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Neimark AI, Yakovleva AY, Lapii GA. [Outcomes of ER:YAG LASER treatment of stress urinary incontinence in women]. Urologiia 2018:20-25. [PMID: 29901290] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM To evaluate the effectiveness of a new method of treatment for stress urinary incontinence in women using an ER: YAG laser in SMOOTH mode and investigate pathophysiological and pathomorphological changes induced by erbium laser. MATERIALS AND METHODS This study comprised 98 women aged 37-63 years, who between 2014 and 2016 were diagnosed with SUI (type 1 and 2a, 2b) and grade 0-2 vaginal prolapse. The treatment was performed with a 2940 nm Er:YAG laser (Fotona, Slovenia) using a SMOOTH mode. Clinical assessment included PFIQ-7 and PISQ-12 questionnaires, uroflowmetry, laser Doppler flowmetry and biopsy of the anterior vaginal wall. The examination was carried out at baseline and 1-2 months after the treatment. RESULTS The effectiveness of treatment was 73%. There was no deterioration after the procedure. Analysis of PFIQ-7 and PISQ-12 questionnaires showed that patients with mild incontinence had the greatest difference between pre- and posttreatment results. Uroflowmetry parameters improved in a majority of patients. Results of laser Doppler flowmetry demonstrated the improvement of blood flow in the microvascular bed. An important feature of the vaginal biopsy after laser exposure was an increase in neoangiogenesis. DISCUSSION The findings of questionnaires and clinical evaluation of patients with SUI and vaginal prolapse before and after treatment with Er: YAG laser showed high therapeutic effectiveness of this treatment modality. CONCLUSION Clinical effectiveness of ER: YAG laser in SMOOTH mode was 73%. Patients with type 1 and 2a SUI and mild or moderate incontinence have the best prognosis after treatment with this method.
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Affiliation(s)
- A I Neimark
- Altai State Medical University of Minzdrav of Russia, Barnaul, Russia
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
| | - A Yu Yakovleva
- Altai State Medical University of Minzdrav of Russia, Barnaul, Russia
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
| | - G A Lapii
- Altai State Medical University of Minzdrav of Russia, Barnaul, Russia
- Institute of Molecular Pathology and Pathomorphology, Novosibirsk, Russia
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Verheul HAM, Blok LJ, Burger CW, Hanifi-Moghaddam P, Kloosterboer HJ. Levels of Tibolone and Estradiol and their Nonsulfated and Sulfated Metabolites in Serum, Myometrium, and Vagina of Postmenopausal Women Following Treatment for 21 Days With Tibolone, Estradiol, or Estradiol Plus Medroxyprogestrone Acetate. Reprod Sci 2016; 14:160-8. [PMID: 17636227 DOI: 10.1177/1933719106298684] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tibolone has estrogenic effects on the vagina but not on the uterus. To explain this, levels of tibolone and estradiol and their metabolites were determined in serum, myometrium, and vagina. Thirty-four postmenopausal women with uterine prolapse received either no treatment, tibolone, E(2) or E(2) + medroxyprogesterone acetate (MPA) for 21 days, or a single dose of tibolone. Twenty +/- 6 hours after administration, >98% of the 3-hydroxytibolone metabolites in serum and tissues were disulfated. Of the unconjugated metabolites, the estrogenic 3alpha-hydroxytibolone predominated in serum, whereas the progestagenic/ androgenic Delta(4)-tibolone predominated in myometrium and vagina. Levels of disulfated metabolites in serum and tissues were higher (3- to 5-fold) after multiple dosing than after a single dose. Tissue:serum ratios were <1, except for Delta(4)-tibolone. In all groups, E(2) tissue levels were higher than serum levels; the percentage of serum E(1)S was >90%. Tibolone did not affect endogenous E(1), E(2), or E(1)S levels in serum, but in myometrium and vagina, E(1) levels were significantly higher and E(1)S levels tended to be lower than in controls. Serum and tissue levels of endogenous and exogenous E(1), E(2), and E(1)S were markedly increased 20 hours after E(2) or E(2) + MPA; the percentage of E(1)S and tissue:serum ratios were not affected. MPA had no effect on the degree of sulfation of E(1). Compared with serum, tissue levels of E(2) were high in all groups; absolute E(2) levels in control and tibolone groups were much lower than in the E(2) groups. Tibolone metabolite patterns are different in serum, myometrium, and vagina.
