell therapy of stress urinary incontinence. Front Cell Dev Biol 2023; 11:1090386. [PMID: 36846586 PMCID: PMC9944745 DOI: 10.3389/fcell.2023.1090386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023] Open
Abstract
Stress urinary incontinence (SUI) is very common in women. It affects patients' mental and physical health, and imposed huge socioeconomic pressure. The therapeutic effect of conservative treatment is limited, and depends heavily on patient persistence and compliance. Surgical treatment often brings procedure-related adverse complications and higher costs for patients. Therefore, it is necessary to better understand the potential molecular mechanisms underlying stress urinary incontinence and develop new treatment methods. Although some progress has been made in the basic research in recent years, the specific molecular pathogenic mechanisms of SUI are still unclear. Here, we reviewed the published studies on the molecular mechanisms associated with nerves, urethral muscles, periurethral connective tissue and hormones in the pathogenesis of SUI. In addition, we provide an update on the recent progresses in research on the use of cell therapy for treating SUI, including research on stem cells therapy, exosome differentiation and gene regulation.
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Affiliation(s)
- Xiao-xiao Wang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Lei Zhang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
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Post WM, Widomska J, Grens H, Coenen MJH, Martens FMJ, Janssen DAW, IntHout J, Poelmans G, Oosterwijk E, Kluivers KB. Molecular Processes in Stress Urinary Incontinence: A Systematic Review of Human and Animal Studies. Int J Mol Sci 2022; 23:ijms23063401. [PMID: 35328824 PMCID: PMC8949972 DOI: 10.3390/ijms23063401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/18/2022] [Indexed: 02/01/2023] Open
Abstract
Stress urinary incontinence (SUI) is a common and burdensome condition. Because of the large knowledge gap around the molecular processes involved in its pathophysiology, the aim of this review was to provide a systematic overview of genetic variants, gene and protein expression changes related to SUI in human and animal studies. On 5 January 2021, a systematic search was performed in Pubmed, Embase, Web of Science, and the Cochrane library. The screening process and quality assessment were performed in duplicate, using predefined inclusion criteria and different quality assessment tools for human and animal studies respectively. The extracted data were grouped in themes per outcome measure, according to their functions in cellular processes, and synthesized in a narrative review. Finally, 107 studies were included, of which 35 used animal models (rats and mice). Resulting from the most examined processes, the evidence suggests that SUI is associated with altered extracellular matrix metabolism, estrogen receptors, oxidative stress, apoptosis, inflammation, neurodegenerative processes, and muscle cell differentiation and contractility. Due to heterogeneity in the studies (e.g., in examined tissues), the precise contribution of the associated genes and proteins in relation to SUI pathophysiology remained unclear. Future research should focus on possible contributors to these alterations.
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Affiliation(s)
- Wilke M. Post
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Joanna Widomska
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Hilde Grens
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
| | - Marieke J. H. Coenen
- Radboud Institute of Health Sciences, Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Frank M. J. Martens
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Dick A. W. Janssen
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Joanna IntHout
- Department of Health Evidence, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
| | - Geert Poelmans
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (J.W.); (G.P.)
| | - Egbert Oosterwijk
- Department of Urology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (F.M.J.M.); (D.A.W.J.); (E.O.)
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (W.M.P.); (H.G.)
