Effect of hormones on collagen metabolism and collagenase activity in the pubic symphysis ligament of the guinea pig

Cyclic loading induces anabolic gene expression in ACLs in a load-dependent and sex-specific manner

Anterior cruciate ligament (ACL) injuries are historically thought to be a result of a single acute overload or traumatic event. However, recent studies suggest that ACL failure may be a consequence of fatigue damage. Additionally, the remodeling response of ACLs to fatigue loading is unknown. Therefore, the objective of this study was to investigate the remodeling response of ACLs to cyclic loading. Furthermore, given that women have an increased rate of ACL rupture, we investigated whether this remodeling response is sex specific. ACLs were harvested from male and female New Zealand white rabbits and cyclically loaded in a tensile bioreactor mimicking the full range of physiological loading (2, 4, and 8 MPa). Expression of markers for anabolic and catabolic tissue remodeling, as well as inflammatory cytokines, was quantified using quantitative reverse transcription polymerase chain reaction. We found that the expression of markers for tissue remodeling of the ACL is dependent on the magnitude of loading and is sex specific. Male ACLs activated an anabolic response to cyclic loading at 4 MPa but turned off remodeling at 8 MPa. These data support the hypothesis that noncontact ACL injury may be a consequence of failed tissue remodeling and inadequate repair of microtrauma resulting from elevated loading. Compared to males, female ACLs failed to increase anabolic gene expression with loading and exhibited higher expression of catabolic genes at all loading levels, which may explain the increased rate of ACL tears in women. Together, these data provide insight into load-induced ACL remodeling and potential causes of tissue rupture.

Factors involved in changes in the levator ani during pregnancy

INTRODUCTION AND HYPOTHESIS

Levator ani muscle (LAM) dimensions increase during pregnancy to allow the delivery of the fetus. The objective was to investigate which factors are involved in LAM modifications during pregnancy.

METHODS

A prospective longitudinal observational study was conducted between July 2015 and March 2018. Ninety-nine nulliparous pregnant women were included. Data on the physical examination, 4D transperineal ultrasound and hormonal concentrations (progesterone, oestradiol and relaxin) were collected during the first and third trimesters.

RESULTS

We found higher hiatal dimensions at the beginning of pregnancy than in other studies with nonpregnant women. Increases in the levator ani hiatal (LH) dimensions were observed at contraction (1.01 ±1.96 cm2), rest (0.82 ± 2.51 cm2) and on Valsalva (2.36 ± 3.64 cm2) throughout pregnancy. The distensibility in the third trimester was higher than in the first trimester (5.79 vs 4.24 cm2; p=0); however, the contractility was lower (-3.32 vs -3.5 cm2; p=0.04). Women with lower scores on the Modified Oxford Grading Scale in the third trimester presented with lower contractility in the LAM. A larger LH at the end of pregnancy was associated with age and body mass index. Eleven women developed ballooning during pregnancy; in these women, relaxin was higher in both trimesters than in women without ballooning, but these results were not statistically significant. The linear models to predict third-trimester Valsalva LH, distensibility and contractility were not conclusive and did not show any factors to predict LAM modifications during pregnancy.

CONCLUSIONS

Hormones could play a role in modifying the muscle properties of LAM from the beginning of pregnancy, but we did not find an association between LAM measurements and hormone concentration in this study.

Predictors for Anterior Cruciate Ligament (ACL) Re-injury after Successful Primary ACL Reconstruction (ACLR)

Introduction:

Few authors have addressed risk factors related to an ipsilateral graft rupture and contralateral anterior cruciate ligament (ACL) injury after return to sports (RTS) following primary ACL reconstruction.

Material and Methods:

Patients with ACL re-injury to either knee after successful primary ACLR were included in Group I and those with no further re-injury were included in Group II. Variables including age, gender, side, body mass index (BMI), thigh atrophy, anterior knee laxity difference between both knees measured by KT-1000 arthrometer, mean time of return to sports (RTS), graft type, type of game, mode of injury, Tegner Activity Score, hormone levels, femoral tunnel length (FTL), posterior tibial slope (PTS) and notch width index (NWI) were studied. Binary logistic regression was used to measure the relative association.

Results:

A total of 128 athletes were included with 64 in each group. Mean age in Group I and II were 24.90 and 26.47 years respectively. Mean follow-up of Group I and Group II were 24.5 and 20.11 months respectively. Significant correlation was present between ACL re-injury and following risk factors; PTS of >10º, KT difference of >3.0mm, thigh atrophy of >2.50cm and time to RTS <9.50 months P value <0.05). No correlation was found with age, sex, BMI, type of game, Tegner Activity Score, mode of injury, NWI, size of graft, FTL and hormone levels.

Conclusion:

Possible risk factors include PTS of ≥ 10º, KT difference of ≥ 3.0mm at 1 year follow-up, thigh atrophy of ≥ 2.50cm at 1 year follow-up and RTS <9.5 months after primary ACLR.

The effect of estrogen and progesterone on porcine corneal biomechanical properties

PURPOSE

To determine the effect of the hormones estrogen and progesterone on the biomechanical properties of porcine corneas.

METHODS

Thirty fresh porcine corneas were acquired from an abattoir. The corneas were equally divided into three groups. Groups were incubated for 1 week in Eusol-C solution containing supra-physiologic concentrations of estrogen, progesterone, or control (no added hormone). After incubation, the central corneal thickness (CCT) of each cornea was measured using an electronic caliper, and then the corneas were cut into strips. The strips were then clamped in the pneumatic jaws of a computer-controlled biomaterial tester (Instron 4502, USA) and stretched at a constant rate of 1 mm/min until tissue rupture while constantly recording the stress and strain of the tissue. Stress-strain curves were plotted and Young's modulus was calculated for each corneal strip.

