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Allen-Brady K, Chua JWF, Cuffolo R, Koch M, Sorrentino F, Cartwright R. Systematic review and meta-analysis of genetic association studies of pelvic organ prolapse. Int Urogynecol J 2021; 33:67-82. [PMID: 33893823 PMCID: PMC8739292 DOI: 10.1007/s00192-021-04782-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/24/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Family and twin studies demonstrate that pelvic organ prolapse (POP) is heritable, but the genetic etiology is poorly understood. This review aimed to identify genetic loci and specific polymorphisms associated with POP, while assessing the strength, consistency, and risk of bias among reported associations. METHODS Updating an earlier systematic review, PubMed and HuGE Navigator as well as relevant conference abstracts were searched using genetic and phenotype keywords from 2015 to 2020. Screening and data extraction were performed in duplicate. Fixed and random effects meta-analyses were conducted using co-dominant models of inheritance. We assessed credibility of pooled associations using interim Venice criteria. RESULTS We screened 504 new abstracts and included 46 published and 7 unpublished studies. In pooled analyses we found significant associations for four polymorphisms: rs2228480 at the ESR1 gene (OR 0.67 95% CI 0.46-0.98, I2 = 0.0%, Venice rating BAB), rs12589592 at the FBLN5 gene (OR 1.46 95% CI 1.11-1.82, I2 = 36.3%, Venice rating BBB), rs484389 in the PGR gene (OR 0.61 95% CI 0.39-0.96, I2 = 32.4%, Venice rating CBB), and rs1800012 at the COL1A1 gene (OR 0.80 95% CI 0.66-0.96, I2 = 0.0%, Venice rating BAB). Further credible novel variants have also been recently identified in genome-wide association studies. CONCLUSION The genetic contributions to POP remain poorly understood. Several biologically plausible variants have been identified, but much work is required to establish the role of these genes in the pathogenesis of POP or to establish a role for genetic testing in clinical practice.
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Affiliation(s)
- Kristina Allen-Brady
- Department of Internal Medicine, Genetic Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - John W F Chua
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Romana Cuffolo
- Department of Obstetrics & Gynaecology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Marianne Koch
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Rufus Cartwright
- Department of Epidemiology & Biostatistics, Imperial College London, Norfolk Place, London, UK. .,Department of Urogynaecology, LNWH NHS Trust, London, UK.
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Ashikari A, Suda T, Miyazato M. Collagen type 1A1, type 3A1, and LOXL1/4 polymorphisms as risk factors of pelvic organ prolapse. BMC Res Notes 2021; 14:15. [PMID: 33413618 PMCID: PMC7792296 DOI: 10.1186/s13104-020-05430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/24/2020] [Indexed: 11/30/2022] Open
Abstract
Objective Collagen and elastin are the main components of the female pelvic tissue. We investigated whether single nucleotide polymorphisms (SNPs) of collagen type 1 alpha 1 (COL1A1), collagen type 3 alpha 1 (COL3A1), and lysyl oxidase-like (LOXL) 1 and 4 were associated with the onset of pelvic organ prolapse (POP) in Japanese women. Fifty-two women with POP and 28 women without POP were included. SNPs were identified using the TaqMan® SNP genotyping assay. Results Age, parity, and lower urinary tract symptoms were significantly higher in the POP group than in the control group. The prevalence of genotypes with rs2862296 polymorphism of LOXL4, an enzyme essential for extracellular matrix remodeling, was different between the POP (26.9% for GG, 51.9% for AG) and control groups (14.8% for GG, 33.3% for AG). However, polymorphisms of COL1A1, COL3A1, and LOXL1 were not related to the onset of POP. In the multivariate logistic regression analysis, age was significantly associated with the occurrence of POP. In the univariate analysis, LOXL4 polymorphism was associated with the onset of POP in Japanese women. The knowledge of acquired risk factors and polymorphisms in the genomic background of patients with POP may help prevent POP via early conservative interventions.
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Affiliation(s)
- Asuka Ashikari
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Tetsuji Suda
- Department of Urology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Minoru Miyazato
- Department of Systems Physiology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa, Japan.
