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Wang Y, Wen Y, Kim K, Wu H, Zhang J, Dobberfuhl AD, Chen B. Functional outcome of the anterior vaginal wall in a pelvic surgery injury rat model after treatment with stem cell-derived progenitors of smooth muscle cells. Stem Cell Res Ther 2024; 15:291. [PMID: 39256865 DOI: 10.1186/s13287-024-03900-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 08/26/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Stem-cell-derived therapy is a promising option for tissue regeneration. Human iPSC-derived progenitors of smooth muscle cells (pSMCs) exhibit limited proliferation and differentiation, which minimizes the risk of tumor formation while restoring smooth muscle cells (SMCs). Up to 29% of women suffer from recurrence of vaginal prolapse after prolapse surgery. Therefore, there is a need for therapies that can restore vaginal function. SMCs contribute to vaginal tone and contractility. We sought to examine whether human pSMCs can restore vaginal function in a rat model. METHODS Female immunocompromised RNU rats were divided into 5 groups: intact controls (n = 12), VSHAM (surgery + saline injection, n = 35), and three cell-injection groups (surgery + cell injection using pSMCs from three patients, n = 14/cell line). The surgery to induce vaginal injury was analogous to prolapse surgery. Menopause was induced by surgical ovariectomy. The vagina, urethra, bladder were harvested 10 weeks after surgery (5 weeks after cell injection). Organ bath myography was performed to evaluate the contractile function of the vagina, and smooth muscle thickness was examined by tissue immunohistochemistry. Collagen I, collagen III, and elastin mRNA and protein expressions in tissues were assessed. RESULTS Vaginal smooth muscle contractions induced by carbachol and KCl in the cell-injection groups were significantly greater than those in the VSHAM group. Collagen I protein expression in the vagina of the cell-injections groups was significantly higher than in the VSHAM group. Vaginal elastin protein expression was similar between the cell-injection and VSHAM groups. In the urethra, gene expression levels of collagen I, III, and elastin were all significantly greater in the cell-injection groups than in the VSHAM group. Collagen I, III, and elastin protein expression of the urethra did not show a consistent trend between cell-injection groups and the VSHAM group. CONCLUSIONS Human iPSC-derived pSMCs transplantation appears to be associated with improved contractile function of the surgically injured vagina in a rat model. This is accompanied by changes in extracellular protein expression the vagina and urethra. These observations support further efforts in the translation of pSMCs into a treatment for regenerating the surgically injured vagina in women who suffer recurrent prolapse after surgery.
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Affiliation(s)
- Yiting Wang
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA
| | - Yan Wen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA.
- , Palo Alto, USA.
| | - Kayla Kim
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA
| | - Hugo Wu
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA
| | - Jerry Zhang
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University, Stanford, CA, 94305, USA
| | - Bertha Chen
- Department of Obstetrics and Gynecology, Stanford University, Stanford, USA
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Tian Z, Li Q, Wang X, Sun Z. The difference in extracellular matrix metabolism in women with and without pelvic organ prolapse: A systematic review and meta-analysis. BJOG 2024; 131:1029-1041. [PMID: 38291948 DOI: 10.1111/1471-0528.17768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Studies on the changes of extracellular matrix (ECM) in pelvic organ prolapse (POP) are still controversial. OBJECTIVE To identify the changes in the ECM in POP patients. SEARCH STRATEGY Comprehensive searching in Embase, PubMed, Web of Science and the Cochrane Library was carried out until 23 February 2023. SELECTION CRITERIA Studies comparing the protein levels of ECM-related components between women with and without POP. DATA COLLECTION AND ANALYSIS Quality and risk of bias were assessed using the Agency for Healthcare Research and Quality assessment. Indicators were pooled with random or fixed effect meta-analysis based on heterogeneity and sub-grouped analysed by the biopsy site. MAIN RESULTS Thirty cross-sectional studies were included, comprising 840 POP cases and 755 controls. Overall results showed that the expression of type III collagen (COLIII) and several matrix metalloproteinases (MMP-1, -2 and -9) were increased, whereas those of type I collagen (COLI), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were decreased in patients with POP. Subgroup analysis showed that the expression of COLIII in the anterior vaginal wall (AVW) and COLIII, MMP-2 and -9 in the uterosacral ligament (USL) were consistent with the overall results. However, the expression of COLI and MMP-1 in the AVW showed no difference and the expression of COLI and MMP-1 in the USL is still controversial based on current studies. CONCLUSIONS Patients with POP have lower expression of COLI and TIMP-1 and higher expression of COLIII and MMPs compared with non-POP cases, but further studies are required to investigate in specified anatomical sites.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Centre for Obstetric & Gynaecological Diseases, Beijing, China
| | - Qiutong Li
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Centre for Obstetric & Gynaecological Diseases, Beijing, China
| | - Xiuqi Wang
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Centre for Obstetric & Gynaecological Diseases, Beijing, China
| | - Zhijing Sun
- Department of Obstetrics and Gynaecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Centre for Obstetric & Gynaecological Diseases, Beijing, China
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3
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Garzón-Alfaro MT, Cruz-Medel I, Alcaraz-Clariana S, García-Luque L, Carmona-Pérez MC, Garrido-Castro JL, Alburquerque-Sendín F, Rodrigues-de-Souza DP. Influence of vaginal birth on lumbopelvic muscle mechanical properties on urinary incontinence. Clin Rehabil 2024; 38:558-568. [PMID: 38295335 DOI: 10.1177/02692155231224058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To identify differences in the muscle mechanical properties of the pelvic floor (PF) and lumbar paravertebral (LP) muscles between young nulliparous and uni/multiparous women. Secondarily, specific behaviors, depending on the presence or absence or urinary incontinence (UI), were also researched. DESIGN Case-control study. SETTING Higher education institution. PARTICIPANTS One hundred young women participated, divided into two groups depending on whether they had vaginal birth (nulliparous or uni/multiparous). Each group included women with and without UI. MAIN MEASURES A muscle mechanical properties (tone, stiffness, decrement-inverse of elasticity-, and viscoelastic properties: relaxation and creep) assessment of the PF and LP muscles were performed with a hand-held tonometer. RESULTS Tone and stiffness of both sides of the PF presented group by UI interaction (p < 0.05), with uni/multiparous women with UI showing higher tone and stiffness compared to multiparous women without UI. In LP muscles, uni/multiparous women showed greater tone and stiffness on the right and left sides [-2.57 Hz (95% confidence interval -4.42,-0.72) and -79.74 N/m (-143.52,-15.97); -2.20 Hz (-3.82,-0.58) and -81.30 N/m (-140.66-,21.95), respectively], as well as a decrease in viscoelastic properties compared to nulliparous women [relaxation: 2.88 ms (0.31,5.44); creep: 0.15 (0.01,0.30); relaxation: 2.69 ms (0.13,5.25); creep: 0.14 (0,0.28), respectively]. CONCLUSIONS Vaginal birth and UI have a differential influence on the muscle mechanical properties of the PF and LP muscles. The determination of muscle mechanical properties by externally applied hand-held tonometry improves the knowledge of the lumbopelvic status, with applicability in clinical and research fields.
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Affiliation(s)
- María Teresa Garzón-Alfaro
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Inés Cruz-Medel
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - María Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
| | - Juan Luis Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
| | - Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, Córdoba, Spain
- GC05 Systemic and chronic inflammatory autoimmune diseases of the locomotor system and connective tissue, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba, Spain
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4
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van Velthoven MJJ, Gudde AN, van der Kruit M, van Loon MPC, Rasing L, Wagener FADTG, Roovers JP, Guler Z, Kouwer PHJ. An Improved Understanding of the Pathophysiology of Pelvic Organ Prolapse: A 3D In Vitro Model under Static and Mechanical Loading Conditions. Adv Healthc Mater 2024; 13:e2302905. [PMID: 38219051 DOI: 10.1002/adhm.202302905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Indexed: 01/15/2024]
Abstract
The suboptimal outcomes of pelvic organ prolapse (POP) surgery illustrate the demand for improved therapies. However, their development is hampered by the limited knowledge on the cellular pathophysiology of POP. Current investigations, that are limited to tissues and 2D in vitro models, provide highly inconclusive results on how the extracellular matrix (ECM) metabolism and fibroblasts are affected in POP. This study uses a physiologically relevant 3D in vitro model to investigate the cellular pathophysiology of POP by determining the differences between POP and non-POP fibroblasts on ECM metabolism, proliferation, and fibroblast-to-myofibroblast (FMT) transition. This model, based on the synthetic and biomimetic polyisocyanide hydrogel, enables the incorporation of mechanical loading, which simulates the forces exerted on the pelvic floor. Under static conditions, 3D cultured POP fibroblasts are less proliferative, undergo FMT, and exhibit lower collagen and elastin contents compared to non-POP fibroblasts. However, under mechanical loading, the differences between POP and non-POP fibroblasts are less pronounced. This study contributes to the development of more comprehensive models that can accurately mimic the POP pathophysiology, which will aid in an enhanced understanding and may contribute to improved therapies in the future.