RESULTS

Average corneal thickness was 873.5 ± 143.1 μm for the control group, 928.0 ± 97.7 μm for the estrogen group, and 922.0 ± 116.7 μm for the progesterone group (data presented as mean ± SD). There was no statistically significant difference between the groups regarding the CCT (p = 0.89). The average Young's modulus was 17.00 ± 3.46 MPa for the control group, 16.95 ± 6.83 MPa for the progesterone group, and 12.33 ± 3.24 MPa for the estrogen group. The difference between the control and estrogen groups was statistically significant (p = 0.018) while the difference between the control and progesterone groups was not (p = 0.72).

CONCLUSION

Estrogen has a relaxing effect on the porcine cornea, resulting in reduced stiffness of the tissue. Progesterone has no significant effect on the biomechanical properties of porcine corneas. Estrogen and progesterone do not significantly affect CCT.

Temporal changes in matrix metalloproteinases, their inhibitors, and cathepsins in mouse pubic symphysis during pregnancy and postpartum

Remodeling and relaxation of the mouse pubic symphysis (PS) are central events in parturition. The involvement of endogenous proteins such as matrix metalloproteinases (MMPs), tissue inhibitors of matrix metalloproteinases (TIMPs), and cathepsins in these phenomena remains unclear. In this work, we used a combination of immunolocalization, protein expression/activity, and relative messenger RNA (mRNA) expression to examine the changes in selected MMPs (-2, -9, and -8), TIMPs (-1 and -2), and cathepsins (B and K) during pregnancy and postpartum in mice. Immunohistochemistry revealed the presence of all of these proteins in the cytoplasm of chondrocytes, fibrochondrocytes, and fibroblast-like cells in the interpubic tissues. Zymography showed increases in the active forms of MMP-2 and -9 primarily on days 15 to 19 of pregnancy. Western blotting showed enhanced expression of MMP-8 on days 12 to 15 of pregnancy, with no changes in cathepsins B and K. Matrix metalloproteinases 2, TIMP-1 and -2, and cathepsin B had significant relative gene expression throughout pregnancy. These findings indicate that during pregnancy and postpartum there are variations in the expression and activity of proteins that may have an important role in remodeling the pubic symphysis during these events.

Changes of large molecular weight hyaluronan and versican in the mouse pubic symphysis through pregnancy

During pregnancy, the mouse pubic symphysis undergoes expansion and remodeling resulting in formation of a flexible and elastic interpubic ligament allowing passage of a term fetus. In the current study, we sought to identify and characterize components of the extracellular matrix that likely play an important role in elongation and flexibility of the interpubic ligament during parturition. Mouse pubic symphyses and interpubic ligaments collected at time points during pregnancy and postpartum were utilized to evaluate collagen type, collagen content, processing and solubility, matricellular protein, and proteoglycan expression and quantitative assessment of all glycosaminoglycans. These studies revealed increased gene expression for hyaluronan synthase 1, hyaluronan synthase 2, and versican on Gestation Day 18 as well as a decline in protein expression for the versican-degrading protease a disintegrin-like and metalloprotease with thrombospondin type 1 (ADAMTS1) motif. These findings suggest that the primary mediators of increased elongation and flexibility of the interpubic ligament at term result from increased synthesis and reduced metabolism of viscoelasticity-promoting molecules such as high molecular weight hyaluronan and versican.

Painful pelvic joints induced by a levonorgestrel-releasing intrauterine system

The normally occurring loosening of the pelvic joints with separation of the symphysis during pregnancy may give rise to pain over the symphysis pubis or/and over the sacroiliac joints. In contrast, increased mobility between the pubic bones and pelvic pain without any direct connection with pregnancy is rare and its etiology is unclear. The following is a report of a patient who experienced symphysiolysis-like pelvic pain following the use of a levonorgestrel-releasing intrauterine system.

The effect of relaxin on the female anterior cruciate ligament: Analysis of mechanical properties in an animal model

BACKGROUND

The peptide hormone relaxin, found in pregnant and non-pregnant females, has been shown to have collagenolytic effects on ligamentous tissue. Relaxin receptors have recently been identified on the human female anterior cruciate ligament (ACL). Relaxin may affect the load bearing properties of the female ACL and contribute to non-contact ACL injuries.

HYPOTHESIS

The administration of recombinant relaxin+/-estrogen will lead to a significant decrease in ACL integrity in the guinea pig model.

STUDY DESIGN

Controlled laboratory study.

METHODS

Adult female guinea pigs were divided into three experimental groups. Group 1 (n=4) was administered only 20 microg/h of recombinant porcine relaxin for 3 weeks. Group 2 (n=4) was administered 20 microg/h of recombinant porcine relaxin and 5 microg/h of estradiol for 3 weeks. Group 3 (n=4) served as both a normal control before surgical transection of the ACL and a positive ACL tear control after transection. All hormones were administered using separate implanted osmotic pumps. ACL laxity was tested by implanting radio-opaque markers in the femur and tibia of each leg. After applying a standard anterior force (22 N), the distance between markers was measured radiographically at day 0 and day 21. The animals were then sacrificed and the ACL's were analyzed for load-to-failure using a material testing machine.

RESULTS

Load-to-failure testing indicated that animals treated with relaxin only had significantly weaker ACL's (micro=40.4 N, p=0.001) compared to controls (micro=64.1 N). The relaxin+estrogen group (micro=32.7 N) was also significantly weaker than controls (p=0.007). There were no statistical differences between relaxin and relaxin+estrogen groups. Both relaxin only and relaxin+estrogen groups showed an increase in anterior translation of the tibia after 3 weeks of infusion, but it did not achieve statistical significance.

CONCLUSIONS

Relaxin significantly alters the mechanical properties of the ACL in an animal model.

CLINICAL RELEVANCE

The effects of relaxin, possibly in conjunction with estrogen, may contribute to a comprehensive etiology for human female non-contact ACL injuries.