- Correspondence:
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Novel non-operative treatment of uterovaginal prolapse in a preterm neonate. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Zhuang G, Wen Y, Briggs M, Shao Q, Tran D, Wang H, Chen B. Secretomes of human pluripotent stem cell-derived smooth muscle cell progenitors upregulate extracellular matrix metabolism in the lower urinary tract and vagina. Stem Cell Res Ther 2021; 12:228. [PMID: 33823931 PMCID: PMC8025391 DOI: 10.1186/s13287-021-02292-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/17/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adult mesenchymal stem cells (MSCs) have been studied extensively for regenerative medicine; however, they have limited proliferation in vitro, and the long culture time induces cell senescence. MSCs also contribute to tissue repair through their paracrine function. In this study, we sought to examine the paracrine effects of human smooth muscle cell progenitors (pSMC) on the urethra and adjacent vagina of stress urinary incontinence rodents. We use human pluripotent stem cell (PSC) lines to derive pSMCs to overcome the issue of decreased proliferation in tissue culture and to obtain a homogenous cell population. METHOD Three human PSC lines were differentiated into pSMCs. The conditioned medium (CM) from pSMC culture, which contain pSMC secretomes, was harvested. To examine the effect of the CM on the extracellular matrix of the lower urinary tract, human bladder smooth muscle cells (bSMCs) and vaginal fibroblasts were treated with pSMC-CM in vitro. Stress urinary incontinence (SUI) was induced in rats by surgical injury of the urethra and adjacent vagina. SUI rats were treated with pSMC-CM and monitored for 5 weeks. Urethral pressure testing was performed prior to euthanasia, and tissues were harvested for PCR, Western blot, and histological staining. Kruskal-Wallis one-way ANOVA test and Student t test were used for statistical comparisons. RESULTS pSMC-CM upregulated MMP-2, TIMP-2, collagen, and elastin gene expression, and MMP-9 activity in the human bladder and vaginal cells consistent with elastin metabolism modulation. pSMC-CM treatment in the SUI rat improved urethral pressure (increase in leak point pressure compared to intact controls, p < 0.05) and increased collagen and elastin expression in the urethra and the adjacent vagina. CONCLUSION Conditioned media from smooth muscle cell progenitors derived from human pluripotent stem cells improved urethral leak point pressure and collagen and elastin content in the SUI rat. These findings suggest a novel therapeutic potential for PSC-based treatments for SUI and pelvic floor disorders where tissues are affected by collagen, elastin, and smooth muscle loss.
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Affiliation(s)
- Guobing Zhuang
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Yan Wen
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Mason Briggs
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Qingchun Shao
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Darlene Tran
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
| | - Hongbo Wang
- Department of Obstetrics/Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
| | - Bertha Chen
- Department of Obstetrics/Gynecology, Stanford University School of Medicine, 300 Pasteur Drive HH-333, Stanford, CA 94305 USA
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D'alessandro G, Leone M, Antolini J, Ferrero S, Sala P, Melloni G, Fasolis G, Gustavino C. Three-year follow-up in patients with urinary stress incontinence treated with Altis® single-incision sling. MINERVA GINECOLOGICA 2020; 72:12-18. [PMID: 32153158 DOI: 10.23736/s0026-4784.20.04496-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of the study is to report three years follow-up of single incision slings for the treatment of stress urinary incontinence (SUI). The main outcomes are to evaluate the efficacy of the device and to assess safety, adverse events, quality of life, demographic features of treated women and prognostic factors for SUI. METHODS We performed a retrospective, double-center, single-arm study. Data were collected by medical records and a telephone interview 3 years after the implant of the mini-sling. Complication rate, subjective efficacy and degree of satisfaction were investigated. RESULTS Fifty-four patients were treated between March 2015 and March 2017, of which 47 answered the survey. Forty-one of 47 procedures (87.2%) were considered effective. Among more relevant complications, there was one case of extrusion of mesh and three cases of new onset of urinary disfunction, of which two cases of urgency urinary incontinence (UUI) and one case of de-novo SUI. Most complications were solved within few days after the procedure. Concerning the subjective impression of improvement, investigated by using the Patient Global Impression of Improvement (PGI-I) questionnaires, 41 patients reported subjective satisfaction, three reported no change in quality of life and three patients had worsening of symptoms. CONCLUSIONS The procedure was safe and effective for the treatment of SUI but more data are needed to confirm our preliminary results.