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Affiliation(s)
- Melissa J J van Velthoven
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Aksel N Gudde
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Marit van der Kruit
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Malou P C van Loon
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Lissy Rasing
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 28, Nijmegen, 6525 GA, The Netherlands
| | - Frank A D T G Wagener
- Department of Dentistry-Orthodontics and Craniofacial Biology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Philips van Leydenlaan 25, Nijmegen, 6525 EX, The Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Zeliha Guler
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
- Reproductive Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center, location AMC, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Paul H J Kouwer
- Institute for Molecules and Materials, Radboud University, Heyendaalseweg 135, Nijmegen, 6525 AJ, The Netherlands
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Zhao Z, Huang G, He Y, Zuo X, Han W, Li H. Estrogen inhibits the differentiation of fibroblasts induced by high stiffness matrix by enhancing DNMT1 expression. Tissue Cell 2023; 85:102207. [PMID: 37708582 DOI: 10.1016/j.tice.2023.102207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse(POP) is a multifactorial connective tissue disorder caused by damage to the supporting structures of the pelvic floor. Evidence from several studies suggests that anterior vaginal wall stiffness is higher in patients with POP, but the mechanisms involved remain unknown. METHODS Tissue from the anterior vaginal wall of patients with POP or other benign diseases was obtained. The modulus of elasticity of the anterior vaginal wall was measured using a microindenter. Cells were cultured in vitro on acrylamide gels of different stiffness and treated with DNMT1 inhibitor, microtubule polymerisation inhibitor and estrogen. Western blot or immunohistochemical staining was performed to detect DNA Methyltransferase 1, α-smooth muscle actin(α-SMA) expression, and connective tissue growth factor(CTGF) expression. CONCLUSION Estrogen can inhibit high stiffness matrix-induced fibroblast differentiation, by enhancing DNMT1 expression. This study may help to elucidate the complex crosstalk between fibroblasts and their surrounding matrix under healthy and pathological conditions and provide new insights into the options for material-related therapeutic applications.
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Affiliation(s)
- Zhihan Zhao
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Guotao Huang
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Yong He
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Xiaohu Zuo
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Wuyue Han
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China
| | - Hong Li
- Department of Gynecology and Obstetrics, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, PR China.
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Gudde A, van Velthoven MJJ, Türkel B, Kouwer PHJ, Roovers JPWR, Guler Z. Vaginal Fibroblast Behavior as a Function of Stiffness Changes in a Polyisocyanide Hydrogel for Prolapse Repair. ACS APPLIED BIO MATERIALS 2023; 6:3759-3767. [PMID: 37589427 PMCID: PMC10521013 DOI: 10.1021/acsabm.3c00433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/03/2023] [Indexed: 08/18/2023]
Abstract
There is an urgent need for improved outcomes in the treatment of pelvic organ prolapse (POP). Success of primary surgery relies on the load bearing capacity of plicated connective tissue underneath the vaginal wall, which is compromised due to an altered vaginal fibroblast function and collagen composition. There is an important factor in connective tissue repair that relates to changes in stiffness of the vaginal fibroblast microenvironment, which influences cell activity through cellular mechanosensing. The aim of this study is to investigate the effect of stiffness changes on vaginal fibroblast functions that relate to connective tissue healing in prolapse repair. The substrate stiffness was controlled by changing the polymer concentration in the fibrous and strongly biomimetic polyisocyanide (PIC) hydrogel. We analyzed stiffness during cell culture and assessed the consequential fibroblast proliferation, morphology, collagen deposition, and contraction. Our results show that increasing stiffness coincides with vaginal fibroblast alignment, promotes collagen deposition, and inhibits PIC gel contraction. These findings suggest that the matrix stiffness directly influences vaginal fibroblast functionality. Moreover, we observed a buildup in stiffness and collagen, with an enhanced fibroblast and collagen organization on the PIC-substrate, which indicate an enhanced structural integrity of the hydrogel-cell construct. An improved tissue structure during healing is relevant in the functional repair of POP. Therefore, this study encourages future research in the use of PIC gels as a supplement in prolapse surgery, whereby the hydrogel stiffness should be considered.
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Affiliation(s)
- Aksel
N. Gudde
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Melissa J. J. van Velthoven
- Department
of Urology, Radboud Institute for Molecular
Life Sciences, Radboud University Medical Centre, Geert Grooteplein Zuid 28, 6525 GA Nijmegen, The Netherlands
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Betül Türkel
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Paul H. J. Kouwer
- Institute
for Molecules and Materials, Radboud University, Heyendaalseweg 135, 6525 AJ Nijmegen, The Netherlands
| | - Jan-Paul W. R. Roovers
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Zeliha Guler
- Department
of Obstetrics and Gynecology, Amsterdam
University Medical Center−location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Reproductive
Biology Laboratory, Amsterdam Reproduction and Development, Amsterdam University Medical Center−location
AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Non-invasive biomechanical assessment of the prolapsed vaginal wall: an explorative pilot study on cutometry and indentometry. Sci Rep 2023; 13:2751. [PMID: 36797400 PMCID: PMC9935514 DOI: 10.1038/s41598-023-29403-4] [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: 08/03/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
The clinical assessment of pelvic organ prolapse (POP) and associated treatment strategies is currently limited to anatomical and subjective outcome measures, which have limited reproducibility and do not include functional properties of vaginal tissue. The objective of our study was to evaluate the feasibility of using cutometry and indentometry for non-invasive biomechanical assessment of the vaginal wall in women with POP. Both techniques were applied on the vaginal wall of 20 women indicated for surgical correction of POP stage two or higher. The primary outcome was the measurement success rate. Measurements were considered successful if biomechanical parameters were generated after a maximum of three attempts. Secondary outcomes included acquisition time, number of attempts to obtain a successful measurement, and biomechanical parameters. Measurements were successfully performed on the anterior vaginal wall of 12 women with cystocele and the posterior vaginal wall of eight women with rectocele. The success rate was 100% for both techniques and acquisition time was under 1 minute for all 20 measurements. Tissue fast elasticity of the posterior vaginal wall (rectocele) was significantly higher than that of the anterior vaginal wall (cystocele) and negatively correlated with age (r = - 0.57, P < 0.05). In women with POP, measuring the biomechanical properties of the vaginal wall using cutometry and indentometry is technically feasible. Objective evaluation of biomechanical properties may help to understand the pathophysiology behind surgical outcomes, providing an opportunity for the identification of patients at risk for (recurrent) prolapse, and individualized treatment decisions.
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Asymmetries of the Muscle Mechanical Properties of the Pelvic Floor in Nulliparous and Multiparous Women, and Men: A Cross-Sectional Study. Symmetry (Basel) 2022. [DOI: 10.3390/sym14102124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study aimed to identify if the muscle mechanical properties (MMPs) of both sides of pelvic floor muscles (PFMs) are symmetrical in different populations of both sexes. Between-sides comparisons of MMPs of PFMs, assessed with manual myotonometry, were performed in three groups, with 31 subjects each, composed of healthy nulliparous women (without any type of delivery or pregnancy), multiparous women (with at least two vaginal deliveries), and healthy adult men. Intra-group correlations between MMPs and age, body mass index (BMI), or clinical state of pelvic floor were also obtained. The nulliparous women and the men showed no between-sides differences in any MMP of PFMs. However, the multiparous women showed that the right side displayed less frequency (−0.65 Hz, 95% CI = −1.01, −0.20) and decrement (0.5, 95% CI = 0.11, 0.01), and more relaxation (1.00 ms, 95% CI = 0.47, 1.54) and creep (0.07 De, 95% CI = 0.03, 0.11), than the left side. Further, MMPs were related to age, sex, and BMI, also depending on the population, with the multiparous women being the only group with some between-sides asymmetries, which in this case were positive and of fair intensity for the left side of the PFMs, between BMI, and frequency and stiffness (rho Spearman coefficient: 0.365 and 0.366, respectively). The symmetry of MMPs of the PFMs could depend on the subject’s condition. Multiparous women show a higher tendency to asymmetries than nulliparous women and men, which should be considered in research and clinical settings.