Regional changes in the spatio-temporal pattern of progesterone receptor (PR) expression in the guinea-pig genital tract as parturition approaches

Normal parturition in guinea-pig involves changes in responsiveness of the genital tract to estrogen and progesterone. To better characterize endocrine control of guinea-pig parturition, protein and mRNA expression of estrogen receptor-alpha (ERalpha) and progesterone receptor (PR) were quantitatively evaluated in lower (LUS) and upper (UUS) uterine segments, cervix (C) and pubic symphyseal ligament (PSL) at three stages of pregnancy (established based on interpubic distance, 0mm: non-relaxed group, 4-6mm: 5 days before parturition, 11-14 mm: 1-2 days prepartum) and immediately after parturition. Towards parturition, no changes in PR mRNA levels were recorded in the UUS, whereas the LUS displayed a gradual increase. PR transcripts exhibited decreased levels during parturition in C and PSL. Levels of PR mRNA were increased in the LUS compared with that of the UUS only at parturition. Regarding protein expression during parturition, PR levels decreased in the UUS whereas in the LUS increased. In C and PSL, PR protein expression decreased 1-2 days prepartum and remained low during parturition. None of the regions studied showed changes in mRNA or protein expression of ERalpha. Therefore, functional regionalization of the guinea-pig genital tract is associated with changes in the spatio-temporal pattern of PR expression as parturition approaches.

Relaxation of the mouse pubic symphysis during late pregnancy is not accompanied by the influx of granulocytes

In some animals, such as mice and guinea pigs, a hormonally controlled mechanism increases the flexibility of the pubic symphysis and enhances the cervical remodeling necessary for safe delivery. Cervical ripening during pregnancy is associated with a paradoxical influx of leukocytes. However, the changes in cell metabolism during relaxation of the mouse pubic symphysis for delivery have not been extensively studied. In this work, we used light microscopy and transmission and scanning electron microcopy, as well as immunohistochemistry and Western blotting for MMP-8, to investigate the involvement of granulocytes or resident stromal cells in the relaxation of the virgin pubic symphysis during late pregnancy (days 18 and 19, before delivery) in vivo and in explanted joints. MMP-8 was studied because this collagenase is a hallmark for cervical ripening associated with the influx of granulocytes during late pregnancy. Extensive dissolution and disorganization of the extracellular matrix was seen around fibroblastic-like cells in late pregnancy. In contrast to the cervix (positive control), morphological and immunohistochemical analyses revealed that there was no characteristic cellular inflammatory response in the interpubic tissue. Staining for MMP-8 was observed in chondroid and fibroblastic-like cells of virgin and relaxed interpubic ligament, respectively. However, no granulocytes were seen during the extensive remodeling of the pubic joint in late pregnancy. These results indicate that constitutive stromal cells may have an important role in tissue relaxation during remodeling of the pubic symphysis in pregnancy.

The effects of relaxin on extracellular matrix remodeling in health and fibrotic disease

Since its discovery as a reproductive hormone 80 years ago, relaxin has been implicated in a number of pregnancy-related functions involving extracellular matrix (ECM) turnover and collagen degradation. It is now becoming evident that relaxin's ability to reduce matrix synthesis and increase ECM degradation has important implications in several nonreproductive organs, including the heart, lung, kidney, liver and skin. The identification of relaxin and RXFP1 (Relaxin family peptide receptor-1) mRNA and/or binding sites in cells or vessels of these nonreproductive tissues, has confirmed them as targets for relaxin binding and activity. Recent studies on Rln1 and Rxfp1 gene-knockout mice have established relaxin as an important naturally occurring and protective moderator of collagen turnover, leading to improved organ structure and function. Furthermore, through its ability to regulate the ECM and in particular, collagen at multiple levels, relaxin has emerged as a potent anti-fibrotic therapy, with rapid-occurring efficacy. It not only prevents fibrogenesis, but also reduces established scarring (fibrosis), which is a leading cause of organ failure and affects several tissues regardless of etiology. This chapter will summarize these coherent findings as a means of highlighting the significance and therapeutic potential of relaxin.

The characteristics of aromatase deficient hairless mice indicate important roles of extragonadal estrogen in the skin

The roles of extragonadal estrogen in the skin are poorly understood, due to the lack of proper animal models. We examined the skin phenotypes of aromatase-knockout hairless (ArKO) mice and wild-type hairless (WT) mice, both of which were obtained through crossbreeding of Ar+/- mice and hairless mice. Differences in the skins of ArKO and WT mice were compared with those of ovariectomized (OVX) and control (Sham) mice. A difference was observed in the skin tone of ArKO mice, which is pale white and differs from the pinkish tone of all other mice. However, both ArKO and OVX mice similarly exhibited deteriorations of skin properties as compared to their respective controls. Furthermore, all the deteriorations were similarly amplified by chronic UVB irradiation in both ArKO and OVX mice as compared to their respective controls. The unique skin phenotype of ArKO mice was observed in sunburn reactions. Specifically, skins of ArKO mice showed no reaction after an acute UVB irradiation at dose intensities caused sunburn in others. However, follow-up observation found delayed reactions associated with brownish skin color and swelling only in ArKO mice, thereby suggesting that the role of extragonadal estrogen may be connected with the protective reactions of skin.

Anterior cruciate ligament biology and its relationship to injury forces

Anterior cruciate ligament injury is determined by two variables: the ultimate failure load of the ligament and the mechanical load applied to the ligament. All factors that contribute to anterior cruciate ligament injury must do so by affecting one or both of these two basic variables. Some factors, such as sex hormones and tissue remodeling, have a multifaceted effect on the failure load of the anterior cruciate ligament and the magnitude of the load applied to it. The model also illustrates the potentially profound effects that sex hormones and tissue remodeling likely have on female susceptibility to anterior cruciate ligament injuries.

Ovariectomy is sufficient to accelerate spontaneous skin ageing and to stimulate ultraviolet irradiation-induced photoageing of murine skin

BACKGROUND

Wrinkling and sagging of the skin during photoageing is physiologically associated with diminished elasticity, which can be attributed to increased fibroblast-derived elastase activity. This degrades the dermal elastic fibres needed to maintain the three-dimensional structure of the skin. We previously reported that ovariectomy accelerates ultraviolet (UV)B-induced wrinkle formation in rat hind limb skin by altering the three-dimensional structure of elastic fibres.