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Affiliation(s)
- Gloria D'alessandro
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy - .,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy -
| | - Maurizio Leone
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
| | - Jacopo Antolini
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Simone Ferrero
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy.,Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy
| | - Paolo Sala
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
| | - Guglielmo Melloni
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Giuseppe Fasolis
- Department of Urology, San Lazzaro Hospital, ASL-CN2, Alba, Cuneo, Italy
| | - Claudio Gustavino
- Academic Unit of Obstetrics and Gynecology, San Martino IRCCS and Polyclinic Hospital, Genoa, Italy
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Multimodal vaginal toning for bladder symptoms and quality of life in stress urinary incontinence. Int Urogynecol J 2016; 28:1201-1207. [PMID: 28035444 PMCID: PMC5514206 DOI: 10.1007/s00192-016-3248-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 12/12/2016] [Indexed: 11/26/2022]
Abstract
Introduction and hypothesis Treatment options for women with stress urinary incontinence (SUI) have limitations. We hypothesized that multimodal vaginal toning therapy would improve bladder symptoms and quality of life in women with postpartum SUI and sexual function complaints. Methods Patients self-administered 24 sessions of multimodal vaginal toning therapy lasting 10 min each over 50 days. Outcomes included 1-h pad weight test, Urogenital Distress Inventory Short Form (UDI-6), Incontinence Impact Questionnaire-Short Form (IIQ-7), Female Sexual Distress Scale-Revised 2005 (FSDS-R), Female Sexual Function Index (FSFI), pelvic floor muscle strength, patient satisfaction, and adverse events. Results Of the 55 patients enrolled (safety population), 48 completed the study per-protocol (PP population). A total of 38 (79%) patients had a positive 1-h pad weight test at baseline. In this group, urine leakage was moderate or severe in 82% of patients at baseline, but in only 18% after treatment. Treatment success was 84%, defined as >50% improvement in pad weight relative to baseline. In the PP population, mean UDI-6 score improved by 50% (p < 0.001) and IIQ-7 score improved by 69% (p < 0.001). Sexual function quality of life improved by 54% for FSDS-R and 15% for FSFI (both p < 0.001). Pelvic floor muscle strength significantly improved (p < 0.001). Patient satisfaction with therapy was reported in 83% of patients. In the safety population, 2 (3.6%) adverse events were reported—1 urinary tract infection and 1 report of discomfort due to excessive warmth. Conclusions Multimodal vaginal toning therapy yields clinically meaningful improvements in bladder symptoms, pelvic floor muscle strength, and quality of life in women with SUI.
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Abstract
BACKGROUND Although some studies have analyzed the prevalence of urinary incontinence during pregnancy, there are scarce data on the frequency and characteristics of fecal incontinence during this period. OBJECTIVE The aim of this study was to determine the incidence and characteristics of women with fecal incontinence symptoms during early and late pregnancy, to evaluate its impact on quality of life, and to identify whether there is a specific clinical pattern that could identify patients at risk. DESIGN This was a cross-sectional observational study. SETTINGS The study was conducted at the maternity unit of a university tertiary care center. PATIENTS Pregnant women undergoing obstetric follow-up were included in the study. MAIN OUTCOME MEASURES A prospective study was conducted. All of the patients attending our maternity unit for obstetric ultrasound examination during the first and third trimesters were eligible for inclusion. Selected patients completed a self-reported questionnaire that included items on fecal incontinence, Wexner score, and stool consistency. Quality of life was assessed using the Medical Outcomes Study Short Form 36. RESULTS The study included 228 consecutive pregnant women. Ninety-three patients (40.8%) had some episode of fecal incontinence in the 4 weeks before the survey, 15 patients with solid stool, 6 patients with liquid stools, and 72 with flatus. In these patients, the mean Wexner score was 3.82 (range, 2.0-13.0). In patients with incontinence, quality of life was significantly affected in most subscales of Medical Outcomes Study Short Form 36. There were no significant differences in the following variables between patients with and without symptoms of fecal incontinence, including age (p = 0.090), BMI (p = 0.094), history of previous deliveries (p = 0.492), trimester of pregnancy (p = 0.361), and Bristol Stool Form Scale (p = 0.388). LIMITATIONS The cross-sectional design hampered identification of specific time at which the impact of pregnancy occurred. CONCLUSIONS The prevalence of fecal incontinence is high during pregnancy with a notable impact on quality of life. There was no specific clinical pattern during pregnancy that could define patients at risk for fecal incontinence during this period of life.