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Giri A, Hartmann KE, Hellwege JN, Velez Edwards DR, Edwards TL. Obesity and pelvic organ prolapse: a systematic review and meta-analysis of observational studies. Am J Obstet Gynecol 2017; 217:11-26.e3. [PMID: 28188775 DOI: 10.1016/j.ajog.2017.01.039] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 12/20/2016] [Accepted: 01/31/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Studies evaluating the association between obesity and pelvic organ prolapse report estimates that range from negative to positive associations. Heterogeneous definitions for pelvic organ prolapse and variable choices for categorizing obesity measures have made it challenging to conduct meta-analysis. OBJECTIVE We systematically evaluated evidence to provide quantitative summaries of association between degrees of obesity and pelvic organ prolapse, and identify sources of heterogeneity. STUDY DESIGN We searched for all indexed publications relevant to pelvic organ prolapse up until June 18, 2015, in PubMed/MEDLINE to identify analytical observational studies published in English that reported risk ratios (relative risk, odds ratio, or hazard ratio) for body mass index categories in relation to pelvic organ prolapse. Random effects meta-analyses were conducted to report associations with pelvic organ prolapse for overweight and obese body mass index categories compared with women in the normal-weight category (referent: body mass index <25 kg/m2). RESULTS Of the 70 studies that reported evidence on obesity and pelvic organ prolapse, 22 eligible studies provided effect estimates for meta-analysis of the overweight and obese body mass index categories. Compared with the referent category, women in the overweight and obese categories had meta-analysis risk ratios of at least 1.36 (95% confidence interval, 1.20-1.53) and at least 1.47 (95% confidence interval, 1.35-1.59), respectively. Subgroup analyses showed effect estimates for objectively measured clinically significant pelvic organ prolapse were higher than for self-reported pelvic organ prolapse. Other potential sources of heterogeneity included proportion of postmenopausal women in study and reported study design. CONCLUSION Overweight and obese women are more likely to have pelvic organ prolapse compared with women with body mass index in the normal range. The finding that the associations for obesity measures were strongest for objectively measured, clinically significant pelvic organ prolapse further strengthens this evidence. However, prospective investigations evaluating obesity and pelvic organ prolapse are few.
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Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine E Hartmann
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Jacklyn N Hellwege
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Digna R Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN; Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
| | - Todd L Edwards
- Division of Epidemiology, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN.
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Wang H, Zhang ZQ, Wang SZ, Lu JL, Wang XL, Zhang ZY. Association of matrix metalloproteinase-10 polymorphisms with susceptibility to pelvic organ prolapse. J Obstet Gynaecol Res 2015; 41:1972-81. [PMID: 26419737 DOI: 10.1111/jog.12809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 06/14/2015] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to explore the correlation between genetic mutations in matrix metalloproteinase-10 (MMP-10) and susceptibility to pelvic organ prolapse (POP). MATERIAL AND METHODS From September 2011 to December 2013, 263 subjects were recruited, including 91 patients with POP (case group) and 172 non-POP patients (control group). Total MMP-10 concentrations in serum were measured by enzyme-linked immunosorbent assay. The genotyping of MMP-10 was achieved by quantitative real-time polymerase chain reaction. All data were analyzed with SPSS 18.0. RESULTS We found that parity, menopause, history of total hysterectomy, and family history of POP were all significantly higher in the POP group than in the control group (P = 0.017, P = 0.046, P = 0.0029 and P < 0.001, respectively). Serum MMP-10 levels were obviously higher in the POP group than in the control group (P < 0.05). In addition, there was a statistically significant difference between the two groups in the distribution frequency of the MMP-10 (rs17435959G/C) genotype (P < 0.05). However, the distribution frequency of the MMP-10 (rs17293607C/T) genotype between the two groups showed no significant differences (P > 0.05). Furthermore, the patients with parity > 2 and postmenopausal women had elevated serum MMP-10 levels, and the patients with parity > 2 and postmenopausal women who carried the G/C + C/C genotype in the MMP-10 gene had an increased risk of POP. CONCLUSION We support the view that the rs17435959 polymorphism of the MMP-10 gene may be associated with an increased risk of POP.
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Affiliation(s)
- Hong Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing, China
| | - Zhi-Qiang Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing, China
| | - Shu-Zhen Wang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing, China
| | - Jun-Li Lu
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing, China
| | - Xiao-Lan Wang
- Department of Obstetrics and Gynecology, China Meitan General Hospital, Beijing, China
| | - Zhen-Yu Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing, China
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Rao S, Lang J, Zhu L, Chen J. Exome sequencing identifies a novel gene, WNK1, for susceptibility to pelvic organ prolapse (POP). PLoS One 2015; 10:e0119482. [PMID: 25739019 PMCID: PMC4349638 DOI: 10.1371/journal.pone.0119482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 01/16/2015] [Indexed: 12/13/2022] Open
Abstract
Pelvic organ prolapse (POP) is a common gynecological disorder; however, the genetic components remain largely unidentified. Exome sequencing has been widely used to identify pathogenic gene mutations of several diseases because of its high chromosomal coverage and accuracy. In this study, we performed whole exome sequencing (WES), for the first time, on 8 peripheral blood DNA samples from representative POP cases. After filtering the sequencing data from the dbSNP database (build 138) and the 1000 Genomes Project, 2 missense variants in WNK1, c.2668G > A (p.G890R) and c.6761C> T (p.P2254L), were identified and further validated via Sanger sequencing. In validation stage, the c.2668G > A (p.G890R) variant and 8 additional variants were detected in 11 out of 161 POP patients. All these variants were absent in 231 healthy controls. Functional experiments showed that fibroblasts from the utero-sacral ligaments of POP with WNK1 mutations exhibited loose and irregular alignment compared with fibroblasts from healthy controls. In sum, our study identified a novel gene, WNK1, for POP susceptibility, expanded the causal mutation spectrums of POP, and provided evidence for the genetic diagnosis and medical management of POP in the future.