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Nan K, Feig VR, Ying B, Howarth JG, Kang Z, Yang Y, Traverso G. Mucosa-interfacing electronics. NATURE REVIEWS. MATERIALS 2022; 7:908-925. [PMID: 36124042 PMCID: PMC9472746 DOI: 10.1038/s41578-022-00477-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
The surface mucosa that lines many of our organs houses myriad biometric signals and, therefore, has great potential as a sensor-tissue interface for high-fidelity and long-term biosensing. However, progress is still nascent for mucosa-interfacing electronics owing to challenges with establishing robust sensor-tissue interfaces; device localization, retention and removal; and power and data transfer. This is in sharp contrast to the rapidly advancing field of skin-interfacing electronics, which are replacing traditional hospital visits with minimally invasive, real-time, continuous and untethered biosensing. This Review aims to bridge the gap between skin-interfacing electronics and mucosa-interfacing electronics systems through a comparison of the properties and functions of the skin and internal mucosal surfaces. The major physiological signals accessible through mucosa-lined organs are surveyed and design considerations for the next generation of mucosa-interfacing electronics are outlined based on state-of-the-art developments in bio-integrated electronics. With this Review, we aim to inspire hardware solutions that can serve as a foundation for developing personalized biosensing from the mucosa, a relatively uncharted field with great scientific and clinical potential.
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Affiliation(s)
- Kewang Nan
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Vivian R. Feig
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Binbin Ying
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Julia G. Howarth
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Ziliang Kang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Yiyuan Yang
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
| | - Giovanni Traverso
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA USA
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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Saputra AND, Rizal DM, Ayuandari S, Pangastuti N. The difference in collagen type-1 expression in women with and without pelvic organ prolapse: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1803-1812. [PMID: 35596801 DOI: 10.1007/s00192-022-05229-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study was aimed at identifying the difference in collagen type-1 expression in women with and without pelvic organ prolapse (POP). METHODS A systematic review and meta-analysis was carried out women with and without pelvic organ prolapse. This meta-analysis was conducted on research articles describing the evaluation of collagen type-1 expression between patients with and without POP. The articles were obtained from PubMed, EBSCO, and ProQuest, and were published between January 2000 and June 2021. Pooled mean difference (MD) and pooled odds ratio (OR) were calculated using fixed effect models. Review Manager (RevMan 5.4) was used to analyze the data. The main outcome measures were pooled MD and pooled OR of collagen type-1 expression in patients with and without POP. RESULTS A total of seven case-control studies were included in the meta-analysis using the effect size of the MD and two case-control studies were included in the meta-analysis using the effect size of the OR. A total of 247 POP cases and 132 non-POP cases were identified from the studies. Our study indicated that patients with POP had a lower level of collagen type-1 expression than non-POP patients (MD = -6.77; 95% CI: -8.37, -5.17, p < 0.00001). Patients with low expression of collagen type-1 in pelvic support tissue are at a more than 3 times higher risk of suffering from pelvic organ prolapse (OR = 3.23, 95% CI: 1.52 to 6.87, p = 0.002). CONCLUSION The results of this study showed that patients with pelvic organ prolapse have lower expression of collagen type-1 than nonpelvic organ prolapse patients.
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Affiliation(s)
- Akbar Novan Dwi Saputra
- Doctorate Program of Medical and Health Science, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Dicky Moch Rizal
- Department of Physiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sarrah Ayuandari
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Nuring Pangastuti
- Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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11
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Rodrigues-de-Souza DP, Alcaraz-Clariana S, García-Luque L, Carmona-Pérez C, Garrido-Castro JL, Cruz-Medel I, Camargo PR, Alburquerque-Sendín F. Absolute and Relative Reliability of the Assessment of the Muscle Mechanical Properties of Pelvic Floor Muscles in Women with and without Urinary Incontinence. Diagnostics (Basel) 2021; 11:diagnostics11122315. [PMID: 34943552 PMCID: PMC8700723 DOI: 10.3390/diagnostics11122315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
An analysis of the muscle mechanical properties (MMPs) of the pelvic floor muscles (PFMs) is relevant for understanding the physiopathology of urinary incontinence (UI). However, there is no objective and reliable methodology currently available for quantifying the MMPs of PFMs. Thus, the objective was to determine the intra-rater and inter-rater reliability of the MMPs of PFM assessment with a hand-held tonometer device, called the MyotonPRO, in young women with and without UI. Sociodemographic and pelvic floor questionnaires, plus MMPs of PFMs were assessed in 38 nulliparous women with UI and 40 matched healthy women by two trained physiotherapists on two different occasions, 48-72 h apart. Good to excellent absolute reliability was found for tone, stiffness, and decrement of both intra- and inter-rater analyses in both study groups (Intraclass Correlation Coefficient ranged from 0.75 to 0.92), with a trend of lower values for relaxation and creep. The standard error of measurement (SEM) did not achieve 10% of the mean values for any MMPs. The minimum detectable change (MDC) values were also provided for clinical applications. In conclusion, the relative reliability of tone, stiffness, and the assessment of the decrement of PFMs with MyotonPRO is good to excellent for UI and healthy women. The SEM and MDC values were acceptable for their application in clinical settings.
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Affiliation(s)
- Daiana Priscila Rodrigues-de-Souza
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
| | - Sandra Alcaraz-Clariana
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
| | - Lourdes García-Luque
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
| | - Cristina Carmona-Pérez
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
| | - Juan Luis Garrido-Castro
- Department of Computer Science and Numerical Analysis, Rabanales Campus, University of Córdoba, 14071 Córdoba, Spain;
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
| | - Inés Cruz-Medel
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
| | - Paula R. Camargo
- Laboratory of Analysis and Intervention of the Shoulder Complex, Department of Physical Therapy, Universidade Federal de São Carlos, Rodovia Washington Luis km 235, São Carlos 13565-905, SP, Brazil;
| | - Francisco Alburquerque-Sendín
- Department of Nursing, Pharmacology and Physical Therapy, Faculty of Medicine and Nursing, University of Córdoba, 14004 Córdoba, Spain; (D.P.R.-d.-S.); (S.A.-C.); (L.G.-L.); (C.C.-P.); (I.C.-M.)
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14004 Córdoba, Spain
- Correspondence: ; Tel.: +34-957-218-241
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12
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Clark-Patterson GL, Roy S, Desrosiers L, Knoepp LR, Sen A, Miller KS. Role of fibulin-5 insufficiency and prolapse progression on murine vaginal biomechanical function. Sci Rep 2021; 11:20956. [PMID: 34697337 PMCID: PMC8546087 DOI: 10.1038/s41598-021-00351-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/31/2021] [Indexed: 02/04/2023] Open
Abstract
The vagina plays a critical role in supporting the pelvic organs and loss of support leads to pelvic organ prolapse. It is unknown what microstructural changes influence prolapse progression nor how decreased elastic fibers contributes to vaginal remodeling and smooth muscle contractility. The objective for this study was to evaluate the effect of fibulin-5 haploinsufficiency, and deficiency with progressive prolapse on the biaxial contractile and biomechanical function of the murine vagina. Vaginas from wildtype (n = 13), haploinsufficient (n = 13), and deficient mice with grade 1 (n = 9) and grade 2 or 3 (n = 9) prolapse were explanted for biaxial contractile and biomechanical testing. Multiaxial histology (n = 3/group) evaluated elastic and collagen fiber microstructure. Western blotting quantified protein expression (n = 6/group). A one-way ANOVA or Kruskal-Wallis test evaluated statistical significance. Pearson's or Spearman's test determined correlations with prolapse grade. Axial contractility decreased with fibulin-5 deficiency and POP (p < 0.001), negatively correlated with prolapse grade (ρ = - 0.80; p < 0.001), and positively correlated with muscularis elastin area fraction (ρ = - 0.78; p = 0.004). Circumferential (ρ = 0.71; p < 0.001) and axial (ρ = 0.69; p < 0.001) vaginal wall stresses positively correlated with prolapse grade. These findings demonstrated that fibulin-5 deficiency and prolapse progression decreased vaginal contractility and increased vaginal wall stress. Future work is needed to better understand the processes that contribute to prolapse progression in order to guide diagnostic, preventative, and treatment strategies.
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Affiliation(s)
| | - Sambit Roy
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Laurephile Desrosiers
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Leise R Knoepp
- Department of Female Pelvic Medicine and Reconstructive Surgery, University of Queensland Ochsner Clinical School, New Orleans, 70121, USA
| | - Aritro Sen
- Department of Animal Sciences, Reproductive and Developmental Sciences Program, Michigan State University, East Lansing, 48824, USA
| | - Kristin S Miller
- Department of Biomedical Engineering, Tulane University, New Orleans, 70118, USA.
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13
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Yang D, Zhang M, Liu K. Tissue engineering to treat pelvic organ prolapse. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2021; 32:2118-2143. [PMID: 34313549 DOI: 10.1080/09205063.2021.1958184] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Pelvic organ prolapse (POP) is a frequent chronic illness, which seriously affects women's living quality. In recent years, tissue engineering has made superior progress in POP treatment, and biological scaffolds have received considerable attention. Nevertheless, pelvic floor reconstruction still faces severe challenges, including the construction of ideal scaffolds, the selection of optimal seed cells, and growth factors. This paper summarizes the recent progress of pelvic floor reconstruction in tissue engineering, and discusses the problems that need to be further considered and solved to provide references for the further development of this field.