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Chen B, Dave B. Challenges and Future Prospects for Tissue Engineering in Female Pelvic Medicine and Reconstructive Surgery. Curr Urol Rep 2014; 15:425. [DOI: 10.1007/s11934-014-0425-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Sangsawang B, Sangsawang N. Stress urinary incontinence in pregnant women: a review of prevalence, pathophysiology, and treatment. Int Urogynecol J 2013; 24:901-12. [PMID: 23436035 PMCID: PMC3671107 DOI: 10.1007/s00192-013-2061-7] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 01/26/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Stress urinary incontinence (SUI) is the most common type of urinary incontinence (UI) in pregnant women and is known to have detrimental effects on the quality of life in approximately 54.3 %. Pregnancy is the main risk factor for the development of SUI. This review provides details of the pathophysiology leading to SUI in pregnant women and SUI prevalence and treatment during pregnancy. METHODS We conducted a PubMed search for English-language and human-study articles registered from January 1990 to September 2012. This search was performed for articles dealing with prevalence and treatment of SUI during pregnancy. In the intervention studies, we included studies that used a randomized controlled trial (RCT) design or studies comparing a treatment intervention to no treatment. RESULTS A total of 534 articles were identified; 174 full-text articles were reviewed, and 28 of them met eligibility criteria and are reported on here. The mean prevalence of SUI during pregnancy was 41 % (18.6-60 %) and increased with gestational age. The increasing pressure of the growing uterus and fetal weight on pelvic-floor muscles (PFM) throughout pregnancy, together with pregnancy-related hormonal changes, may lead to reduced PFM strength as well as their supportive and sphincteric function. These cause mobility of the bladder neck and urethra, leading to urethral sphincter incompetence. Pelvic floor muscle exercise (PFME) is a safe and effective treatment for SUI during pregnancy, without significant adverse effects. CONCLUSIONS Understanding these issues can be useful for health-care professionals when informing and counseling pregnant women to help prevent SUI during pregnancy and the postpartum period.
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Affiliation(s)
- Bussara Sangsawang
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Srinakharinwirot University, 215-216 Ammarinnivet III Saimai Soi 79, Saimai Rd., Bangkok, 10220, Thailand.
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The impact of cesarean delivery on pelvic floor dysfunction in lysyl oxidase like-1 knockout mice. Female Pelvic Med Reconstr Surg 2012; 16:21-30. [PMID: 22453086 DOI: 10.1097/spv.0b013e3181d00035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE : Lysyl oxidase like-1 (LOXL1) knockout mice have abnormal elastic fiber homeostasis and frequently develop pelvic floor dysfunction after pregnancy and delivery. The objective of this study was to test the hypothesis that tissue changes associated with vaginal delivery lead to pelvic floor dysfunction as a result of abnormal elastic fiber homeostasis. METHODS : Female LOXL1 knockout mice delivered either spontaneously or by cesarean delivery. Mice were assessed weekly for pelvic organ prolapse (POP). At 12 weeks postpartum, lower urinary tract function was assessed by cystometry and leak-point pressure testing. Urethrovaginal cross-sections were analyzed using a histologic grading scale to assess elastin fiber disorganization. RESULTS : A total of 39 mice delivered by spontaneous vaginal delivery and 36 by cesarean delivery. Twelve weeks after spontaneous vaginal delivery or cesarean delivery, 23 (59%) and 11 (31%) mice had developed POP, respectively. The mean time to develop POP was 7.2 weeks after spontaneous vaginal delivery and 10.5 weeks after cesarean delivery (log rank, P = 0.0008). The Cox proportional hazard ratio was 0.55 (95% confidence interval, 0.38-0.79). Mice with POP had increased frequency of bladder contractions not associated with voiding during cystometry (P = 0.02). POP, but not mode of delivery, was associated with increased elastic fiber disorganization. CONCLUSIONS : Cesarean delivery delays the development of POP in LOXL1 knockout mice. POP is associated with increased bladder contraction frequency and increased elastic fiber disorganization in the urethra and vagina. The mechanisms underlying these findings warrant further investigation.
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Grimshaw R, Jain P, Latthe P. Management of mixed urinary incontinence. WOMENS HEALTH 2012; 8:567-77. [PMID: 22934730 DOI: 10.2217/whe.12.38] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Mixed urinary incontinence accounts for 33% of all incontinence and is the involuntary loss of urine associated with the sensation of urgency; it is also associated with exertion, sneezing or coughing. Risk factors include vaginal delivery, obesity, age and possible genetic factors. Treatment includes lifestyle changes, behavioral therapies, medication and nerve modulation. Surgery with midurethral slings can cure both stress and urge components in 40-50% of cases. Future therapies may include new medications adapting potassium and calcium channels and more widespread use of sacral neuromodulation. This review focuses on the investigation and optimal management of mixed urinary incontinence.
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Affiliation(s)
- Rosamund Grimshaw
- Department of Obstetrics & Gynaecology, Birmingham Women's NHS Foundation Trust, Birmingham, UK.