OBJECTIVES

In this study, we used hairless mice to assess the effects of ovariectomy with or without chronic UVA or UVB radiation on sagging and wrinkling of skin, on the elasticity of skin, as well as on matrix metalloproteinase activities in the skin.

METHODS

Ovariectomies or sham operations were performed on 6-week-old female ICR/HR hairless mice.

RESULTS

Even in the ovariectomy group without UV irradiation, the skin elasticity was significantly decreased during the 3-13 weeks after ovariectomy, which was accompanied by a significant increase in elastase activity in the skin. After UVA or UVB irradiation, skin elasticity was significantly decreased to a greater extent in the ovariectomy group than in the sham operation group, and this was accompanied by a reciprocal increase in elastase activity but not in the activities of collagenases I or IV in the skin. Consistent with the decreased skin elasticity, UVA irradiation for 12 weeks elicited more marked sagging in the ovariectomy group than in the sham operation group. UVB irradiation for 12 weeks also induced more marked wrinkle formation in the ovariectomy group than in the sham operation group.

CONCLUSIONS

These results suggest that ovariectomy alone is sufficient to accelerate skin ageing and to increase UV sensitivity, which results in the further deterioration of the skin and photoageing, and may account for the accelerated skin ageing seen in postmenopausal women.

Relaxin's induction of metalloproteinases is associated with the loss of collagen and glycosaminoglycans in synovial joint fibrocartilaginous explants

Diseases of specific fibrocartilaginous joints are especially common in women of reproductive age, suggesting that female hormones contribute to their etiopathogenesis. Previously, we showed that relaxin dose-dependently induces matrix metalloproteinase (MMP) expression in isolated joint fibrocartilaginous cells. Here we determined the effects of relaxin with or without β-estradiol on the modulation of MMPs in joint fibrocartilaginous explants, and assessed the contribution of these proteinases to the loss of collagen and glycosaminoglycan (GAG) in this tissue. Fibrocartilaginous discs from temporomandibular joints of female rabbits were cultured in medium alone or in medium containing relaxin (0.1 ng/ml) or β-estradiol (20 ng/ml) or relaxin plus β-estradiol. Additional experiments were done in the presence of the MMP inhibitor GM6001 or its control analog. After 48 hours of culture, the medium was assayed for MMPs and the discs were analyzed for collagen and GAG concentrations. Relaxin and β-estradiol plus relaxin induced the MMPs collagenase-1 and stromelysin-1 in fibrocartilaginous explants – a finding similar to that which we observed in pubic symphysis fibrocartilage, but not in articular cartilage explants. The induction of these proteinases by relaxin or β-estradiol plus relaxin was accompanied by a loss of GAGs and collagen in joint fibrocartilage. None of the hormone treatments altered the synthesis of GAGs, suggesting that the loss of this matrix molecule probably resulted from increased matrix degradation. Indeed, fibrocartilaginous explants cultured in the presence of GM6001 showed an inhibition of relaxin-induced and β-estradiol plus relaxin-induced collagenase and stromelysin activities to control baseline levels that were accompanied by the maintenance of collagen or GAG content at control levels. These findings show for the first time that relaxin has degradative effects on non-reproductive synovial joint fibrocartilaginous tissue and provide evidence for a link between relaxin, MMPs, and matrix degradation.

Histochemical and ultrastructural study of collagen fibers in mouse pubic symphysis during late pregnancy

Reference is usually made to the parallel orientation towards the main line of exerted tension at the pubic joint in mice, for supporting forces applied to the joint. Despite the wealth of morphological information about the extracellular matrix in this joint, little is known regarding the involvement of the crimp of collagen fibers in the dramatic transformations occurring in this region during the last 3 days of pregnancy. Examination of the collagenous architecture suggests that the biomechanical properties are directly related to fibril diameters, composition of ground substance and changes in the bundle morphology, particularly in the crimp structure. The purpose of this study was to further describe the transformation of the collagen fibers of the pubic symphysis during late mouse pregnancy. We examined the architecture of collagen fibers in the symphysis and pubic ligament through the Picrosirius-polarization method and also through scanning electron microscopy to directly visualize and measure the crimping from pregnant and virgin mice. The crimp angle and the length of five consecutive crimps were measured according to Patterson-Kane et al. [Connect. Tissue Res. 36 (1997) 253]. It could be demonstrated that the angles progressively decreased and the crimp length increased, denoting that the fibers have untwisted during the relaxation process. Our findings suggest that a disruption of the helical arrangement of the collagen containing fibers may contribute to explaining the rapid remodeling that occurs at the end of pregnancy and that is responsible for an increase in pliancy and length of the pubic ligament in mice.

Guinea-pig interpubic joint (symphysis pubica) relaxation at parturition: underlying cellular processes that resemble an inflammatory response

BACKGROUND

At term, cervical ripening in coordination with uterine contractions becomes a prerequisite for a normal vaginal delivery. Currently, cervical ripening is considered to occur independently from uterine contractions. Many evidences suggest that cervical ripening resembles an inflammatory process. Comparatively little attention has been paid to the increased flexibility of the pelvic symphysis that occurs in many species to enable safe delivery. The aim of this study was to investigate whether the guinea-pig interpubic joint relaxation process observed during late pregnancy and parturition resembles an inflammatory process.

METHODS

Samples of pubic symphysis were taken from pregnant guinea-pigs sacrificed along gestation, parturition and postpartum. Serial sections of paraffin-embedded tissues were used to measure the interpubic distance on digitalized images, stained with Giemsa to quantify leukocyte infiltration and to describe the vascular area changes, or studied by the picrosirius-polarization method to evaluate collagen remodeling. P4 and E2 serum levels were measured by a sequential immunometric assay.

