Effects of prostaglandins on the production of collagenase by rabbit uterine cervical fibroblasts

Are animal models relevant to key aspects of human parturition?

Preterm birth remains the most serious complication of pregnancy and is associated with increased rates of infant death or permanent neurodevelopmental disability. Our understanding of the regulation of parturition remains inadequate. The scientific literature, largely derived from rodent animal models, suggests two major mechanisms regulating the timing of parturition: the withdrawal of the steroid hormone progesterone and a proinflammatory response by the immune system. However, available evidence strongly suggests that parturition in the human has significantly different regulators and mediators from those in most of the animal models. Our objectives are to critically review the data and concepts that have arisen from use of animal models for parturition and to rationalize the use of a new model. Many animal models have contributed to advances in our understanding of the regulation of parturition. However, we suggest that those animals dependent on progesterone withdrawal to initiate parturition clearly have a limitation to their translation to the human. In such models, a linear sequence of events (e.g., luteolysis, progesterone withdrawal, uterine activation, parturition) gives rise to the concept of a "trigger" mechanism. Conversely, we propose that human parturition may arise from the concomitant maturation of several systems in parallel. We have termed this novel concept "modular accumulation of physiological systems" (MAPS). We also emphasize the urgency to determine the precise role of the immune system in the process of parturition in situations other than intrauterine infection. Finally, we accentuate the need to develop a nonprimate animal model whose physiology is more relevant to human parturition. We suggest that the guinea pig displays several key physiological characteristics of gestation that more closely resemble human pregnancy than do currently favored animal models. We conclude that the application of novel concepts and new models are required to advance translational research in parturition.

Matrix metalloproteinases and their tissue inhibitors in endometrial remodelling and menstruation

The architecture of the human endometrium is extensively remodelled during the course of each normal menstrual cycle, unlike most other tissues and organs which undergo very little change during adult life. During menstruation, when loss of most of the functionalis layer occurs, there is concomitant epithelial regrowth; repair of the luminal surface is complete almost as bleeding ceases. During the proliferative phase of the cycle and under the influence of rising oestrogen levels, the stromal cells, glands and blood vessels undergo rapid proliferation which results in tissue thickening. Following ovulation (around day 14 of the idealized 28-day cycle), the secretory phase of the cycle is characterized by increasing tortuosity of the spiral arterioles and glands and increased glandular secretory activity. After about day 22, decidualization of many of the stromal fibroblasts also occurs, the resultant decidual cells having many characteristics typical of epithelial cells. Periods of tissue oedema are apparent both in mid-proliferative (days 8–11) and mid-secretory (days 20–23) endometrium. Late in the cycle, there is regression of the tissue as menstruation is initiated.

Prostaglandins and cervical dilatation

The efficacy of labour is determined by uterine, fetopelvic and cervical factors. Whereas the first two of these are well recognized, acknowledgement of the modulating function of the cervix during labour is relatively new. In particular, clarification of the synthesis and metabolism of prostaglandins has contributed considerably to our understanding of the biological control of the cervix.

Parturition and recruitment of macrophages in cervix of mice lacking the prostaglandin F receptor

Parturition does not occur in transgenic mice lacking the prostaglandin F receptor (Ptgfr(-/-)) because luteolysis is forestalled and progesterone production persists. Ovariectomy of pregnant Ptgfr(-/-) mice leads to a decline in circulating progesterone and delivery of live pups. The objective of the present study was to test the hypothesis that immigration of macrophages and increased innervation of the cervix of Ptgfr(-/-) mice was associated with ripening and parturition. The cervix of pregnant Ptgfr(-/-) mice was studied on Days 15-21 after breeding; additional groups were ovariectomized on Day 19 of pregnancy, and the cervix obtained on Day 20 of pregnancy before birth or the next day at about 24 h after birth. On Days 18-19 of pregnancy, macrophage numbers and nerve fiber density increased more than 3-fold compared with findings in nonpregnant or Day 15 or 21 pregnant Ptgfr(-/-) mice. The magnitude and time course of these changes were comparable to those found in wild-type controls that delivered on Day 19 after breeding. Thus, the mechanism regulating macrophage immigration, innervation, and cervical remodeling in Ptgfr(-/-) mice with delayed parturition is similar to wild-type controls that deliver at term. By contrast, ovariectomy forestalled the decrease in cervical macrophages in Ptgfr(-/-) mice. By Day 21 after breeding, macrophage numbers more than double those after ovariectomy, relative to those found in pregnant Ptgfr(-/-) mice, whereas nerve fiber density was the same regardless of birth. Density of collagen structure in these mice directly matched macrophage traffic in the cervix. The findings indicate that the prostaglandin F(2alpha) receptor and progesterone withdrawal are a necessary part of the final common pathway for ripening of the cervix and the process of parturition.