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Gene Expression and Immunoreactivity of Elastolytic Enzymes in the Uterosacral Ligaments From Women With Uterine Prolapse. Reprod Sci 2012; 19:354-9. [DOI: 10.1177/1933719111424443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stothers L, Friedman B. Risk factors for the development of stress urinary incontinence in women. Curr Urol Rep 2012; 12:363-9. [PMID: 21938471 DOI: 10.1007/s11934-011-0215-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Large-scale population-based surveys published in the past decade give new insights regarding risk factors for stress urinary incontinence (SUI) in women. Age plays a significant role in the development of all forms of urinary incontinence, but findings regarding the role of hormonal changes are inconsistent. Obesity is an increasingly prevalent health condition that was shown to have detrimental impact on SUI development, while weight reduction was proven to reduce SUI. Other modifiable risk factors, such as diabetes, also are related to SUI. Pregnancy, delivery, and pelvic floor surgery are risk factors discussed in the review. Recent genetic studies identified several genes encoding components of the extracellular matrix, which could be related to a predisposition to SUI. Identifying risk factors for SUI can facilitate prevention strategies in an aim to reduce SUI prevalence among women.
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Affiliation(s)
- Lynn Stothers
- University of British Columbia, Vancouver, British Columbia V5Z 1M9, Canada.
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Wen Y, Whitin J, Yu T, Cohen H, Polan ML, Chen B. Identification of protein marker in vaginal wall tissues of women with stress urinary incontinence by protein chip array. J Obstet Gynaecol Res 2011; 38:89-96. [PMID: 22136672 DOI: 10.1111/j.1447-0756.2011.01690.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM We sought to investigate protein biomarkers for stress urinary incontinence (SUI) in vaginal tissues using surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS) and examine if this is a reliable methodology to examine proteins in small tissue specimens. MATERIAL AND METHODS We compared protein expression profile of vaginal tissue from women with SUI and continent controls. A 22.6kDa peak was identified by subsequent weak cation-exchange, reverse-phase fractionation, gel electrophoresis, and trypsin digestion, then analyzed by matrix assisted laser desorption/ionization mass spectrometry (MALDI MS) and MALDI MS-MS. Biomarker identity and expression level were confirmed by Western-blotting and immunohistochemistry. RESULTS Expression of the 22.6kDa protein, identified as SM-22α, was significantly higher in women with SUI versus controls. A 3×3-mm tissue sample was sufficient for identification. Western-blot/immunohistochemistry confirmed the SELDI-TOS MS findings. CONCLUSION SM-22α, a marker for myofibroblasts, was identified as a biomarker of SUI. Differential protein profiling by SELDI-TOF MS is a powerful and reliable tool for urogynecological research as it allows us to study an array of proteins simultaneously using small tissue samples.
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Affiliation(s)
- Yan Wen
- Department of Obstetrics and Gynecology Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA.
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Campeau L, Gorbachinsky I, Badlani GH, Andersson KE. Pelvic floor disorders: linking genetic risk factors to biochemical changes. BJU Int 2011; 108:1240-7. [PMID: 21883823 DOI: 10.1111/j.1464-410x.2011.10385.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pelvic floor disorders (PFDs) such as stress urinary incontinence (SUI) and pelvic organ prolapse (POP) may share a common pathophysiological process related to pelvic floor tissue laxity and loss of support. We reviewed recent literature on observed biochemical changes in women with SUI and POP, linking them to genetic predisposition. We found that studies of pelvic tissues showed differences between control subjects and women with POP and SUI in collagen and elastin structure at a molecular and fibrillar level. Studies were heterogeneous but showed a trend towards decreased collagen and elastin content. The contribution of matrix metalloproteinases to increased collagenolysis can be related to genetic polymorphisms present in higher frequency in women with PFD. Extracellular matrix (ECM) protein turnover plays a role in the development of POP and SUI, but much remains to be understood of this complex dynamic interplay of enzymes, proteins and molecules. Genotyping of candidate genes participating in ECM formation will elucidate the missing link between the manifestation of the disease and the biochemical changes observed systematically, in addition to those in the pelvic floor.
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Affiliation(s)
- Lysanne Campeau
- Institute for Regenerative Medicine, Wake Forest University, Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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Bortolini MAT, Rizk DEE. Genetics of pelvic organ prolapse: crossing the bridge between bench and bedside in urogynecologic research. Int Urogynecol J 2011; 22:1211-9. [PMID: 21789659 DOI: 10.1007/s00192-011-1502-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 07/11/2011] [Indexed: 12/22/2022]
Abstract
An increasing number of scientists have studied the molecular and biochemical basis of pelvic organ prolapse (POP). The extracellular matrix content of the pelvic floor is the major focus of those investigations and pointed for potential molecular markers of the dysfunction. The identification of women predisposed to develop POP would help in the patients' management and care. This article includes a critical analysis of the literature up to now; discusses implications for future research and the role of the genetics in POP.