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Affiliation(s)
- Deyu Yang
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
| | - Min Zhang
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
| | - Kehai Liu
- Department of Biopharmaceutics, College of Food Science and Technology, Shanghai Ocean University, Shanghai, P.R. China
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14
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Zhang Y, Ma Y, Chen J, Wang M, Cao Y, Li L, Yang H, Liu X, Li Y, Zhu L. Mesenchymal stem cell transplantation for vaginal repair in an ovariectomized rhesus macaque model. Stem Cell Res Ther 2021; 12:406. [PMID: 34266489 PMCID: PMC8281669 DOI: 10.1186/s13287-021-02488-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/02/2021] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Current surgical therapies for pelvic organ prolapse (POP) do not repair weak vaginal tissue and just provide support; these therapies may trigger severe complications. Stem cell-based regenerative therapy, due to its ability to reconstruct damaged tissue, may be a promising therapeutic strategy for POP. The objective of this study is to evaluate whether mesenchymal stem cell (MSC) therapy can repair weak vaginal tissue in an ovariectomized rhesus macaque model. METHODS A bilateral ovariectomy model was established in rhesus macaques to induce menopause-related vaginal injury. Ten bilaterally ovariectomized rhesus macaques were divided into two groups (n=5/group): the saline group and the MSC group. Three months after ovariectomy, saline or MSCs were injected in situ into the injured vaginal wall. The vaginal tissue was harvested 12 weeks after injection for histological and biochemical analyses to evaluate changes of extracellular matrix, microvascular density, and smooth muscle in the vaginal tissue. Biomechanical properties of the vaginal tissue were assessed by uniaxial tensile testing. Data analysis was performed with unpaired Student's t test or Mann-Whitney. RESULTS Twelve weeks after MSC transplantation, histological and biochemical analyses revealed that the content of collagen I, elastin, and microvascular density in the lamina propria of the vagina increased significantly in the MSC group compared with the saline group. And the fraction of smooth muscle in the muscularis of vagina increased significantly in the MSC group. In addition, MSC transplantation improved the biomechanical properties of the vagina by enhancing the elastic modulus. CONCLUSION Vaginal MSC transplantation could repair the weak vaginal tissue by promoting extracellular matrix ingrowth, neovascularization, and smooth muscle formation and improve the biomechanical properties of the vagina, providing a new prospective treatment for POP.
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Affiliation(s)
- Ye Zhang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yidi Ma
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Juan Chen
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Min Wang
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Rheumatology, Beijing Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan Cao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Li
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hua Yang
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xudong Liu
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yaqian Li
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Lan Zhu
- Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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15
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Mao M, Li Y, Zhang Y, Kang J, Zhu L. Human umbilical cord mesenchymal stem cells reconstruct the vaginal wall of ovariectomized Sprague-Dawley rats: implications for pelvic floor reconstruction. Cell Tissue Res 2021; 386:571-583. [PMID: 34264376 DOI: 10.1007/s00441-021-03478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 05/24/2021] [Indexed: 11/27/2022]
Abstract
Vaginal structural defects are involved in pelvic organ prolapse (POP). We tested whether mesenchymal stem cell (MSC) therapy can repair the weakened vaginal wall of POP patients as a novel POP treatment. Ninety-six ovariectomized rats were divided into 4 groups (n = 24/group): saline (sal), collagen (col), sal + MSC, and col + MSC groups. Two weeks after ovariectomy, rats received subepithelial injection of 0.3 ml saline, 0.3 ml collagen I gel, and 0.3 ml saline: 3 × 106 human umbilical cord mesenchymal stem cells (HUMSCs), or 0.3 ml collagen I gel: 3 × 106 HUMSCs into the anterior vaginal wall. Eight additional rats underwent in vivo bioluminescence imaging (BLI) to evaluate in vivo cell viability. The BLI signal disappeared within 1 week after MSC injection, and no in vivo MSC differentiation was found. Collagen I content was significantly lower at 4 and 12 weeks in the two MSC groups than in the sal and col groups, while collagen III was significantly higher (P < 0.001). The fraction of smooth muscle in the nonvascular muscularis increased significantly in the two MSC groups at 12 weeks (P < 0.001). ACTA2 mRNA in the col + MSC group was significantly higher than that in the sal group at 2 and 4 weeks (P = 0.042 and P = 0.040). mRNA levels of angiogenic factors (bFGF or VEGF) in the two MSC groups were significantly higher than those in the sal and col groups at different time points. HUMSCs normalized the fibromuscular structures of the vaginal wall of ovariectomized rats potentially through a paracrine effect.
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Affiliation(s)
- Meng Mao
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- Department of Gynecology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yaqian Li
- Medical Science Research Center, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ye Zhang
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jia Kang
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Lan Zhu
- Departments of Obstetrics and Gynecology, National Clinical Research Center for Obstetric & Gynecologic Diseases, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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16
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Jameson SA, Swaminathan G, Dahal S, Couri B, Kuang M, Rietsch A, Butler RS, Ramamurthi A, Damaser MS. Elastin homeostasis is altered with pelvic organ prolapse in cultures of vaginal cells from a lysyl oxidase-like 1 knockout mouse model. Physiol Rep 2021; 8:e14436. [PMID: 32533648 PMCID: PMC7292929 DOI: 10.14814/phy2.14436] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/23/2022] Open
Abstract
Pelvic organ prolapse (POP) decreases quality of life for many women, but its pathophysiology is poorly understood. We have previously shown that Lysyl oxidase‐like 1 knockout (Loxl1 KO) mice reliably prolapse with age and increased parity, similar to women. Both this model and clinical studies also indicate that altered elastin metabolism in pelvic floor tissues plays a role in POP manifestation, although it is unknown if this is a cause or effect. Using Loxl1 KO mice, we investigated the effects of genetic absence of Loxl1, vaginal parity, and presence of POP on the expression of genes and proteins key to the production and regulation of elastic matrix. Cultured cells isolated from vaginal explants of mice were assayed with Fastin for elastic matrix, as well as RT‐PCR and Western blot for expression of genes and proteins important for elastin homeostasis. Elastin synthesis significantly decreased with absence of LOXL1 and increased with parity (p < .001), but not with POP. Cells from prolapsed mice expressed significantly decreased MMP‐2 (p < .05) and increased TIMP‐4 (p < .05). The results suggest changes to elastin structure rather than amounts in prolapsed mice as well as poor postpartum elastin turnover, resulting in accumulation of damaged elastic fibers leading to abnormal tropoelastin deposition. POP may thus, be the result of an inability to initiate the molecular mechanisms necessary to clear and replace damaged elastic matrix in pelvic floor tissues after vaginal birth.
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Affiliation(s)
- Slater A Jameson
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Shataakshi Dahal
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bruna Couri
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Rietsch
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Robert S Butler
- Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Anand Ramamurthi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.,Department of Molecular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA.,Advanced Platform Technology Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA
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17
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Dahal S, Kuang M, Rietsch A, Butler RS, Ramamurthi A, Damaser MS. Quantitative Morphometry of Elastic Fibers in Pelvic Organ Prolapse. Ann Biomed Eng 2021; 49:1909-1922. [PMID: 33768411 DOI: 10.1007/s10439-021-02760-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022]
Abstract
Pelvic organ prolapse (POP) is common among older women who have delivered children vaginally. While the pathophysiology is not fully delineated, POP can occur in part from insufficient repair of disrupted elastic matrix fibers. Quantification of structural changes to elastic fibers has not been described previously for POP. The goal of this paper is to present a validated technique for morphometric analysis of elastic fibers in vaginal tissue cultures from lysyl oxidase like-1 knock out (LOXL1 KO) mice with POP. The effect of LOXL1 KO, effect of POP, effect of culture, and effect of elastogenic treatment on the changes in elastin fiber characteristics were tested using vaginal tissues from wild type multiparous (WT), LOXL1 KO multiparous prolapsed (POP) and LOXL1 KO multiparous non-prolapsed (NP) mice. Our results show significantly higher mean aspect ratio, maximum diameter and perimeter length in POP compared to NP after 3 weeks of tissue culture. Further, treatment of POP tissues in culture with growth factors with previously documented elastogenic effects caused a significant increase in the mean area and perimeter length of elastic fibers. This technique thus appears to be useful in quantifying structural changes and can be used to assess the pathophysiology of POP and the effect of elastogenic treatments with potential for POP.
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Affiliation(s)
- Shataakshi Dahal
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
| | - Mei Kuang
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Anna Rietsch
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - R S Butler
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anand Ramamurthi
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA
| | - Margot S Damaser
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave. ND20, Cleveland, OH, 44195, USA.