Distributing a fixed amount of cyclic loading to tendon explants over longer periods induces greater cellular and mechanical responses

Tendon overuse injuries are a major source of clinical concern. Cyclic loading causes material damage and induces biochemical responses in tendon. The purpose of this study was to examine the biochemical and biomechanical tendon response after applying cyclical loading over varying durations. Avian flexor digitorum profundus tendons were loaded (3 or 12 MPa) to a fixed number of cycles across either 1 or 12 days in vitro. The tendon response evaluations included biomechanical data gathered during loading and subsequent failure testing. Evaluations also included cellular viability, cell death, and proteoglycan, collagen, collagenase, and prostaglandin E(2) (PGE(2)) content measurements obtained from tissue specimens and media samples. Significant strains (up to 2%) accumulated during loading. Loading to 12 MPa significantly reduced maximum stress (33% and 27%) and energy density (42% and 50%) when applied across 1 or 12 days, respectively. Loading to 3 MPa also caused a 40% reduction in energy density, but only when applied across 12 days. Cell death and collagenase activity increased significantly with increasing magnitude and duration. However, no differences occurred in cell viability or collagen content. Glycosaminoglycan content increased 50% with load magnitude, while PGE(2) production increased 2.5-fold with loading magnitude and 11-fold with increased duration. Mechanical fatigue-induced mechanical property changes were exhibited by the tendons in response to increased loading magnitude across just 1 day. However, when the same loading was applied over a longer period, most outcomes were magnified substantially, relative to the short duration regimens. This is presumably due to the increased response time for the complex cellular response to loading. A key contributor may be the inflammatory mediator, PGE(2), which exhibited large magnitude and duration dependent increases to cyclic loading.

Cyclic loading alters biomechanical properties and secretion of PGE2 and NO from tendon explants

BACKGROUND

Tendon overuse injuries are a common occurrence; accounting for a large proportion of occupational and athletic injuries. The concept examined in this study is the role of load-induced intrinsic inflammation to the mechanism of these injuries. This study examined the influence of cyclical loading on the mechanical properties, cell viability, and inflammatory mediators of cultured tendon explants.

METHODS

Chicken digital flexor tendon explants were isolated and separated into no-load (24 h rest), moderate load (0.25-3.0 MPa, 1 Hz, 4 h, 20 h rest), and aggressive load (0.25-12.0 MPa, 1 Hz, 24 h) treatment groups. Tissue loading was carried out with a pneumatic device under load-control. The loading regimens for each explant treatment group started at a uniform time point (day 3 from isolation, t = 0 h). Medium was collected at t = 24 and t = 48 h and analyzed for the inflammatory mediators prostaglandin E(2) and nitric oxide. Viability was evaluated at t = 48 h.

FINDINGS

Biomechanical data revealed a significantly (P < 0.05) lower strength in the aggressively loaded specimens compared to the moderately loaded samples. Prostaglandin E(2) concentrations of aggressively loaded samples showed significantly higher values compared to moderately loaded samples at t = 48 h. Nitric oxide concentrations were greater in the moderately loaded samples relative to the no-load group at t = 24 h. Viability was not found to differ among the groups.

INTERPRETATION

Alterations in cyclical loading of tendon may cause a change in fibroblast-mediated inflammatory mediator production in tendon. This response is of clinical significance as it may have a role in the pathology of tendon overuse injuries.

Repeated exposure of tendon to prostaglandin-E2 leads to localized tendon degeneration

OBJECTIVE

To determine whether repeated exposure of rabbit patellar tendon to prostaglandin-E(2) leads to degenerative changes in the tendon.

SETTING

Laboratory animal study.

MAIN OUTCOME MEASURES

Intratendinous changes including cellularity, matrix organization, collagen fibril packing, and diameter.

METHODS

Skeletally mature New Zealand White rabbits (n = 10) were transcutaneously injected in the midsubstance of the patellar tendon with prostaglandin-E(2) (PGE(2); 50 ng or 500 ng). The contralateral tendons were used as 3 different controls (no injection, saline injection, and needlestick only). The injection was repeated once a week for 4 weeks, and the rabbits were killed 1 week after the last injection. The patellar tendons were harvested and examined using hematoxylin and eosin staining and transmission electron microscopy.

