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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 Appl Bio Mater 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ruiz-Zapata AM, Heinz A, Kerkhof MH, van de Westerlo-van Rijt C, Schmelzer CEH, Stoop R, Kluivers KB, Oosterwijk E. Extracellular Matrix Stiffness and Composition Regulate the Myofibroblast Differentiation of Vaginal Fibroblasts. Int J Mol Sci 2020; 21:ijms21134762. [PMID: 32635512 PMCID: PMC7369731 DOI: 10.3390/ijms21134762] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 06/29/2020] [Accepted: 06/30/2020] [Indexed: 12/26/2022] Open
Abstract
Fibroblast to myofibroblast differentiation is a key feature of wound-healing in soft tissues, including the vagina. Vaginal fibroblasts maintain the integrity of the vaginal wall tissues, essential to keep pelvic organs in place and avoid pelvic organ prolapse (POP). The micro-environment of vaginal tissues in POP patients is stiffer and has different extracellular matrix (ECM) composition than healthy vaginal tissues. In this study, we employed a series of matrices with known stiffnesses, as well as vaginal ECMs, in combination with vaginal fibroblasts from POP and healthy tissues to investigate how matrix stiffness and composition regulate myofibroblast differentiation in vaginal fibroblasts. Stiffness was positively correlated to production of α-smooth muscle actin (α-SMA). Vaginal ECMs induced myofibroblast differentiation as both α-SMA and collagen gene expressions were increased. This differentiation was more pronounced in cells seeded on POP-ECMs that were stiffer than those derived from healthy tissues and had higher collagen and elastin protein content. We showed that stiffness and ECM content regulate vaginal myofibroblast differentiation. We provide preliminary evidence that vaginal fibroblasts might recognize POP-ECMs as scar tissues that need to be remodeled. This is fundamentally important for tissue repair, and provides a rational basis for POP disease modelling and therapeutic innovations in vaginal reconstruction.
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Affiliation(s)
- Alejandra M. Ruiz-Zapata
- Department of Obstetrics and Gynecology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.v.d.W.-v.R.); (K.B.K.)
- Correspondence:
| | - Andrea Heinz
- Department of Pharmacy, LEO Foundation Center for Cutaneous Drug Delivery, University of Copenhagen, 2100 Copenhagen, Denmark;
| | - Manon H. Kerkhof
- Curilion, Women’s Health Centre, 2015 BJ Haarlem, The Netherlands;
| | - Cindy van de Westerlo-van Rijt
- Department of Obstetrics and Gynecology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.v.d.W.-v.R.); (K.B.K.)
| | - Christian E. H. Schmelzer
- Department of Biological and Macromolecular Materials, Fraunhofer Institute for Microstructure Materials and Systems IMWS, 06120 Halle (Saale), Germany;
| | - Reinout Stoop
- TNO Metabolic Health Research, 2301 DA Leiden, The Netherlands;
| | - Kirsten B. Kluivers
- Department of Obstetrics and Gynecology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (C.v.d.W.-v.R.); (K.B.K.)
| | - Egbert Oosterwijk
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
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Ruiz-Zapata AM, Kerkhof MH, Zandieh-Doulabi B, Brölmann HAM, Smit TH, Helder MN. Functional characteristics of vaginal fibroblastic cells from premenopausal women with pelvic organ prolapse. Mol Hum Reprod 2014; 20:1135-43. [PMID: 25189765 DOI: 10.1093/molehr/gau078] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pelvic organ prolapse (POP) remains a great therapeutic challenge with no optimal treatment available. Tissue maintenance and remodelling are performed by fibroblasts, therefore altered cellular functionality may influence tissue quality. In this study, we evaluated functional characteristics of fibroblastic cells from tissues involved in POP. To rule out normal ageing tissue degeneration, biopsies from 18 premenopausal women were collected from the precervical region (non-POP site) after hysterectomy of 8 healthy and 10 POP cystocele cases (POP-Q stage ≥ II). Extra tissues from the prolapsed sites were taken in the POP cases to distinguish between intrinsic and acquired cellular defects. Twenty-eight primary fibroblastic cultures were studied in vitro. A contractility assay was used to test fibroblast-mediated collagen contraction. Cellular mechanoresponses on collagen-coated or uncoated substrates were evaluated by measuring matrix remodelling factors at protein or gene expression levels. No differences were found between fibroblasts from the controls and the non-POP site of the case group. Fibroblastic cells from the prolapsed site showed delayed fibroblast-mediated collagen contraction and lower production of matrix metalloproteinase-2 (MMP-2) on collagen-coated plates. On uncoated surfaces the gene MMP-2 and its tissue inhibitor of metalloproteinases-2 were up-regulated in POP site fibroblastic cells. In conclusion, fibroblastic cells derived from prolapsed tissues of patients with cystocele, display altered in vitro functional characteristics depending on the surface substrate and compared with non-prolapsed site. This implies an acquired rather than an intrinsic defect for most patients with cystocele, and should be taken into account when trying to improve treatments for POP.