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Affiliation(s)
- Maria Augusta Tezelli Bortolini
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Borges Lagoa, 783 Cj. 31, 04038-031, São Paulo, SP, Brazil.
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Moon YJ, Choi JR, Jeon MJ, Kim SK, Bai SW. Alteration of elastin metabolism in women with pelvic organ prolapse. J Urol 2011; 185:1786-92. [PMID: 21420126 DOI: 10.1016/j.juro.2010.12.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Indexed: 01/27/2023]
Abstract
PURPOSE Although there are many studies about the effects of vaginal birth, the effects of menopause on pelvic floor support have not been identified. We compared elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse, and defined the menopausal regulation of this process. MATERIALS AND METHODS The study group consisted of 35 women who underwent hysterectomy for pelvic organ prolapse. The control group consisted of 39 women without pelvic organ prolapse. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of mRNA, and protein for neutrophil elastase, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by real-time quantitative polymerase chain reaction and ELISA, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin, an inhibitor of neutrophil elastase, was also determined. ANOVA, the Kruskal-Wallis test and multivariate linear regression were used for statistical analysis. RESULTS Expression of neutrophil elastase and matrix metalloproteinase-2 mRNA was higher in women with pelvic organ prolapse than in those without pelvic organ prolapse. Compared to before menopause, neutrophil elastase and matrix metalloproteinase-2 showed a significant decrease in postmenopausal women without pelvic organ prolapse, although these remained increased in postmenopausal women with pelvic organ prolapse. Alpha-1-antitrypsin was significantly less in postmenopausal women with pelvic organ prolapse than in postmenopausal women without pelvic organ prolapse. The activities of neutrophil elastase, matrix metalloproteinase-2 and matrix metalloproteinase-9 were increased in women with pelvic organ prolapse, and these trends were similar to neutrophil elastase and matrix metalloproteinase-2 expression even after adjustment for age, parity and menopausal status. CONCLUSIONS After menopause increased elastolytic protease has a significant role in the development of pelvic organ prolapse.
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Affiliation(s)
- Yeo Jung Moon
- Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Korea
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Breyer BN, Wang G, Lin G, Shindel AW, Yang R, Lin CS, Lue TF. The effect of long-term hormonal treatment on voiding patterns during filling cystometry and on urethral histology in a postpartum, ovariectomized female rat. BJU Int 2010; 106:1775-81. [PMID: 20201831 PMCID: PMC2912975 DOI: 10.1111/j.1464-410x.2010.09268.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study whether long-term treatment with oestrogen (E(2) ), selective E(2) receptor modulators (SERMs), or growth hormone (GH) can prevent the development of abnormal voiding patterns during filling cystometry (CMG) in a postpartum, ovariectomized (Ovx) female rat. MATERIALS AND METHODS Immediately after spontaneous delivery, 60 primiparous Sprague-Dawley rats were randomly divided into six equal groups. One group served as uninjured sham controls and five groups underwent intravaginal balloon dilatation. On day seven, previously dilated rats underwent bilateral Ovx and implantation of a subcutaneous hormone-delivery pump. The five treatment groups received normal saline (control), E(2) , raloxifene, levormeloxifene, or GH for 7 weeks. Conscious CMG was performed 7 weeks after Ovx. Urethral sphincter tissue was harvested for elastin immunohistochemistry and real-time polymerase chain reaction of α(1A) -adrenoceptor mRNA. RESULTS No abnormal voiding patterns were detected in the group treated with GH. The E(2) , raloxifene and levormeloxifene groups had greater detrusor overactivity and urethral relaxation incontinence than control rats. The raloxifene group had a significantly lower baseline bladder pressure and opening pressure. GH-treated rats had higher elastin content in the urethra. Urethral α(1A) -adrenoceptor mRNA concentration was significantly lower in the SERM-treated rats compared with controls. CONCLUSIONS GH prevents the development of abnormal voiding patterns during filling CMG in a rat model of parturition-induced incontinence; E(2) and SERMs may worsen voiding patterns.