RESULTS

Compared with the control groups, tendons exposed to PGE(2) by injection showed focal areas of hypercellularity, loss of normal tissue architecture, and focal areas of tendon disorganization and degeneration. Tendons injected with PGE(2) exhibited loosely organized collagen fibrils and had thinner collagen fibril diameter compared with control tendons (P < 0.005). Tendons injected with 500 ng PGE(2) appeared to be more disorganized and degenerated than those injected with 50 ng PGE(2).

CONCLUSIONS

Repeated exposure of the tendon to PGE(2) leads to degenerative changes within the tendon.

CLINICAL RELEVANCE

It is known that human tendon fibroblasts produce PGE(2) in vitro and in vivo in response to repetitive mechanical loading. This study demonstrates that repetitive exposure of the tendon to PGE(2) can result in degenerative changes within the tendon. Therefore, PGE(2) produced by tendon fibroblasts in response to repetitive mechanical loading in vivo might contribute to the development of exercise-induced tendinopathy.

Inflammatory mediators and cervical ripening

The mechanisms which soften the cervix and allow it to dilate at birth are not well known. This is a crucial element in labour and current pharmacological approaches, largely the use of prostaglandins (PG), are only semi-selective for the cervix and can cause inappropriate myometrial contractions. Cervical ripening is accompanied by the influx of neutrophils, the neutrophil is a ready source of collagenase, and the cervix is dependent on collagen for its rigidity. Thus it is important to study factors controlling neutrophil influx into the cervix at term. PGE and interleukin-8 (IL-8, or neutrophil chemotactic factor) work synergistically in inducing neutrophil influx into tissue. Activating this type of synergy, between a vasoactive and a chemotactic agent is likely to be the physiological mechanism for inducing cervical ripening. Future approaches to control the cervix are likely to exploit these pathways and lead to more effective and acceptable methods for inducing labour.

Biochemical events in cervical ripening dilatation during pregnancy and parturition

In specimens taken from the posterior lip of the cervix uteri we determined the collagenase activity and the glycosaminoglycan concentration. In biopsies obtained from the lower uterine segment during cesarian section we measured cytokines (IL-8, IL-2, TNF alpha) and matrix metalloproteinases (MMP-8, MMP-9). We found that the release of collagenases is critically involved in the process of cervical dilatation. The glycosaminoglycan concentration increases during pregnancy and shows remarkable changes of the distribution patterns of the different glycosaminoglycans. The parturition is characterized by a dramatic loss of most of the glycosaminoglycans. Furthermore, the IL-8 shows a close correlation to the clinical feature of cervical ripening and is closely associated with the release of MMP-8 and MMP-9. Summarizing the process of cervical maturation and dilatation is a complex enzymatic controlled process with substantial remodelling of the cervical extracellular matrix. The cytokines IL-8 seems to play an essential role in triggering the process of cervical dilatation.

Leukotriene C4 upregulates collagenase expression and synthesis in human lung fibroblasts

Leukotriene C4 (LTC4), a mediator generated by a variety of inflammatory cells, participates in several physiological and pathological processes. It has been shown that LTC4 stimulates collagen synthesis by fibroblasts, suggesting a role in collagen turnover. However, the possible effect of this mediator on collagen degradation has not been examined. In this study we explored the role of LTC4 in the modulation of fibroblast interstitial collagenase and TIMP-1. Confluent cultures of three human normal lung fibroblast cell lines, and one derived from idiopathic pulmonary fibrosis (IPF) were exposed to LTC4 0.1, 1 and 10 nM, and to IL-1 beta as positive control. Collagenase and TIMP mRNAs expression were analyzed by Northern blot followed by densitometric scanning. Immunoreactive procollagenase was detected by immunoblot, and collagenase activity was measured using [3H]collagen. Our results showed that LTC4 enhanced several-fold collagenase mRNA expression in collagenase-producing fibroblasts, and induced the expression of the enzyme mRNA in collagenase-nonproducing fibroblasts, both in normal and IPF derived cell lines. LTC4 1 nM induced the highest response. Collagenolytic activity and immunoreactive collagenase paralleled collagenase mRNA expression. Interestingly, simultaneous exposure of fibroblasts to LTC4 plus IL-1 failed to show additive effects. Moreover, in two cell lines the combination resulted in a decrease of collagenase mRNA expression compared with both mediators separately. TIMP mRNA levels were not significantly modified by LTC4, nor IL1 beta. Our findings suggest that LTC4 plays a role in the modulation of fibroblast collagenase, and it may participate in extracellular matrix remodeling during lung inflammation.