- Advanced Platform Technology Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
- Department of Biomedical Engineering, Cleveland Clinic Lerner College of Medicine at Case Western Reserve University, Cleveland, OH, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
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18
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Evaluation of extracellular matrix protein expression and apoptosis in the uterosacral ligaments of patients with or without pelvic organ prolapse. Int Urogynecol J 2020; 32:2273-2281. [PMID: 32737532 DOI: 10.1007/s00192-020-04446-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This study aimed to compare the expression levels of extracellular matrix (ECM) and apoptosis proteins in the uterosacral ligament (USL) of patients with and without pelvic organ prolapse (POP). METHODS The USL were obtained from patients with POP-Q ≥ III (n = 35) and without POP (n = 20). Immunohistochemistry (IHC) staining and RT-qPCR were conducted to assess the protein and mRNA levels, respectively. The levels of type I collagen (COLI), type III collagen (COLIII), matrix metalloproteinase (MMP)1, MMP2, MMP9, tissue inhibitor of metalloproteinase (TIMP)1, TIMP2, estrogen receptor (ER)α, ERβ and apoptosis-related gene B cell lymphoma 2 (Bcl-2)-associated agonist of cell death (Bad) and Bcl-2-associated X (Bax) in the USL were analyzed. RESULTS The protein expression and mRNA levels of MMP2 and MMP9, mRNA levels of BAD and BAX, and protein expression of active cleaved-Caspase3 were significantly higher in the POP group. There were no evident differences in COLIII, MMP1 or ERβ expression at either the mRNA or protein level or in TIMP1, TIMP2 or Caspase3 by IHC between the two groups. However, obvious decreases in COLI and ERα were evident at both the mRNA and protein levels in the POP group, and the mRNA levels of TIMP1 and TIMP2 were also decreased compared to those of the control group. CONCLUSION ECM in the USL tissues of POP patients is remodeled compared with non-POP patients and is characterized by decreased synthesis and increased degradation of collagen; moreover, the levels of the main proteins involved in apoptosis are increased in POP tissue.
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Zhang H, Huang J, Liu J, Li Y, Gao Y. BMMSC-sEV-derived miR-328a-3p promotes ECM remodeling of damaged urethral sphincters via the Sirt7/TGFβ signaling pathway. Stem Cell Res Ther 2020; 11:286. [PMID: 32678010 PMCID: PMC7364490 DOI: 10.1186/s13287-020-01808-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background Stress urinary incontinence (SUI) is a common and bothersome condition. Invasive surgery will always be considered after conservative treatment fails, but the rates of postoperative complications and long-term recurrence are high. Thus, a new treatment strategy is still needed. In recent years, bone marrow mesenchymal stem cells (BMMSC) have shown great promise for SUI treatment. The therapeutic effects of BMMSC on SUI are achieved mainly by paracrine pathway signaling molecules, such as small extracellular vesicles (sEV). sEV are recognized as essential mediators of cell-to-cell communication. However, the therapeutic effects and detailed mechanisms of BMMSC-derived sEV in SUI remain mostly unexplored. Methods The effects of BMMSC-sEV on extracellular matrix (ECM) metabolism were assessed in vitro and in vivo. In a SUI rat model, TGF-β1 signaling was examined with or without BMMSC-sEV stimulation. sEV miRNAs were deeply sequenced, and the most likely miRNAs were evaluated as mediators of the TGF-β1 signaling pathway. Results BMMSC-sEV enhanced the synthesis of ECM components, including elastin, collagen I, and collagen III, and improved urethral function. Furthermore, BMMSC-sEV activated TGF-β1 signaling in primary fibroblast cells and in rat urethras. Several differentially expressed miRNAs were identified in the BMMSC-sEV. Bioinformatics analysis and in vitro studies showed that BMMSC-sEV miR-328a-3p can be transferred from BMMSC to fibroblasts and can regulate the Sirt7/TGF-β1 signaling pathway. Conclusion BMMSC-sEV promote ECM remodeling of damaged urethral sphincters by transferring miR-328a-3p to regulate the Sirt7/TGF-β1 signaling pathway.
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Affiliation(s)
- Hanke Zhang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiayu Huang
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jiaying Liu
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yanhui Li
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Ying Gao
- Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Softness sensing probe with multiple acoustic paths for laparoscopic surgery. Int J Comput Assist Radiol Surg 2020; 15:1537-1547. [PMID: 32514729 DOI: 10.1007/s11548-020-02207-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Surgeon's tactile sense is restricted during laparoscopic surgery. We aim to develop a softness sensing probe for endometriosis. Identification of the boundary of the lesion through a tactile sensor during laparoscopic surgery can provide an appropriate cut line, reducing excessive cut. METHOD We expand our acoustic reflection-based sensing to the proposed probe, which has three force-sensing points to measure the softness of the object. The compensation of the sensor posture with the three sensor outputs was additionally proposed. This sensor has a simple structure and no electrical elements in the part inserted into the body. The sensing principle was verified using the theoretical analysis. Fundamental experiment to make the estimation model and evaluation test with the simulated environment were conducted. RESULT The fundamental experiment showed that different softness can be estimated and that leave-one-out cross-validation resulted that the root-mean-square-error of the softness estimation was 31.5 kPa within the range of 7.5° in the probe posture. Samples which have similar softness as normal and lesioned uterus were used for the evaluation test using laparoscopic box trainer and a general trocar. Six participants operated the sensor, and the results showed that the samples were significantly discriminated by the softness estimated. CONCLUSION The experimental results showed that the sensor can estimate the softness while compensating the posture and discriminate model samples of normal and lesioned uterus in the simulated environment, indicating the possibility of boundary identification between normal and lesioned tissues during laparoscopic surgery of endometriosis.
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Gordon MT, DeLancey JOL, Renfroe A, Battles A, Chen L. Development of anatomically based customizable three-dimensional finite-element model of pelvic floor support system: POP-SIM1.0. Interface Focus 2019; 9:20190022. [PMID: 31263537 PMCID: PMC6597525 DOI: 10.1098/rsfs.2019.0022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/24/2022] Open
Abstract
To develop an anatomically based customizable finite-element (FE) model of the pelvic floor support system to simulate pelvic organ prolapse (POP): POP-SIM1.0. This new simulation platform allows for the construction of an array of models that objectively represent the key anatomical and functional variation in women with and without prolapse to test pathomechanism hypotheses of the prolapse formation. POP-SIM1.0 consists of anatomically based FE models and a suite of Python-based tools developed to rapidly construct FE models by customizing the base model with desired structural parameters. Each model consists of anatomical structures from three support subsystems which can be customized based on magnetic resonance image measurements in women with and without prolapse. The customizable structural parameters include presence of levator ani (LA) avulsion, hiatus size, anterior vaginal wall dimension, attachment fascia length and apical location in addition to the tissue material properties and intra-abdominal pressure loading. After customization, the FE model was loaded with increasing intra-abdominal pressure (0-100 cmH2O) and solved using ABAQUS explicit solver. We were able to rapidly construct anatomically based FE models with specific structural geometry which reflects the morphology changes often observed in women with prolapse. At maximum loading, simulated structural deformations have similar anatomical characteristics to those observed during clinical exams and stress magnetic resonance images. Simulation results showed the presence of LA muscle avulsion negatively impacts the pelvic floor support. The normal model with intact muscle had the smallest exposed vaginal length of 11 mm, while the bilateral avulsion produced the largest exposed vaginal length at 24 mm. The unilateral avulsion model had an exposed vaginal length of 18 mm and also demonstrated a tipped perineal body similar to that seen in clinical observation. Increasing the hiatus size, vaginal wall length and fascia length also resulted in worse pelvic floor support, increasing the exposed vaginal length from 18 mm in the base model to 33 mm, 54 mm and 23.5 mm, respectively. The developed POP-SIM1.0 can simulate the anatomical structure changes often observed in women with prolapse. Preliminary results showed that the presence of LA avulsion, enlarged hiatus, longer vaginal wall and fascia length can result in larger prolapse at simulated maximum Valsalva.