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Affiliation(s)
- Benjamin N Breyer
- Department of Urology, Knuppe Molecular Urology Laboratory, University of California, San Francisco, CA, USA
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Gill BC, Moore C, Damaser MS. Postpartum stress urinary incontinence: lessons from animal models. EXPERT REVIEW OF OBSTETRICS & GYNECOLOGY 2010; 5:567-580. [PMID: 21113428 PMCID: PMC2989536 DOI: 10.1586/eog.10.48] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Postpartum stress urinary incontinence (SUI) is associated with chronic SUI in later life, which is 240% more likely to occur in women who deliver vaginally than those who did not. The etiology of SUI is multifactoral and has been associated with defects in both neuromuscular and structural components of continence. Specifically, clinical studies have demonstrated that pudendal nerve damage occurs during vaginal delivery, supporting the concept that neuromuscular damage to the continence mechanism can result in postpartum SUI. Urethral hypermobility and the loss of pelvic floor support, such as that involved in pelvic organ prolapse, have also been associated with SUI. Animal models provide an opportunity to investigate these injuries, individually and in combination, enabling researchers to gain further insight into their relative contributions to the development of SUI and the effectiveness of potential therapies for it. This article discusses the use of animal models of postpartum SUI in addition to the broad insights into treatment efficacy they provide.
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Affiliation(s)
- Bradley C Gill
- Cleveland Clinic Lerner College of Medicine, Department of Biomedical Engineering, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44195, USA
| | - Courtenay Moore
- Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, Q10, Cleveland, OH 44195, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Glickman Urological and Kidney Institute, Lerner College of Medicine, Cleveland Clinic, 9500 Euclid Ave, ND20, Cleveland, OH 44195, USA
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Abstract
Stress urinary incontinence (SUI), the most common type of incontinence in women, is a frequent and costly ailment responsible for an alteration in the quality of life. Although medical treatment gives some rather deceiving results, surgical techniques that include colposuspension or tension-free vaginal tape, employed in cases of urethral support defect, give a 5-year cure rate of more than 80%. However, these techniques could lead to complications or recurrence of symptoms. Recently, the initiation of urethral cell therapy has been undertaken by doctors and researchers. One principal source of autologous adult stem cells is generally used: muscle precursor cells (MPCs) which are the progenitors of skeletal muscle cells. Recently, a few research groups have shown interest in the MPCs and their potential for the treatment of urinary incontinence. However, using MPCs or fibroblasts isolated from a striated muscle biopsy could be questionable on several points. One of them is the in vitro cultivation of cells, which raises issues over the potential cost of the technique. Besides, numerous studies have shown the multipotent or even the pluripotent nature of stromal vascular fraction (SVF) or adipose-derived stem cells (ASCs) from adipose tissue. These cells are capable of acquiring in vitro many different phenotypes. Furthermore, recent animal studies have highlighted the potential interest of SVF cells or ASCs in cell therapy, in particular for mesodermal tissue repair and revascularization. Moreover, the potential interest of SVF cells or ASCs for the treatment of urinary incontinence in women is supported by many other characteristics of these cells that are discussed here. Because access to these cells via lipoaspiration is simple, and because they are found in very large numbers in adipose tissue, their future potential as a stem cell reservoir for use in urethral or other types of cell therapy is enormous.
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Affiliation(s)
- Régis Roche
- LBGM, Laboratoire de Biochimie et de Génétique Moléculaire, Université de l'île de la Réunion, Saint-Denis Messag Cedex, France.
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Man WC, Ho JYP, Wen Y, Sokol ER, Polan ML, Chen B. Is lysyl oxidase-like protein-1, alpha-1 antitrypsin, and neutrophil elastase site specific in pelvic organ prolapse? Int Urogynecol J 2009; 20:1423-9. [PMID: 19763368 DOI: 10.1007/s00192-009-0905-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 04/24/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND HYPOTHESIS We investigated whether the expression of alpha-1 antitrypsin (ATT), neutrophil elastase (NE), and lysyl oxidase-like protein 1 (LOXL-1) vary within the vagina in subjects with pelvic organ prolapse (POP). METHODS Biopsies were obtained from the anterior and posterior vaginal wall of 22 women with POP (> or =stage 2 by POP-Q). The subjects were grouped by the most prominent defect: cystocele, cystocele plus uterine prolapse, and rectocele. Comparative real-time PCR, Western blotting, and NE enzyme activity assay were performed. RESULTS The ratio of anterior and posterior vaginal wall ATT, NE, and LOXL-1 expression varied between individuals within the same defect group. CONCLUSIONS ATT, NE, and LOXl-1 expression was variable among different biopsy sites in the vagina. No consistent pattern was present when the subjects were grouped by the most prominent defect. We recommend careful consideration of biopsy sites in future studies on POP to enhance reproducibility of data.