Effect of different magnitudes of tension force on prostaglandin E2 production by human periodontal ligament cells

Periodontal ligament (PDL) cells are known to produce prostaglandin E2 (PGE2) in response to mechanical stress. However, the rate of PGE2 production from PDL cells in response to different magnitudes of tension forces has not been examined. This study, therefore, was undertaken to determine the effect of different magnitudes of tension forces on PGE2 production and inositol trisphosphate (IP3) levels in PDL cells in vitro. Human PDL cells were cultured on flexible-bottomed plates and placed on a Flexercell strain unit. Cells were flexed at six cycles (5-s strain, 5-s relaxation) at six steps of tension force (9, 12, 15, 18, 21, 24% increase in surface area) for 5 days. PGE2 production and IP3 levels were determined by radioimmunoassay. There was a 6- and 25-fold increase in the rate of PGE2 production by cells exposed to low (9%) and high (24%) tension forces, respectively, and these increases were tension force-dependent. Tension force also induced increases in the intracellular levels of IP3 that did not seem to be directly related to the production of PGE2. The different rates of PGE2 production by PDL cells in response to different magnitudes of mechanical stress may be of importance in PDL and alveolar bone metabolism.

Hyaluronate depolymerization activity induced by progesterone in cultured fibroblasts derived from human uterine cervix

High-molecular-weight [14C]hyaluronate was incubated with cultured fibroblasts from human uterine cervix and skin, and then the depolymerization of the hyaluronate was investigated. [14C]Hyaluronate in the medium of skin fibroblasts was depolymerized into a constant molecular weight (M(r) about 40,000), whereas that of cervix fibroblasts was not depolymerized, irrespective of incubation period. However, when progesterone was added to the medium of cervix fibroblasts, hyaluronate was depolymerized to the same extent as that in skin fibroblasts. The reducing terminal sugar of the depolymerized hyaluronate was N-acetylglucosamine. These results suggest that a hyaluronate-depolymerizing enzyme, endo-beta-N-acetylglucosaminidase, was induced by progesterone in cultured fibroblasts derived from human uterine cervix.

Serum collagenase levels during pregnancy and parturition

Recent studies have described the origin of the collagenase responsible for the degradation and loss of collagen during cervical ripening and dilatation to be polymorphonuclear leukocytes. In the present study the clinical feature of cervical dilatation was correlated to the serum levels of human granulocyte collagenase. The serum collagenase level was measured in 19 premenopausal women and in 181 pregnant women. In 15 of these pregnant women serum samples were obtained from the onset of labour to the active phase of labour at four different times. The collagenase concentrations remained low up to the 35th week of gestation (19.4 ng/ml) in comparison with the beginning of pregnancy. From the 35th week of gestation on we found a slight increase in collagenase in maternal serum. The maximum peak was reached during parturition at a cervical dilatation of 6-8 cm (71.2 ng/ml). The serum levels returned to non-pregnant values the first day following delivery. The results show that collagenases are critically involved in parturition.

Prostaglandins biosynthesis in the rabbit uterine cervix at various stages of pregnancy

The accumulation of prostaglandins (PGs: 6-keto PGF1 alpha, PGE2, PGF2 alpha and TXB2) elicited by A-23187, a Ca(2+)-ionophore, was studied in the uterine cervical tissue taken from non-pregnant and pregnant (10th, 20th and 30th day of pregnancy) rabbits in vitro. At every stage of pregnancy, the accumulation of PGs levels increased as follows; 6-keto PGF1 alpha, PGE2, PGF2 alpha and TXB2. Biosynthesis of each began to increase from the 20th day of pregnancy, and was significantly elevated at the 30th day. Especially, 6-keto PGF1 alpha and PGE2 were remarkably higher than PGF2 alpha and TXB2 at term, and so they are thought to play a more important role in cervical dilation and ripening than the other PGs. Six-keto PGF1 alpha was significantly elevated on the 20th day, when other PGs had not yet began to increase. It is thus conceivable that PGI2 plays an important role in the predispositing of cervical ripening.

Interleukin-8 production by the human cervix

OBJECTIVES

Our purpose was (1) to determine whether the human cervix is capable of producing interleukin-8 in vitro and to examine the possibility of stimulating an increase in any such output and (2) to examine the concomitant production of prostaglandins.