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Affiliation(s)
- Mark T. Gordon
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - John O. L. DeLancey
- Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
| | - Aaron Renfroe
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - Andrew Battles
- Department of Bioengineering, California Baptist University, Riverside, CA, USA
| | - Luyun Chen
- Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
- Department of Biomedical Engineering, Pelvic Floor Research Group, University of Michigan, Ann Arbor, MI, USA
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Tissue Composition and Biomechanical Property Changes in the Vaginal Wall of Ovariectomized Young Rats. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8921284. [PMID: 31467917 PMCID: PMC6699277 DOI: 10.1155/2019/8921284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 06/10/2019] [Accepted: 07/14/2019] [Indexed: 01/01/2023]
Abstract
Ideal animal models are needed to reflect the changes in the biochemical and biomechanical properties of the vagina that occur in pelvic organ prolapse (POP). In this study, we aimed to demonstrate the short and long-term effect of menopause on the biochemical and biomechanical properties of rat anterior vaginas. Here, Sprague-Dawley rats were bilaterally ovariectomized to induce menopause. Rats without ovariectomy served as the normal control group (n=12). The histology changes and the expression of collagen I, III, and a-SMA were assessed to indicate the biochemical changes in the vagina 2 weeks, 4 weeks, and 16 weeks after ovariectomy (n=6 for 2 and 4 weeks, n=12 for 16 weeks). Uniaxial biomechanical testing was conducted in the control group and ovariectomized rats 16 weeks after ovariectomy. Compared with the control group, the ovariectomy group showed a significant increase in the expression of collagen I 2 weeks after ovariectomy, while collagen III showed a declining trend. Two weeks after ovariectomy, the smooth muscle bundles began to become disorganized, and the fraction of smooth muscle in the nonvascular muscularis of the proximal vagina was significantly decreased (P<0.001). However, there was no difference in the expression of a-SMA in the distal vagina. Compared with the control group, the ovariectomy group had stiffer vaginas with a declining trend in the ultimate load 16 weeks after ovariectomy. In conclusion, surgically induced menopause had a significant short- and long-term impact on tissue composition and biomechanical properties of the rat vagina, which may lead to increased susceptibility to POP development.
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Massalou D, Masson C, Afquir S, Baqué P, Arnoux PJ, Bège T. Influence of gender, age, shelf-life, and conservation method on the biomechanical behavior of colon tissue under dynamic solicitation. Clin Biomech (Bristol, Avon) 2019; 65:34-40. [PMID: 30954683 DOI: 10.1016/j.clinbiomech.2019.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 03/19/2019] [Accepted: 03/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data from biomechanical tissue sample studies of the human digestive tract are highly variable. The aim of this study was to investigate 4 factors which could modify the mechanical response of human colonic specimens placed under dynamic solicitation until tissue rupture: gender, age, shelf-life and conservation method. METHODS We performed uniaxial dynamic tests of human colonic specimens. Specimens were taken according to three different protocols: refrigerated cadavers without embalming, embalmed cadavers and fresh colonic tissue. A total of 143 specimens were subjected to tensile tests, at a speed of 1 m s-1. FINDINGS Young's modulus of the different conservation protocols are as follows: embalmed, 3.08 ± 1.99; fresh, 2.97 ± 2.59; and refrigerated 3.17 ± 2.05. The type of conservation does not modify the stiffness of the tissue (p = 0.26) but does modify the stress necessary for rupture (p < 0.001) and the strain required to obtain lesions of the outer layer and the inner layer (p < 0.001 and p < 0.05, respectively). Gender is also a factor responsible for a change in the mechanical response of the colon. The age of the subjects and the shelf-life of the bodies did not represent factors influencing the mechanical behavior of the colon (p > 0.05). INTERPRETATION The mechanical response of the colon tissue showed a biphasic injury process depending on gender and method of preservation. The age and shelf-life of anatomical subjects do not alter the mechanical response of the colon.
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Affiliation(s)
- D Massalou
- Emergency Surgery Unit, University Hospital of Nice, CHU de Nice Hôpital Pasteur 2, Université de Nice Sophia-Antipolis, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - C Masson
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - S Afquir
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France
| | - P Baqué
- Emergency Surgery Unit, University Hospital of Nice, CHU de Nice Hôpital Pasteur 2, Université de Nice Sophia-Antipolis, France.
| | - P-J Arnoux
- Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
| | - T Bège
- Department of Visceral Surgery, AP-HM Hôpital Nord, Aix-Marseille University, France; Biomechanical Applied Laboratory, UMRT24, IFSTTAR, Aix-Marseille University, France.
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Reply by Authors. J Urol 2018; 200:395-396. [DOI: 10.1016/j.juro.2018.02.3118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Dodero D, Frascani F, Angelucci M, Bernabei G, Merlo E, Locatelli F, Murina F. Solid State Vaginal Laser for the Treatment of Genitourinary Syndrome of Menopause: A Preliminary Report. ACTA ACUST UNITED AC 2018. [DOI: 10.4236/ojog.2018.82015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Khadzhieva MB, Kolobkov DS, Kamoeva SV, Salnikova LE. Expression changes in pelvic organ prolapse: a systematic review and in silico study. Sci Rep 2017; 7:7668. [PMID: 28794464 PMCID: PMC5550478 DOI: 10.1038/s41598-017-08185-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 07/05/2017] [Indexed: 01/23/2023] Open
Abstract
Pelvic organ prolapse (POP) is a highly disabling condition common for a vast number of women worldwide. To contribute to existing knowledge in POP pathogenesis, we performed a systematic review of expression studies on both specific gene and whole-genome/proteome levels and an in silico analysis of publicly available datasets related to POP development. The most extensively investigated genes in individual studies were related to extracellular matrix (ECM) organization. Three premenopausal and two postmenopausal sets from two Gene Expression Omnibus (GEO) studies (GSE53868 and GSE12852) were analyzed; Gene Ontology (GO) terms related to tissue repair (locomotion, biological adhesion, immune processes and other) were enriched in all five datasets. Co-expression was higher in cases than in controls in three premenopausal sets. The shared between two or more datasets up-regulated genes were enriched with those related to inflammatory bowel disease (IBD) in the NHGRI GWAS Catalog. ECM-related genes were not over-represented among differently expressed genes. Up-regulation of genes related to tissue renewal probably reflects compensatory mechanisms aimed at repair of damaged tissue. Inefficiency of this process may have different origins including age-related deregulation of gene expression.
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Affiliation(s)
- Maryam B Khadzhieva
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia.,Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, 1 Samory Mashela str., Moscow, 117997, Russia
| | - Dmitry S Kolobkov
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia
| | - Svetlana V Kamoeva
- Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow, 117997, Russia
| | - Lyubov E Salnikova
- Vavilov Institute of General Genetics, Russian Academy of Sciences, 3 Gubkina str., Moscow, 119333, Russia. .,Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology, 1 Samory Mashela str., Moscow, 117997, Russia.
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Hong S, Hong L, Li B, Wu D, Liu C, Min J, Guo W, Hu M, Tang J, Li Y. The role of GPX1 in the pathogenesis of female pelvic organ prolapse. PLoS One 2017; 12:e0181896. [PMID: 28783735 PMCID: PMC5546568 DOI: 10.1371/journal.pone.0181896] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 07/10/2017] [Indexed: 12/29/2022] Open
Abstract
Gestation and delivery can increase intra-abdominal pressure, which are well-known risk factors for Pelvic Organ Prolapse (POP). But the pathogenesis mechanism of POP remains unclear. Our previous research showed that the expression of glutathione peroxidase type 1 (GPX1) decreased in pelvic floor ligaments from POP patients, implying that oxidative stress (OS) may be related to POP. The aim of this study was to figure out the role of GPx1 regulation in the pathogenesis of POP. Women (>45 years) who received hysterectomy surgery were enrolled in this research, identified by screening. We applied mechanical strain of 0μ, 5333 μ to GPX1-overexpressing human uterosacral ligament fibroblasts (hUSLFs) isolated from menopausal women without POP respectively for 4 hours, in order to investigate the changes of cell apoptosis, oxidative status and ECM metabolism when cytomechanics model loaded on GPX1-overexpressing hUSLFs. Comparing with the non-transfection and mock-vehicle groups, we found that GPX1 not only protects hUSLFs from cell apoptosis, oxidative damage, but also improves the remodeling of ECM induced by mechanical stimulation. These results suggested that mechanical strain caused abnormalities of ECM metabolism via OS pathway in hUSLFs, which was involved in the pathogenesis of POP, and that GPx1 played a significant role in regulating mechanical strain induced POP.