RESULTS

Data showed that the pubic relaxation is associated with an increase in collagen remodeling. In addition, a positive correlation between E2 serum levels and the increase in the interpubic distance was found. On the other hand, a leukocyte infiltration in the interpubic tissue around parturition was described, with the presence of almost all inflammatory cells types. At the same time, histological images show an increase in vascular area (angiogenesis). Eosinophils reached their highest level immediately before parturition; whereas for the neutrophilic and mononuclear infiltration higher values were recorded one day after parturition. Correlation analysis showed that eosinophils and mononuclear cells were positively correlated with E2 levels, but only eosinophilic infiltration was associated with collagen remodeling. Additionally, we observed typical histological images of dissolution of the connective tissue matrix around eosinophils.

CONCLUSION

The present study shows that a timely regulated influx of infiltrating leukocytes is associated with an extensive collagen remodeling process that allows the pubic separation for a normal delivery in guinea-pig. Thus, the findings in this study support the hypothesis that the guinea-pig pubic symphyseal relaxation at parturition resembles an inflammatory process.

Effect of pregnancy on joint contracture in the rat knee

As there is evidence that ligamentous laxity is affected by the female hormones, we hypothesized that hormonal changes occurring during pregnancy could have a therapeutic role in preventing the development of a joint contracture. Knee joint contractures were created in pregnant and nonpregnant rats. After 2 wk of immobilization, the degree of contracture was measured with structural properties of the medial collateral and anterior cruciate ligaments and the pubic symphysis. Although not statistically significant, there was a general trend toward reduced contracture in pregnant compared with nonpregnant rats. Cutting the posterior capsule significantly decreased contracture for both the pregnant and nonpregnant groups, confirming the contribution of capsular structures to contracture. Ultimate loads of the medial collateral and anterior cruciate ligaments significantly decreased after immobilization compared with control, but there was no significant effect due to pregnancy. Stiffness and ultimate load of the pubic symphysis were not significantly different between pregnant and nonpregnant groups. The trend toward reduced contracture with pregnancy points toward a possible therapeutic role for female hormones in the prevention of postoperative and/or posttraumatic joint contracture.

Reproductive hormones and stress urinary incontinence in pregnancy

BACKGROUND

The cause of transient stress urinary incontinence during pregnancy remains uncertain. Anatomical change, such as a pressure effect of the enlarged uterus, changes in renal function, and alterations in bladder and urethral function have been proposed. There is little information about the role of reproductive hormones in stress urinary incontinence with onset during pregnancy.

METHODS

In a prospective, longitudinal, observational cohort study 200 consecutive women attending in early pregnancy were observed by repeated measurements of stress urinary incontinence, its possible determinants as well as serum concentrations of progesterone, estradiol and relaxin.

RESULTS

The prevalence rate of stress urinary incontinence increased to a stable level of about 25% from mid-pregnancy and increased with parity. A higher serum relaxin value early in pregnancy was correlated to a lower prevalence rate of stress urinary incontinence with onset during pregnancy, also when the influence of potentially important factors was taken into account in a multivariate analysis. No significant difference was shown regarding serum concentrations of estrogen or progesterone, maternal age, weight gain, time since last delivery or smoking, although this can be due to a small sample size.

CONCLUSION

The reproductive hormone relaxin might have a role in maintaining urinary continence during pregnancy. A mechanism is uncertain.

Sex hormones and knee ligament injuries in female athletes

Female athletes tear their anterior cruciate ligaments (ACLs) more frequently than male athletes participating in similar athletic events do. The reasons for this discrepancy are not known. Many possible causative factors, such as size, strength, anatomic, social, and hormonal differences, have been suggested. The possible involvement of normal tissue remodeling events in susceptibility to ACL injury has not been thoroughly examined. We are characterizing gender differences in matrix metalloproteinases and their inhibitors. Results of these studies are summarized and discussed in the context of tissue remodeling in general, with an emphasis on the cell biology of ACL repair.

Relaxin increases secretion of matrix metalloproteinase-2 and matrix metalloproteinase-9 during uterine and cervical growth and remodeling in the pig

Matrix metalloproteinases are proteolytic enzymes that degrade the extracellular matrix and are essential for tissue remodeling. Uterine and cervical growth require remodeling of structural barriers to cell invasion and matrix metalloproteinase-2 and -9 degrade type IV collagen, the major component of basement membranes. Relaxin stimulates uterine and cervical growth and remodeling, which includes remodeling of support elements such as basement membranes. The objective of this study was to determine whether relaxin alters the production and/or activity of matrix metalloproteinase-2 and -9 in the uterus or cervix of the pig. The growth-promoting effects of relaxin were elicited by administering relaxin to prepubertal gilts every 6 h for 54 h. The expression of matrix metalloproteinase-2 and matrix metalloproteinase-9 was characterized by gel zymography, and proteins were quantified by immunoblotting. Total enzyme activity was measured using matrix metalloproteinase-specific fluorescent substrate assays. In both uterine and cervical tissues, immunoreactive matrix metalloproteinase-2 and matrix metalloproteinase-9 protein expression was similar in relaxin-treated and control animals. However, tissue-associated gelatinase activity was attenuated by relaxin (P < 0.05). In contrast, relaxin significantly increased the secretion of active matrix metalloproteinase-2 and -9 protein into uterine fluid (P < 0.05). Given the importance of matrix metalloproteinases in extracellular matrix degradation, the observation that relaxin promotes uterine secretion of matrix metalloproteinase-2 and -9 supports the concept that relaxin facilitates the growth and remodeling of reproductive tissues by increasing extracellular proteolysis in the pig reproductive tract.