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Affiliation(s)
- Shuquan Rao
- National Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Tsinghua University, Beijing, 100005, PR China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, PR China
| | - Lan Zhu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, PR China
| | - Juan Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100005, PR China
- * E-mail:
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Cartwright R, Kirby AC, Tikkinen KAO, Mangera A, Thiagamoorthy G, Rajan P, Pesonen J, Ambrose C, Gonzalez-Maffe J, Bennett P, Palmer T, Walley A, Järvelin MR, Chapple C, Khullar V. Systematic review and metaanalysis of genetic association studies of urinary symptoms and prolapse in women. Am J Obstet Gynecol 2015; 212:199.e1-24. [PMID: 25111588 PMCID: PMC4342521 DOI: 10.1016/j.ajog.2014.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 06/01/2014] [Accepted: 08/06/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Family studies and twin studies demonstrate that lower urinary tract symptoms and pelvic organ prolapse are heritable. This review aimed to identify genetic polymorphisms tested for an association with lower urinary tract symptoms or prolapse, and to assess the strength, consistency, and risk of bias among reported associations. STUDY DESIGN PubMed and HuGE Navigator were searched up to May 1, 2014, using a combination of genetic and phenotype key words, including "nocturia," "incontinence," "overactive bladder," "prolapse," and "enuresis." Major genetics, urology, and gynecology conference abstracts were searched from 2005 through 2013. We screened 889 abstracts, and retrieved 78 full texts. In all, 27 published and 7 unpublished studies provided data on polymorphisms in or near 32 different genes. Fixed and random effects metaanalyses were conducted using codominant models of inheritance. We assessed the credibility of pooled associations using the interim Venice criteria. RESULTS In pooled analysis, the rs4994 polymorphism of the ADRB3 gene was associated with overactive bladder (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.7-3.6; n = 419). The rs1800012 polymorphism of the COL1A1 gene was associated with prolapse (OR, 1.3; 95% CI, 1.0-1.7; n = 838) and stress urinary incontinence (OR, 2.1; 95% CI, 1.4-3.2; n = 190). Other metaanalyses, including those for polymorphisms of COL3A1,LAMC1,MMP1,MMP3, and MMP9 did not show significant effects. Many studies were at high risk of bias from genotyping error or population stratification. CONCLUSION These metaanalyses provide moderate epidemiological credibility for associations of variation in ADRB3 with overactive bladder, and variation of COL1A1 with prolapse. Clinical testing for any of these polymorphisms cannot be recommended based on current evidence.
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Affiliation(s)
- Rufus Cartwright
- Department of Epidemiology and Biostatistics, Imperial College London, London, England, United Kingdom; Department of Urogynecology, Imperial College London, London, England, United Kingdom.
| | - Anna C Kirby
- Department of Reproductive Medicine, University of California, San Diego, School of Medicine, and Department of Obstetrics and Gynecology, Kaiser Permanente, San Diego, CA
| | - Kari A O Tikkinen
- Departments of Urology and Public Health, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Altaf Mangera
- Department of Urology Research, University of Sheffield, Sheffield, England, United Kingdom
| | - Gans Thiagamoorthy
- Department of Urogynecology, King's College London, London, England, United Kingdom
| | - Prabhakar Rajan
- Beatson Institute for Cancer Research, University of Glasgow, Glasgow, Scotland, United Kingdom
| | - Jori Pesonen
- Department of Urology, University of Tampere, Tampere, Finland
| | - Chris Ambrose
- University College London Medical School, London, England, United Kingdom
| | - Juan Gonzalez-Maffe
- Clinical Trials Unit, Imperial College London, London, England, United Kingdom
| | - Phillip Bennett
- Institute for Reproductive and Developmental Biology, Imperial College London, London, England, United Kingdom
| | - Tom Palmer
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, England, United Kingdom
| | - Andrew Walley
- Department of Genomics of Common Disease and Molecular Genetics and Genomics, Imperial College London, London, England, United Kingdom
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, Imperial College London, London, England, United Kingdom; Institute of Health Sciences and Biocenter Oulu, University of Oulu, Finland
| | - Chris Chapple
- Department of Urology Research, University of Sheffield, Sheffield, England, United Kingdom
| | - Vik Khullar
- Department of Urogynecology, Imperial College London, London, England, United Kingdom
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