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Affiliation(s)
- Shasha Hong
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Li Hong
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
- * E-mail:
| | - Bingshu Li
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Debin Wu
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Cheng Liu
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jie Min
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Wenjun Guo
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Ming Hu
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jianming Tang
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yang Li
- Department of Obstetrics and Gynaecology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Glindtvad C, Chen M, Vinge Nygaard J, Wogensen L, Forman A, Danielsen CC, Taskin MB, Andersson KE, Axelsen SM. Electrospun biodegradable microfibers induce new collagen formation in a rat abdominal wall defect model: A possible treatment for pelvic floor repair? J Biomed Mater Res B Appl Biomater 2017; 106:680-688. [DOI: 10.1002/jbm.b.33875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 01/15/2017] [Accepted: 02/20/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Cecilie Glindtvad
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Denmark
| | - Menglin Chen
- iNANO, Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
| | - Jens Vinge Nygaard
- Department of Engineering - Biomechanics and Mechanobiology; Aarhus University; Denmark
| | - Lise Wogensen
- Faculty Secretariat, Faculty of Health Sciences; Aarhus University; Denmark
| | - Axel Forman
- Department of Gynecology and Obstetrics, Aarhus University Hospital; Denmark
| | | | - Mehmet Berat Taskin
- iNANO Department of Engineering - Nano Fiber Technology and Cellular Engineering; Aarhus University; Denmark
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Vaginal Fibroblastic Cells from Women with Pelvic Organ Prolapse Produce Matrices with Increased Stiffness and Collagen Content. Sci Rep 2016; 6:22971. [PMID: 26965792 PMCID: PMC4786799 DOI: 10.1038/srep22971] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/22/2016] [Indexed: 02/08/2023] Open
Abstract
Pelvic organ prolapse (POP) is characterised by the weakening of the pelvic floor support tissues, and often by subsequent prolapse of the bladder outside the body, i.e. cystocele. The bladder is kept in place by the anterior vaginal wall which consists of a dense extracellular matrix rich in collagen content that is maintained and remodelled by fibroblastic cells, i.e. fibroblasts and myofibroblasts. Since altered matrix production influences tissue quality, and myofibroblasts are involved in normal and pathological soft tissue repair processes, we evaluated matrix production of cells derived from pre- and post-menopausal POP and non-POP control anterior vaginal wall tissues. Results showed that cells from postmenopausal POP women deposited matrices with high percentage of collagen fibres with less anisotropic orientation and increased stiffness than those produced by controls. There was a transient increase in myofibroblastic phenotype that was lost after the peak of tissue remodelling. In conclusion, affected fibroblasts from postmenopausal prolapsed tissues produced altered matrices in vitro compared to controls. Such aberrant altered matrix production does not appear to be a consequence of abnormal phenotypical changes towards the myofibroblastic lineage.
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Eberhart R, Chuong CJ, Zimmern P. Exploring biomechanical methods to study the human vaginal wall. Neurourol Urodyn 2016; 36:499-506. [DOI: 10.1002/nau.22968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/18/2016] [Indexed: 01/29/2023]
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Kufaishi H, Alarab M, Drutz H, Lye S, Shynlova O. Static Mechanical Loading Influences the Expression of Extracellular Matrix and Cell Adhesion Proteins in Vaginal Cells Derived From Premenopausal Women With Severe Pelvic Organ Prolapse. Reprod Sci 2016; 23:978-92. [PMID: 26823071 DOI: 10.1177/1933719115625844] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Primary human vaginal cells derived from women with severe pelvic organ prolapse (POP-HVCs) demonstrate altered cellular characteristics as compared to cells derived from asymptomatic women (control-HVCs). Using computer-controllable Flexcell stretch unit, we examined whether POP-HVCs react differently to mechanical loading as compared to control-HVCs by the expression of extracellular matrix (ECM) components, cell-ECM adhesion proteins, and ECM degrading and maturating enzymes. METHODS Vaginal tissue biopsies from premenopausal patients with Pelvic Organ Prolapse Quantification System stage ≥3 (n = 8) and asymptomatic controls (n = 7) were collected during vaginal hysterectomy or repair. Human vaginal cells were isolated by enzymatic digestion, seeded on collagen (COLI)-coated plates, and stretched (24 hours, 25% elongation). Total RNA was extracted, and 84 genes were screened using Human ECM and Adhesion Molecules polymerase chain reaction array; selected genes were verified by quantitative reverse transcription-polymerase chain reaction. Stretch-conditioned media (SCM) were collected and analyzed by protein array, immunoblotting, and zymography. RESULTS In mechanically stretched control-HVCs, transcript levels of integrins (ITGA1, ITGA4, ITGAV, and ITGB1) and matrix metalloproteinases (MMPs) 2, 8, and 13 were downregulated (P < .05); in POP-HVCs, MMP1, MMP3, and MMP10, ADAMTS8 and 13, tissue inhibitor of metalloproteinases (TIMPs) 1 to 3, ITGA2, ITGA4, ITGA6, ITGB1, contactin (CNTN1), catenins (A1 and B1), and laminins (A3 and C1) were significantly upregulated, whereas COLs (1, 4, 5, 6, 11, and 12) and LOXL1 were downregulated. Human vaginal cells massively secrete MMPs and TIMPs proteins; MMP1, MMP8, MMP9 protein expression and MMP2 gelatinase activity were increased, whereas TIMP2 decreased in SCM from POP-HVCs compared to control-HVCs. CONCLUSIONS Primary human vaginal cells derived from women with severe pelvic organ prolapse and control-HVCs react differentially to in vitro mechanical stretch. Risk factors that induce stretch may alter ECM composition and cell-ECM interaction in pelvic floor tissue leading to the abatement of pelvic organ support and subsequent POP development.
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Affiliation(s)
- Hala Kufaishi
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - May Alarab
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Harold Drutz
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Stephen Lye
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Oksana Shynlova
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
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de Landsheere L, Brieu M, Blacher S, Munaut C, Nusgens B, Rubod C, Noel A, Foidart JM, Nisolle M, Cosson M. Elastin density: Link between histological and biomechanical properties of vaginal tissue in women with pelvic organ prolapse? Int Urogynecol J 2015; 27:629-35. [PMID: 26658755 DOI: 10.1007/s00192-015-2901-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 11/15/2015] [Indexed: 01/24/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The aim of the study was to correlate histological and biomechanical characteristics of the vaginal wall in women with pelvic organ prolapse (POP). METHODS Tissue samples were collected from the anterior [point Ba; POP Questionnaire (POP-Q)] and/or posterior (point Bp; POP-Q) vaginal wall of 15 women who underwent vaginal surgery for POP. Both histological and biomechanical assessments were performed from the same tissue samples in 14 of 15 patients. For histological assessment, the density of collagen and elastin fibers was determined by combining high-resolution virtual imaging and computer-assisted digital image analysis. For biomechanical testing, uniaxial tension tests were performed to evaluate vaginal tissue stiffness at low (C0) and high (C1) deformation rates. RESULTS Biomechanical testing highlights the hyperelastic behavior of the vaginal wall. At low strains (C0), vaginal tissue appeared stiffer when elastin density was low. We found a statistically significant inverse relationship between C0 and the elastin/collagen ratio (p = 0.048) in the lamina propria. However, at large strain levels (C1), no clear relationship was observed between elastin density or elastin/collagen ratio and stiffness, likely reflecting the large dispersion of the mechanical behavior of the tissue samples. CONCLUSION Histological and biomechanical properties of the vaginal wall vary from patient to patient. This study suggests that elastin density deserves consideration as a relevant factor of vaginal stiffness in women with POP.
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Affiliation(s)
- Laurent de Landsheere
- Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium.
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
| | - Mathias Brieu
- LML, CNRS UMR 8107, Ecole centrale de Lille, University Nord de France, Lille, France
| | - Silvia Blacher
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Carine Munaut
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Betty Nusgens
- Laboratory of Connective Tissues Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Chrystèle Rubod
- Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, n°2, 59037, Lille Cedex, France
| | - Agnès Noel
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Jean-Michel Foidart
- Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium
- Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Michel Cosson
- Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, n°2, 59037, Lille Cedex, France
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Ogrinc UB, Senčar S, Lenasi H. Novel minimally invasive laser treatment of urinary incontinence in women. Lasers Surg Med 2015; 47:689-97. [PMID: 26388213 PMCID: PMC5396289 DOI: 10.1002/lsm.22416] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary incontinence (UI) is a common disorder that affects women of various ages and impacts all aspects of life. Our aim was to evaluate the non-invasive erbium:yttrium-aluminum-garnet (Er:YAG) laser that exploits its thermal effect and has been used in reconstructive and rejuvenation surgery as a potential treatment strategy for stress UI (SUI) and mixed UI (MUI). STUDY DESIGN/MATERIALS AND METHODS We included 175 women (aged 49.7 ± 10 years) with newly diagnosed SUI (66% of women) and MUI (34%), respectively. Patients were clinically examined and classified by incontinence types (SUI and MUI) and grades (mild, moderate, severe, and very severe) using International Consultation on Incontinence Modular Questionnaire (ICIQ) and assessing Incontinence Severity Index (ISI). Using Er:YAG laser, we performed on average 2.5 ± 0.5 procedures in each woman separated by a 2 month period. At each session, clinical examination was performed, ICIQ and ISI assessed and treatment discomfort measured with visual analog system (VAS) pain scale, and adverse effects and patients' satisfaction were followed. Follow-ups were performed at 2, 6, and 12 months after the treatment. RESULTS After the treatment, ISI decreased for 2.6 ± 1.0 points in patients diagnosed with mild UI before the treatment, for 3.6 ± 1.4 points in those with moderate UI, for 5.7 ± 1.8 points in those with severe UI and for 8.4 ± 2.6 in those with very severe UI (P < 0.001, paired samples t-test). Altogether, in 77% patients diagnosed with SUI, a significant improvement was found after treatment, while only 34% of women with MUI exhibited no UI at one year follow-up. Age did not affect the outcome. No major adverse effects were noticed in either group. CONCLUSION The results of our study, have shown that new non-invasive Er:YAG laser could be regarded as a promising additional treatment strategy for SUI with at least one year lasting positive effects. On the other hand, it does not seem appropriate for treating MUI.