Expression of matrix metalloprotease and tissue inhibitor of metalloprotease genes in human anterior cruciate ligament

Women are more susceptible to anterior cruciate ligament (ACL) injuries than men performing similar athletic activities. Because tissue remodeling may affect ligament strength, we assessed expression of tissue remodeling effector genes in the human ACL. Specifically, we surveyed ACL for RNAs encoding all known matrix metalloproteases (MMPs) and tissue inhibitors of metalloproteases (TIMPs) by reverse transcription/polymerase chain reaction (RT-PCR). These experiments revealed that mRNAs encoding nine of sixteen MMPs and all four TIMPs are present in the normal ACL. The nine expressed proteases were MMPs 1-3, 7, 9, 11, 14, and 17 (collagenase 1, gelatinase A, stromelysin 1, matrilysin, gelatinase B, stromelysin 3, and membrane types 1 and 4, respectively), and MMP-18. Genes for MMPs 8, 10, 12, 13, 15, and 16 appeared not to be expressed in ACL, as their mRNAs were not detected using RT-PCR conditions that did yield positive signals from other tissues (testis or bone). We conclude that numerous genes encoding tissue remodeling effector proteins are expressedin the human ACL.

Ovariectomy Accelerates Photoaging of Rat Skin¶

We have previously reported the formation of wrinkles, a decrease in skin elasticity and a loss in the linearity of dermal elastic fibers in rat hind limb skin irradiated with ultraviolet radiation in wavelength ranging 290-320 nm (UVB) at a suberythemal dose for 6 weeks. Estrogens are considered effective in preventing photoaging in postmenopausal females, but the role of estrogen in the skin remains unclear. In this study we have evaluated the influence of short-term chronic UVB irradiation at a suberythemal dose on the skin of ovariectomized rats. An ovariectomy or a sham operation was performed on each 3 week-old female Sprague-Dawley rat. Starting 1 week after the operation the hind limb skin of each rat was irradiated with UVB at a suberythemal dose (130 mJ/cm2) three times a week for 3 or 6 weeks. Decreases in elasticity and wrinkle formation in the skins of ovariectomized animals were induced more quickly than in the skins of sham-operated animals following UVB irradiation. The linearity of elastic fibers in the ovariectomy group decreased significantly compared with the sham-operation group, but erythema in the ovariectomy group was induced more readily than in the sham-operation group following UVB irradiation. These findings suggest that decreases in the estrogen levels after ovariectomy accelerate photoaging in terms of the morphology and physical properties of the skin surface and the three-dimensional structure of elastic fibers.

Self-reported oral contraceptive use and peripheral joint laxity

STUDY DESIGN

A masked, single-factor, posttest-only control group design.

OBJECTIVE

To explore the relationship between reported oral contraceptive use and peripheral joint laxity.

BACKGROUND

Studies have found an association between increased ligamentous laxity and changes in serum levels of hormones such as estrogen, progesterone, and relaxin. Two of these hormones, estrogen and progesterone, are present in most oral contraceptives. Oral contraceptive users, therefore, provide a population for studying the effects of these hormones on the degree of ligamentous laxity.

METHODS AND MEASURES

Fifty-five women between the ages of 20 and 25 years participated in this study. Thirty users of oral contraceptives were a test group and 25 nonusers of oral contraceptives were controls. The KT-1000 Arthrometer was used to measure passive anterior translation of the tibia in relation to the femur in both knees. Passive abduction and adduction of the proximal interphalangeal (PIP) joint of the second digit of the nondominant hand and distal interphalangeal (DIP) joint hyperextension of the fifth digit of the nondominant hand were measured using a goniometer. A subjective measurement of passive second PIP joint motion was also assessed and a value of minimum, moderate, or maximum laxity was assigned. Independent sample t tests were performed to compare the measurements of the oral contraceptive user and nonuser groups for each joint. A chi-square test compared the subjective PIP joint data between the 2 groups.

RESULTS

No significant differences in laxity measurements at the knee or hand were found between the 2 groups. Average knee laxity varied between 5.7-7.9 mm of anterior displacement for both groups. Average PIP abduction and adduction varied between 6.5-6.7 degrees for both groups and DIP hyperextension was 28.6-29.9 degrees.

CONCLUSIONS

Results of this study indicate that self-reported oral contraceptive use was not associated with peripheral joint laxity.

Estrogen level alters the failure load of the rabbit anterior cruciate ligament

We hypothesized that increasing the level of circulating serum estrogen would decrease the load at failure for the rabbit anterior cruciate ligament. We developed an animal model in which hormonal manipulations could be correlated with load at failure for the anterior cruciate ligament. Sixteen New Zealand White ovariectomized rabbits were matched and divided into two groups. The eight rabbits that were not treated with the estrogen supplement (Group O) and the eight that were treated with the supplement (Group E) were housed for 30 days. Serum estrogen levels were measured. The knees were stripped of all soft tissue, and the load at failure for the anterior cruciate ligament was measured in a materials testing machine with a displacement rate of 0.5 mm/sec. The load at failure for all 16 specimens in Group E (446 +/- 54 N) (mean +/- SD) was significantly reduced (p = 0.02) compared with that for the nine specimens in Group O (503 +/- 48 N). It is recognized that an increased number of anterior cruciate ligament injuries occurs in female athletes. Although the mechanism responsible for failure of the anterior cruciate ligament in women is yet to be defined, this experiment suggests that estrogen may alter ligament strength.

Reproductive hormones and aminoterminal propeptide of type III procollagen in serum as early markers of pelvic pain during late pregnancy

OBJECTIVE

The object was to study serum concentrations of reproductive hormones and aminoterminal propeptide of type III procollagen in early pregnancy as markers of pelvic pain (sacral pain or symphyseal pain) during later pregnancy.

STUDY DESIGN

A prospective, clinical cohort study was performed, with repeated examinations of 200 women.

RESULTS

Serum concentrations of relaxin and serum concentrations of propeptide of type III procollagen (a collagen turnover marker) measured in early pregnancy were significantly correlated with pelvic pain with onset during pregnancy and reported in late pregnancy (positively and negatively, respectively). In a multivariate analysis, relaxin and propeptide of type III procollagen concentrations remained independently and significantly correlated with pelvic pain.

CONCLUSION

Serum concentrations of relaxin and propeptide of type III procollagen measured in early pregnancy may reflect the cause of and indicate an increased risk of pelvic pain (back pain or symphyseal pain) during late pregnancy. The mechanism is unclear.