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Affiliation(s)
- Weng Chi Man
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, 300 Pasteur Drive, HH-333, Stanford, CA 94305-5317, USA
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Chen B, Wen Y, Yu XY, Polan ML. Relaxin increases elastase activity and protease inhibitors in smooth muscle cells from the myometrium compared with cells from leiomyomas. Fertil Steril 2008; 91:1351-4. [PMID: 18554597 DOI: 10.1016/j.fertnstert.2008.03.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Revised: 03/17/2008] [Accepted: 03/17/2008] [Indexed: 11/30/2022]
Abstract
We investigated the effect of relaxin on extracellular matrix remodeling in cultured myometrial compared with leiomyoma smooth muscle cells. Relaxin increases elastase activity and protease inhibitor expressions in myometrial smooth muscle cells, but no effect was observed in leiomyoma cells.
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Affiliation(s)
- Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.
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Yan Wen, Zhao YY, Polan ML, Chen B. Effect of Relaxin on TGF-β1 Expression in Cultured Vaginal Fibroblasts From Women With Stress Urinary Incontinence. Reprod Sci 2008; 15:312-20. [DOI: 10.1177/1933719108315299] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Yan Wen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California,
| | - Yang-Yu Zhao
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Mary Lake Polan
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
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Twiss C, Triaca V, Rodríguez LV. Familial transmission of urogenital prolapse and incontinence. Curr Opin Obstet Gynecol 2008; 19:464-8. [PMID: 17885463 DOI: 10.1097/gco.0b013e3282efdc21] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
PURPOSE OF REVIEW To summarize recent evidence suggesting a genetic basis for the development of urogenital prolapse and stress urinary incontinence. RECENT FINDINGS Epidemiological evidence suggests that some women have a genetic predisposition to the development of urogenital prolapse and stress incontinence. Abnormal expression of various structural proteins is thought to be the molecular genetic mechanism for the development of these conditions. A group of families with an autosomal dominant pattern of transmission of urogenital prolapse with high penetrance has been identified. No similar cohort of families with familial stress incontinence currently exists, although candidate genes have been identified that appear to predispose women to urogenital prolapse and stress incontinence. Additionally, animal models of urogenital prolapse have been developed that closely parallel the development of prolapse in humans. SUMMARY A growing body of evidence suggests a genetic basis for the development of urogenital prolapse and stress incontinence. Candidate genes have been identified that may result in alteration of the normal metabolism of various structural proteins which may ultimately predispose some women to both urogenital prolapse and stress incontinence. Further research into the genetic basis of these conditions may provide a comprehensive understanding of the biological basis of these disorders.
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Affiliation(s)
- Christian Twiss
- Department of Urology, University of California, Los Angeles, California , USA.
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Paladini D, Di Spiezio Sardo A, Mandato VD, Guerra G, Bifulco G, Mauriello S, Nappi C. Association of cutis laxa and genital prolapse: a case report. Int Urogynecol J 2007; 18:1367-70. [PMID: 17453126 DOI: 10.1007/s00192-007-0362-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 03/13/2007] [Indexed: 11/26/2022]
Abstract
Cutis laxa (CL) is an extremely inherited or acquired connective tissue disorder characterised by a markedly reduced systemic elastin content. Genital abnormalities in patients with CL have been rarely reported. We report such a case in a 48-year-old CL patient affected by genital prolapse, focusing on immunohistological and molecular biology assessment of elastin and collagen type I, III, VI content in the main uterine ligaments. The woman was referred to our department for the onset of a rapidly progressing genital prolapse and urinary incontinence. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and sacrocolpopexy. Punch biopsies from both cardinal and uterosacral ligaments revealed a dramatic reduction in elastin and an increase in collagen type VI content. The present report seems to underline the central role exerted primarily by elastin in the supportive connective tissue and might contribute to the knowledge of extracellular matrix abnormalities at the basis of genital abnormalities in CL patients.
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Affiliation(s)
- Dario Paladini
- Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples Federico II, Via Pansini 5, Naples, Italy
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