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Affiliation(s)
- Alejandra M Ruiz-Zapata
- Department of Orthopedic Surgery, VU University Medical Center, Research Institute MOVE, Amsterdam 1007MB, The Netherlands
| | - Manon H Kerkhof
- Department of Obstetrics & Gynaecology, VU University Medical Center, Amsterdam 1007MB, The Netherlands
| | - Behrouz Zandieh-Doulabi
- Department of Oral Cell Biology, ACTA - University of Amsterdam and VU University, Research Institute MOVE, Amsterdam 1081LA, The Netherlands
| | - Hans A M Brölmann
- Department of Obstetrics & Gynaecology, VU University Medical Center, Amsterdam 1007MB, The Netherlands
| | - Theo H Smit
- Department of Orthopedic Surgery, VU University Medical Center, Research Institute MOVE, Amsterdam 1007MB, The Netherlands
| | - Marco N Helder
- Department of Orthopedic Surgery, VU University Medical Center, Research Institute MOVE, Amsterdam 1007MB, The Netherlands
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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: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Zong W, Jallah ZC, Stein SE, Abramowitch SD, Moalli PA. Repetitive mechanical stretch increases extracellular collagenase activity in vaginal fibroblasts. Female Pelvic Med Reconstr Surg 2010; 16:257-262. [PMID: 21603077 PMCID: PMC3097414 DOI: 10.1097/spv.0b013e3181ed30d2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES: The objectives were 1) to determine whether human vaginal fibroblasts are mechanosensitive and 2) to study the impact of mechanical stretch on these cells in the presence and absence of hormones. METHODS: Fibroblasts obtained from biopsies of full thickness vagina of 3 women were cyclically biaxially stretched at a magnitude of 8 and 16% for 72 hours with or without 17-β-estradiol plus progesterone. Culture media was collected and total collagenase activity was measured in duplicate using a fluorogenic substrate degradation assay. Data were analyzed at the 0.05 level of significance using Student t-test. RESULTS: Cells remained 90% viable throughout the experiments. Relative to the controls, hormonal treatment alone decreased collagenase activity (P=0.008). In the presence of mechanical stretch and in the absence of hormones, collagenase activity was increased (8% elongation, P=0.04; 16% elongation, P=0.001, respectively). The increase in collagenase activity was linearly correlated with magnitude (P<0.001). In the presence of hormones, the increase in enzyme activity by mechanical stretch was suppressed to baseline control levels (P=0.46). There was no difference in suppression by hormones by magnitude (P=0.48). CONCLUSIONS: Vaginal connective tissue fibroblasts are mechanosensitive with increased collagenase activity in the presence of stretch. This degradative behavior is inhibited in the presence of hormones. The data provide a mechanism by which events that induce vaginal stretch may lead to progression of pelvic organ prolapse, particularly, in the absence of hormones. Further studies are needed to determine whether these events lead to tissue with inferior mechanical properties.
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Affiliation(s)
- Wenjun Zong
- Department of Obstetrics & Gynecology and Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery and Magee-Womens Research Institute
| | - Zegbeh C Jallah
- Musculoskeletal Research Center and Department of Bioengineering. University of Pittsburgh, Pittsburgh, PA, 15213
| | - Suzan E Stein
- Department of Obstetrics & Gynecology and Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery and Magee-Womens Research Institute
| | - Steven D. Abramowitch
- Musculoskeletal Research Center and Department of Bioengineering. University of Pittsburgh, Pittsburgh, PA, 15213
| | - Pamela A Moalli
- Department of Obstetrics & Gynecology and Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery and Magee-Womens Research Institute
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