The effect of chorion-uterine interaction upon free progesterone metabolism during advanced gestation in the guinea pig

The in vitro fate of [3H]progesterone was studied after incubation with guinea pig tissues at 58/59 days (before pubic symphysis relaxation) and in the final week (post relaxation) of gestation. Buffered steroid was added to the fetal surface of chorion attached to the uterus or to the uterus alone. Neither the amount of recovered progesterone nor its metabolites (6.2% average conversion) differed between the two stages when only uterus was incubated. With chorion present, conversion averaged 28.3% at 58/59 days and 63.4% at the late stage. A 4.6-fold decrease in progesterone concentration, and 3.0-, 2.4- and 3.1-fold increases in the concentrations of 3alpha-hydroxy-5alpha-pregnan-20-one, 3beta-hydroxy-5alpha-pregnan-20-one and 5alpha-pregnane-3,20-dione, respectively, were found in the uterus in the late stage vs 58/59 days. Also, 2.8- and 6.4-fold decreases in progesterone concentration occurred in the myometrium and endometrium, respectively, from 58/59 days to the late stage. In endometrium, the concentrations of the 3alpha- and 3beta-isomers, and 5alpha-pregnane-3,20-dione, increased 2.6-, 2.6- and 5.0-fold, respectively. The above changes were all significant at P < 0.05 or better. Changes in the 3alpha-, 3beta- isomers and dione in the myometrium were not significant. The chorion-uterine interaction and gestation time thus affect the degree of progesterone conversion, and the amounts of metabolites reaching the uterus in the chorion-uterine in vitro system.

Serum relaxin, symphyseal pain, and back pain during pregnancy

OBJECTIVE

Our purpose was to study the relationship between serum relaxin levels and back pain during pregnancy.

STUDY DESIGN

A prospective clinical cohort study with repeated examinations was performed.

RESULTS

There was an initial increase of relaxin levels until a peak value at the twelfth week followed by a decline until the seventeenth week. Thereafter stable serum levels around 50% of the peak value were recorded. Three months after delivery serum relaxin was not detectable. There was a significant correlation between mean serum relaxin levels during the pregnancy and symphyseal pain or low back pain occurring during late pregnancy as measured by medical history or pain-provoking test.

CONCLUSION

Relaxin is known to remodel pelvic connective tissue in several mammalian species during pregnancy. The current data suggest that relaxin might be involved in the development of pelvic pain in pregnant women.

Inhibition of relaxin-induced pubic symphyseal "relaxation" in guinea pigs by glycosaminoglycan polysulfates and pentosan polysulfate

There are similarities between the actions of estrogen and relaxin on the connective tissues of the pubic symphysis and those of neutral proteases on cartilage in osteoarthritis, including cartilage hydration, proteoglycan loss, and dissolution of collagen fibers. We hypothesized that compounds known to inhibit cartilage breakdown in animal models of osteoarthritis, such as polysulfated GAGs, would also antagonize the actions of estrogen and relaxin that increase the laxity and mobility of the pubic symphyses of guinea pigs. Estrogen-primed guinea pigs were injected with relaxin or with relaxin and the test compound. The pubic symphyses were manually palpated 6 h later and the degree of mobility scored. Glycosaminoglycan polysulfates and pentosan polysulfate inhibited relaxin-induced pubic symphyseal relaxation, whereas other types of agents were without effect. The guinea pig pubic symphysis assay for relaxin may thus provide a novel rapid screening test for compounds with potential chondroprotective activity.

Effect of relaxin on the phenotype of collagens synthesized by cultured rabbit chondrocytes

The effect of porcine relaxin on rabbit articular and growth plate chondrocytes in primary culture was investigated by measurement of total collagen production and analysis of the phenotypes of newly synthesized collagen chains. A 24-h treatment of monolayer articular and multilayer growth plate chondrocytes with 2 micrograms per ml relaxin had no effect on total DNA and did not significantly modify the amount of [3H]proline-labelled collagen chains secreted by the cells. However, polyacrylamide gel electrophoresis demonstrated relevant modifications in relaxin treated chondrocytes. A significant increase was observed in the proportion of type III collagen and in the intensity of the band corresponding to alpha 2I chains. Two-dimensional peptide mapping of CNBr-cleaved molecules indicated that the band that was identified as alpha 1II on monodimensional gels contained a significant proportion of alpha 1I collagen chains, as demonstrated by the presence of alpha 1I cyanogen bromide-digested peptides. The intensity of this band was increased by relaxin treatment. Furthermore, total RNA analysis by slot blot and Northern blot techniques showed a dose-dependent stimulation of alpha 1I and alpha 1III mRNA levels after incubation with increased relaxin concentrations, but no change in the amount of alpha 1II mRNA. These results suggested that when added to cartilage cells in vitro, relaxin modulated the expression of type I, type II and type III collagen genes by amplifying the dedifferentiation process.

Bone resorption of the pubis and preauricular area in humans and nonhuman mammals

Some innominates of adult human females show areas of bone resorption on the dorsal aspect of the pubic corpus and preauricular area of the ilium. For both sites, many studies have shown a positive association between degree of resorption and parity. The present study tested hypotheses concerning resorption of the pubis and preauricular area. Samples of innominates from three prehistoric Amerindian populations were used. Within each population, only a minority of females, in general, showed resorption more severe than that which characterized males. The severity of resorption of the pubis was not significantly associated with that of the preauricular area. Pitting of the pubis, but not of the preauricular area, was significantly correlated with age-at-death in each sample of Amerindian females. Also, sacral angulation was not significantly associated with resorption of the preauricular area. Observations on resorption of the pubis and preauricular area in samples of Pan troglodytes and Gorilla gorilla are reported. In previous studies on resorption of the pubis and preauricular area in the human innominate, the proposed etiologies involve ligamentous hyperplasia and joint trauma. However, a number of studies on resorption of the pubis in the nonhuman mammalian innominate have been overlooked by anthropologists. These latter studies demonstrate that estrogen alone can induce resorption of the mammalian pubis by stimulating the synthesis of osteoclastic enzymes. Partial resorption of the pubis may be obstetrically advantageous in some mammals, as resorption would delay or inhibit synostosis of the interpubic joint. The relationship between estrogen and the preauricular area is an issue that requires further research.