STUDY DESIGN

Cervical tissue was obtained from 48 women, 29 pregnant women undergoing surgical termination of pregnancy (20 of whom were treated with the prostaglandin analog Cervagem), 14 nonpregnant, premenopausal women, and three postmenopausal women. Explants were cultured and the medium was assayed for interleukin-8 and prostaglandin E2. Analysis of variance and Newman-Keuls statistical tests were used.

RESULTS

Significant quantities of interleukin-8 were produced by the tissue, and the data indicate that cervical explants from pregnant and nonpregnant women behave in a similar way when challenged by phorbol myristate acetate but that the postmenopausal cervix loses its capacity for interleukin-8 production.

CONCLUSIONS

Human cervix is capable of producing large amounts of interleukin-8 in vitro, and it may be influenced by the steroid hormones. Thus interleukin-8 could be an excellent candidate for a prime role in neutrophil-mediated cervical ripening.

Biochemical changes in human cervical connective tissue after intracervical application of prostaglandin E2

Cervical biopsies were taken during the first trimester from primigravidae and plurigravidae at different time points after intracervical application of prostaglandin E2-gel. Collagenase activity was determined by a highly specific technique using native, triple helical collagen as substrate. Elastase-alpha 1-proteinase-inhibitor complex (elastase) was measured by a commercially available assay, and glycosaminoglycan (GAG) analyses were performed as described by Greiling et al. (5, 6). The maximum activity of collagenase was found 2 hours after PGE2 application in plurigravidae and 4 hours after application in primigravidae. Elastase activity rose nearly 7-fold to maximum values 4 hours after PGE2 application. The total GAG concentrations and the dermatan sulfate concentrations increased by approximately 10%, while the hyaluronic acid concentrations were found to be elevated significantly by nearly 50% in the PGE2-primed cervices. We conclude that a time-dependent enzymatic collagen degradation by collagenases and other proteinases and an increase in hyaluronic acid concentrations are the significant biochemical events underlying PG-induced cervical ripening.

Fibroblast growth factor increases TNF alpha-mediated prostaglandin E2 production and TNF alpha receptor expression in human fibroblasts

To examine the possible role of basic fibroblast growth factor (FGF) in regulating the effects of TNF alpha, we tested the effect of FGF on TNF alpha-mediated PGE2 production and TNF alpha receptor expression in human fibroblasts. We found that, while FGF alone had no effect on PGE2 production, it enhanced the amount of PGE2 produced in response to TNF alpha between 3 and 11-fold. FGF stimulated TNF alpha-induced PGE2 production independent of potential TNF alpha-mediated IL-1 production, as neither anti-IL-1 mAbs nor IL-1 receptor antagonist protein (IRAP) inhibited TNF alpha induced-PGE2 production or the stimulatory effect of FGF. A one minute exposure of cells to FGF prior to removal was sufficient to significantly enhance TNF alpha-induced PGE2 production; the maximal FGF effect was reached after a 6 h preincubation. We also found that FGF significantly enhanced TNF alpha receptor expression. Untreated fibroblasts expressed approximately 3,900 receptors/cell, while cells treated with FGF for 6 h expressed approximately 9,500 receptors/cell, a 2.4-fold increase in receptor number; there was no apparent change in affinity for TNF alpha (Kd 3.8 x 10(-11) M). The FGF-mediated increase in TNF alpha receptor expression and TNF alpha-mediated PGE2 production could be abolished by FGF mAbs, indicating a specific FGF effect. These results show that FGF increases TNF alpha receptor expression and suggest that this may account, at least in part, for the ability of FGF to enhance TNF alpha-mediated PGE2 production in human fibroblasts.