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Affiliation(s)
| | | | - Helena Lenasi
- Institute of PhysiologyMedical FacultyUniversity of LjubljanaZaloška 4Ljubljana1000Slovenia
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The future of research in female pelvic medicine. Curr Urol Rep 2015; 16:2. [PMID: 25604652 DOI: 10.1007/s11934-014-0474-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Female pelvic medicine and reconstructive surgery (FPMRS) was recently recognized as a subspecialty by the American Board of Medical Specialties (ABMS). FPMRS treats female pelvic disorders (FPD) including pelvic organ prolapse (POP), urinary incontinence (UI), fecal incontinence (FI), lower urinary tract symptoms (LUTS), lower urinary tract infections (UTI), pelvic pain, and female sexual dysfunction (FSD). These conditions affect large numbers of individuals, resulting in significant patient, societal, medical, and financial burdens. Given that treatments utilize both medical and surgical approaches, areas of research in FPD necessarily cover a gamut of topics, ranging from mechanistically driven basic science research to randomized controlled trials. While basic science research is slow to impact clinical care, transformational changes in a field occur through basic investigations. On the other hand, clinical research yields incremental changes to clinical care. Basic research intends to change understanding whereas clinical research intends to change practice. However, the best approach is to incorporate both basic and clinical research into a translational program which makes new discoveries and effects positive changes to clinical practice. This review examines current research in FPD, with focus on translational potential, and ponders the future of FPD research. With a goal of improving the care and outcomes in patients with FPD, a strategic collaboration of stakeholders (patients, advocacy groups, physicians, researchers, professional medical associations, legislators, governmental biomedical research agencies, pharmaceutical companies, and medical device companies) is an absolute requirement in order to generate funding needed for FPD translational research.
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Colaco M, Mettu J, Badlani G. The scientific basis for the use of biomaterials in stress urinary incontinence (SUI) and pelvic organ prolapse (POP). BJU Int 2014; 115:859-66. [DOI: 10.1111/bju.12819] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Marc Colaco
- Department of Urology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Jayadev Mettu
- Department of Urology; Wake Forest School of Medicine; Winston-Salem NC USA
| | - Gopal Badlani
- Department of Urology; Wake Forest School of Medicine; Winston-Salem NC USA
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McMillan KS, Siddighi S, Hardesty JS, Yune JJ, Chan PJ. UVA-photoactivated riboflavin effect on isolated vaginal tissues derived from pelvic organ prolapse cases. Int Urol Nephrol 2014; 47:75-9. [PMID: 25218617 DOI: 10.1007/s11255-014-0836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/02/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the optimal riboflavin exposure time before UVA irradiation and to study the effects of exogenous collagen on the mechano-tensile stiffness of isolated vaginal tissue strips after riboflavin UVA photoactivation. METHODS Vaginal tissue strips from pelvic organ prolapse (POP) cases were soaked in 0.1% riboflavin (0, 10, 20, 30 min), exposed to UVA photoactivation, and tensile stiffness was measured with a tensiometer. Collagen solution was injected (0.2 mL) into each strip, exposed to riboflavin with or without UVA photoactivation, and tensile stiffness was measured (n=6). RESULTS Vaginal tissues treated with riboflavin for 10, 20 or 30 min followed by UVA irradiation displayed 21.2, 32.4 and 33.9% stronger tensile stiffness, respectively. Exogenous collagen administered before riboflavin UVA photoactivation resulted in 20% improvement in tensile stiffness. The tensile stiffness of vaginal tissues injected with collagen without the riboflavin UVA treatment was similar to control tissues. CONCLUSION The results demonstrated increased tensile stiffness in isolated POP-derived vaginal tissues after riboflavin UVA photoactivation suggesting improved mechanical properties from collagen cross-linking. Administering exogenous collagen before riboflavin UVA treatment also improved tensile stiffness. More studies are needed to corroborate the present minimally invasive approach for strengthening vaginal tissues.
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Affiliation(s)
- Kimberly S McMillan
- Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, 11370 Anderson Street, Suite 3950, Loma Linda, CA, 92354, USA
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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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Lim VF, Khoo JK, Wong V, Moore KH. Recent studies of genetic dysfunction in pelvic organ prolapse: the role of collagen defects. Aust N Z J Obstet Gynaecol 2014; 54:198-205. [PMID: 24575973 DOI: 10.1111/ajo.12169] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/16/2013] [Indexed: 12/13/2022]
Abstract
Gynaecologists are becoming increasingly aware that women with a family history of prolapse are at an increased risk of prolapse refractory to treatment. In the past five years, several genetic mutations have been shown to correlate with increased prolapse susceptibility. These mutations can result in disordered collagen metabolism, which weaken the fascial support of the pelvic organs. This review examines the contemporary evidence regarding the role of collagen in prolapse.
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Affiliation(s)
- Veronica F Lim
- Pelvic Floor Unit, St George Hospital/University of New South Wales, Sydney, NSW, Australia
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Han L, Wang L, Wang Q, Li H, Zang H. Association between pelvic organ prolapse and stress urinary incontinence with collagen. Exp Ther Med 2014; 7:1337-1341. [PMID: 24940435 PMCID: PMC3991483 DOI: 10.3892/etm.2014.1563] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 01/21/2014] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to investigate the ultrastructure and content of collagen in uterosacral ligaments and paraurethral tissues in patients with pelvic organ prolapse (POP) and stress urinary incontinence (SUI), analyzing the association between POP and collagen dysfunction. The study comprised three groups: Control, POP and POP with SUI (n=30 per group). Histological characteristics of collagen fiber were observed and the diameters were measured using light and electron microscopy to determine the Type I and Type III collagen content of the main ligament in the urethral specimens. In the POP and POP with SUI groups, observations included diffuse atrophy of smooth muscles, active fibroblast metabolism, swollen mitochondria and visible Golgi apparatus. The collagen fibril diameters in the cardinal ligaments, uterosacral ligaments and paraurethral tissues were significantly greater in the POP and POP with SUI groups compared with those in the control group (P<0.01). In addition, the expression levels of Type I and Type III collagen were significantly lower in the POP and POP with SUI groups when compared with the control group (P<0.01). In the POP with SUI group, pelvic tissues were frail, resulting in smooth muscle bundles comminuting and arranging in a disorganized pattern. Fibroblast and myoblast metabolisms were active and new microvascular cells were weak. However, the collagen fibril diameter increased. Thus, collagen and ultrastructural changes in the pelvic floor may be associated with the development of POP and SUI.
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Affiliation(s)
- Liying Han
- Department of Obstetrics and Gynecology, Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Ling Wang
- Department of Obstetrics and Gynecology, Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Qiang Wang
- Department of Obstetrics and Gynecology, Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Helian Li
- Department of Obstetrics and Gynecology, Second Hospital of Jilin University, Changchun, Jilin 130041, P.R. China
| | - Hu Zang
- Department of Orthopedics, The China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China
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Ruiz-Zapata AM, Kerkhof MH, Zandieh-Doulabi B, Brölmann HAM, Smit TH, Helder MN. Fibroblasts from women with pelvic organ prolapse show differential mechanoresponses depending on surface substrates. Int Urogynecol J 2013; 24:1567-75. [PMID: 23579290 PMCID: PMC3745620 DOI: 10.1007/s00192-013-2069-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/06/2013] [Indexed: 01/17/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Little is known about dynamic cell-matrix interactions in the context of pathophysiology and treatments for pelvic organ prolapse (POP). This study sought to identify differences between fibroblasts from women with varying degrees of prolapse in reaction to mechanical stimuli and matrix substrates in vitro. METHODS Fibroblasts from the vaginal wall of three patients with POP Quantification (POP-Q) system stages 0, II, and IV were stretched on artificial polymer substrates either coated or not coated with collagen I. Changes in morphology and anabolic/catabolic compounds that affect matrix remodelling were evaluated at protein- and gene-expression levels. Statistical analysis was performed using one-way analysis of variance (ANOVA), followed by Tukey-Kramer's post hoc test. RESULTS POP fibroblasts show delayed cell alignment and lower responses to extracellular matrix remodelling factors at both enzymatic- and gene-expression levels compared with healthy fibroblasts. CONCLUSION POP fibroblasts, when compared with healthy cells, show differential mechanoresponses on two artificial polymer substrates. This should be taken into account when designing or improving implants for treating POP.
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Affiliation(s)
- Alejandra M Ruiz-Zapata
- Department of Orthopaedics, VU University Medical Center, Research Institute MOVE, Amsterdam, The Netherlands.
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