Collagenase production by rabbit ligaments and tendon

Three periarticular connective tissues from normal rabbits were examined for collagenolytic activity. Enzyme activity was secreted by cultures of anterior cruciate ligament (ACL), medial collateral ligament (MCL) and patellar tendon (PT). A lag period of six days or more was often observed prior to the detection of active collagenase. We attributed this to the presence of an excess of inhibitor in the early days of culture. We quantitated the amount of enzyme and inhibitor produced in 13 days. The levels of collagenase in the ACL and MCL were comparable. The PT, however, consistently secreted more enzyme than the two periarticular (ACL and MCL) ligaments. The reaction products were analyzed for all three collagenases and compared to those generated by the rabbit skin enzyme. We observed the characteristic TCA and TCB collagen fragments for MCL and PT enzymes. Collagen cleavage by the ACL cultures resulted in a product with a molecular weight intermediate between the alpha 2 chain and the TCA piece. These data suggest that quantitative and qualitative differences exist in the ability of these similar connective tissues to degrade collagen.

The influence of steroid hormones on the uterine cervix during pregnancy

This paper reviews the evidence concerning the actions of steroid hormones on the connective tissues of the pelvis. Most available data concern the effects of steroids on the cervix. The time course of cervical softening in rats, sheep and humans suggests the possibility that the changes in connective tissue biochemistry that underlie the physiological phenomenon of cervical softening are under hormonal control. Both oestrogens and progestogens have been implicated in the control of cervical softening. However, recent experiments using inhibitors of 3 beta-hydroxysteroid dehydrogenase suggest that cervical softening can be produced in both sheep and humans by progesterone withdrawal in the absence of high circulating concentrations of oestradiol-17 beta.

Biological significance of interstitial collagenase in DMBA-induced mammary tumors of the rat

In this review the production of interstitial collagenase in DMBA-induced mammary tumors of the rat has been examined. Cell sorting and cell cultures have given us the opportunity to relate the release of collagenase to a specific cell type. By means of FITC-fluorescence and monospecific antibodies (S. Sakamoto, Harvard University, Boston) it was further possible to localize collagenase in vitro and in vivo. The most outstanding characteristic is that collagenase is produced both by cuboidal, epithelial cell and by macrophages in vitro but not by myoepithelial-like cells. On the other hand, synthesis of collagenase in vivo was detected in some stromal cells, possibly macrophages, but not in neoplastic cuboidal cells. This observation has been related to the inability of cuboidal cells to interact with stromal, fibrillar collagen in vivo since tumor cells are arranged in glandular-like structures bordered by myoepithelial cells and a basement membrane. In vitro, fibrillar rat tail tendon collagen was found to be a potent stimulator of collagenase production by cuboidal cells. Collagenase stimulation by interstitial collagen therefore suggests a plausible mechanism for the degradation of collagen fibrils during local invasion by mammary tumor cells.

What controls collagen resorption in vivo?

The local control of collagen degradation in mammals in vivo is currently considered to depend primarily on variations on the level of activity of specific collagenases. Such variations are believed to depend on three factors: a) the rate of active collagenase synthesis and/or of activation of inactive enzyme precursors; b) the action of serum and/or tissue collagenase inhibitors; and c) different combinations of both mechanisms. We suggest that another element contributing to the regulation of collagen degradation in vivo is the susceptibility of the substrate. Support for this suggestion is derived from two sources: 1) experimental data, indicating that the rate of collagen degradation depends on the genetic type of substrate, on its state of aggregation (including degree of cross-linking), and on the nature and amount of other macromolecules associated with collagen in vivo. Other experimental findings supporting our hypothesis are the universal presence of collagen-bound collagenase, the apparent greater affinity of the enzyme for the more recently synthetized substrate molecules, and the increased amounts of intact collagen that may be solubilized from some tissues undergoing massive collagen degradation, 2) analogy with currently accepted views on intracellular protein catabolism, which cannot be rejected a priori as irrelevant to the problem.

The occurrence of uterine stromal and intraepithelial monocytes and heterophils during normal late pregnancy in the rat

The steady decline in plasma progesterone level that occurs during the last week of pregnancy in the normal rat (Wiest, '70) provides good opportunity to study the effect of withdrawal of progesterone on uterine differentiation. Evidence is presented that tissue monocytes, heterophils, and eosinophils are regular components of the normal late gestational uterus and that their number increases as term approaches. Uterine monocytes and heterophils are located in the endometrial and myometrial stroma as well as within the basal intercellular compartment of the luminal epithelium. Stromal monocytes are distributed throughout the attenuated endometrium of late gestation, but are more common immediately beneath the luminal epithelium. In the myometrium, monocytes and heterophils occur, often as perivascular, clusters in the connective tissue septum that separates the two layers of smooth muscle. Eosinophils are present especially in the deep endometrial and myometrial stroma, and increase in number as plasma estrogen rises immediately before parturition. A small population of lymphocytes is regularly present. An important feature of the prepartum uterine stroma is the sparseness of macrophages. Near term, however, the beginnings of monocytic-macrophagic transformation are noticeable as the cell surface becomes more irregular and organelles associated with endocytic activity arise. The prepartum monocytes are positioned in the same histological sites that during the postpartum period of regression will be occupied by macrophages (Padykula and Campbell, '76). Since it is generally accepted that monocytes are precursors of macrophages, this spatial correlation raises the possibility that cellular preparations for regression commence before birth. The possible significance of prepartum monocytic infiltration is discussed in relation to the effect of changing plasma and uterine concentrations of progesterone on uterine collagenase activity. The steady increase in uterine leucocytes which occurs concomitantly with decreasing uterine binding capacity for progesterone supports the hypothesis by Siiteri et al. ('77) that progesterone in high local concentrations has an anti-inflammatory effect.