Gemeprost-induced cervical ripening: histological and biophysical effects

The mechanism of prostaglandin-induced cervical ripening is not clear. The aim of this study was to measure the biophysical and histological effects of gemeprost on the cervix. Thirty-four women admitted for surgical termination of pregnancy in the first trimester were randomised in a double-blind manner to receive either gemeprost or placebo prior to surgery. In 20 (10 active, 10 placebo) a needle biopsy was taken from the anterior lip of the cervix prior to cervical dilatation for histology. The forces required to dilate the cervix from 3 mm to 10 mm were measured. A group of seventeen parous women undergoing surgical termination who did not receive gemeprost were also studied as a parous control group. A needle biopsy was obtained in eight of them and also in six non-pregnant parous women undergoing hysterectomy for benign conditions, the latter acting as a non-pregnant control group. Polymerised collagen was stained with Picrosirius red and glycosaminoglycans with alcian blue using a MgCl2 gradient. Optical densitometry was used as an objective measure of staining. Neutrophil concentration was assessed immunohistochemically. Gemeprost treatment increased free passibility (the size of the largest dilator which could be passed without encountering resistance) (P < 0.01), reduced the forces required to dilate the cervix (P < 0.01) reduced blood loss (P < 0.05), reduced the collagen concentration (P < 0.01) and was associated with a modest neutrophil influx (P < 0.02) as compared to placebo. The pregnant parous group had a significantly lower collagen concentration than the non-pregnant parous group (P < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Activation of protein kinase C stimulates collagenase production by cultured cells of the cervix of the pregnant guinea pig

OBJECTIVE

Dilatation of the uterine cervix at parturition is achieved by an estrogen-induced, collagenase-mediated degradation of type I collagen in the cervix. The objective was to test the hypothesis that collagenase production in the cervix of pregnant guinea pig in culture is mediated by activation of protein kinase C.

STUDY DESIGN

The effects of 17 beta-estradiol, prostaglandin F2 alpha, or activation of protein kinase C by phorbol-12-myristate-13-acetate, 1-stearoyl-2-arachidonyl-sn-glycerol and phospholipase C on collagenase production was studied with primary monolayer cultures of cervical cells from Hartley guinea pigs at 50 days' gestation. Results are analyzed for statistical significance with analysis of variance.

RESULTS

Collagenase production is increased twofold to threefold by 17 beta-estradiol, prostaglandin F2 alpha, or activation of protein kinase C. The observed stimulation of collagenase production by 17 beta-estradiol and prostaglandin F2 alpha was blocked by the protein kinase C inhibitor 1-(5-isoquinoline sulfonyl) 2-methylpiperazine dihydrochloride.

CONCLUSION

Collagenase production in cultured cervical cells of pregnant guinea pig is stimulated by activation of protein kinase C.

Origin of cervical collagenase during parturition

Cervical biopsy specimens were obtained under standard conditions from the posterior lip of the uterine cervix in 105 patients. A significant increase of collagenase activity was observed during parturition as determined with an assay with iodine 125-labeled native triple-helical collagen type I as the substrate. The collagenase was not likely to originate from cervical fibroblasts because in situ hybridization failed to detect synthesis of the specific procollagenase messenger ribonucleic acid. However, migration of polymorphonuclear leukocytes into the cervical stroma occurred on onset of labor, and an antibody specific for human leukocyte collagenase that did not cross react with fibroblast collagenase revealed the presence of the enzyme in the granules of polymorphonuclear leukocytes and subsequently in the extracellular matrix of the cervix. Therefore it is likely that the cells critically involved in collagen degradation during cervical dilatation are not resident fibroblasts but rather polymorphonuclear leukocytes emigrating from blood vessels.

Collagenase activity in the cervix of non-pregnant and pregnant women

Cervical biopsies were obtained from non pregnant patients and from pregnant at various stages of gestation and during labour. The tissues were extract with a Ca(++)-containing buffer, and collagenase activity was determined in these extracts using a solid phase assay in which triple helical 125I-labelled collagen was cleaved. Collagenase was detected in all samples but significantly elevated activity was only present in labour at 6-8 cm cervical dilatation. This provides direct evidence for the crucial role of specific collagen degradation during cervical ripening and dilatation.

The physiology of cervical ripening and cervical dilatation and the effect of abortifacient drugs

The mechanical properties of the human uterine cervix are determined mainly by the connective tissue component, whereas it is doubtful whether the scanty smooth muscle component is of any physiological importance. Histological and biochemical analyses reveal a fibrous connective tissue similar to that found in skin and tendon. Degradation of the collagen and an increase in some special dermatan sulphate proteoglycans can at least partly explain the pregnancy-associated softening of this connective tissue. Relatively high oestrogen levels seem to be an absolute condition for the process, even when it is induced pharmacologically. Treatment with progesterone-receptor blockers, PGE2, PGF2 alpha or relaxin in pregnancy induce cervical softening as well as histological and biochemical changes which cannot be distinguished from the physiological cervical softening which takes place in late pregnancy. Prostaglandins and relaxin might interact and could include cytokines such as interleukin-1 during the process. The effect of cervical tents cannot be explained only by the radial pressures they exert. Most probably stimulation of local prostaglandin synthesis is also involved.