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Dai YX, Lang JH, Zhu L, Liu ZF, Pan LY, Sun DW. [Microarray analysis of gene expression profiles in pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi 2010; 45:342-347. [PMID: 20646442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify the differentially expressed genes in cardinal ligament between patients with pelvic organ prolapse (POP) and postmenopausal women without POP by Human Genome Expression Chip and explore the potential molecular mechanism involved in POP. METHODS From January to May, 2007, cardinal ligament samples were obtained from 3 postmenopausal patients with POP-Q stage III and 3 postmenopausal patients underwent hysterectomy due to other benign gynecologic diseases without POP in Peking Union Medical College Hospital. HE and Masson's trichrome staining was used to verify tissue origin and inspect histological changes. Those differentially expressed genes in cardinal ligaments were identified by Human Genome Chip and further interrogated with Gene Ontology (GO) and Pathway Analysis. Those remarkable expressed genes were confirmed by qRT-PCR. RESULTS Alterations of ligament architecture in POP patients included disarrangement and collapse of smooth muscle bundles and collagen fibers. A total of 179 differentially expressed genes were screened between POP and non-POP cardinal ligament tissue, including 20 functional unknown genes. A total of 107 genes were upregulated in POP group, while 72 genes downregulated. Those differentially genes were revealed associated with multiple functional proteins and metabolic pathways by biological analysis. Among these, Wnt signaling pathway exhibited the most remarkable changes. Real-time quantitative PCR showed the genes of COL1A1, DKK1, SFRP1, FZD5, WNT16b in POP group (2.98+/-1.40, 3.03+/-0.48, 8.13+/-4.42, 5.19+/-3.50, 12.40+/-3.88) were upregulated significantly compared with non-POP group (1.09+/-0.08, 1.20+/-0.18, 0.41+/-0.51, 0.87+/-0.24, 1.40+/-0.47; P<0.05). CONCLUSIONS The pathophysiology of POP is complex and associated with multiple functional proteins and metabolic pathways. Among these, the antagonist DKK1, SFRP1 in Wnt signaling pathway may contribute to a neurodegenerative role in POP development.
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Affiliation(s)
- Yu-xin Dai
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
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Zong W, Meyn LA, Moalli PA. The amount and activity of active matrix metalloproteinase 13 is suppressed by estradiol and progesterone in human pelvic floor fibroblasts. Biol Reprod 2009; 80:367-74. [PMID: 18987329 PMCID: PMC2804822 DOI: 10.1095/biolreprod.108.072462] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 08/01/2008] [Revised: 08/25/2008] [Accepted: 10/17/2008] [Indexed: 11/01/2022] Open
Abstract
As a key degrader of fibrillar collagens, matrix metalloproteinase 13 (MMP13), may contribute to the progression of pelvic organ prolapse. Here we aimed to define the regulation of MMP13 by estradiol and progesterone in the vaginal supportive tissues. Fibroblasts cultured from the arcus tendineous fasciae pelvis of three pre- and three postmenopausal women with prolapse were treated with 17-beta-estradiol (E2), progesterone (P4), E2 + P4, or E2 + ICI 182,780 (ICI). Collagenase inhibitor I (CI) and MG-132 were employed to investigate the mechanism of MMP13 degradation into inactive fragments (fragmentation) by hormones. The regulation of MMP13 in vivo was assessed by comparing tissues of ovariectomized (ovx) vs. sham-operated rats. Expression of MMP13 (proenzyme and active and fragment forms) was quantitated by Western immunoblotting, and MMP13 enzymatic activity was measured using a substrate degradation assay. The amount of cellular active MMP13 and MMP13 proteolytic activity decreased in the presence of hormones. The decrease was paralleled by increased proenzyme and fragment forms. MG-132, not CI, suppressed cellular MMP13 fragmentation. Active MMP13 increased in rats following ovx and was suppressed by E2 + P4 supplementation. Active MMP13 is suppressed in vivo and in vitro by estradiol and progesterone, suggesting a protective effect against vaginal supportive tissue deterioration.
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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, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
| | - Leslie A. Meyn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery and Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
| | - Pamela A. Moalli
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology & Reconstructive Pelvic Surgery and Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213
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Ewies A, Elshafie M. High isoprostane level in cardinal ligament-derived fibroblasts and urine sample of women with uterine prolapse. BJOG 2008; 116:126-7; author reply 127-8. [PMID: 19087086 DOI: 10.1111/j.1471-0528.2008.02012.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chen YS, Hua KQ. [Expression of androgen receptor in the vaginal wall and cardinal ligament of patients with pelvic organ prolapse]. Zhonghua Yi Xue Za Zhi 2008; 88:2920-2923. [PMID: 19080100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate the role of androgen and its receptor in the pathogenesis of prolapse of pelvic floor. METHODS Specimens of right cardinal ligament and vaginal wall were collected from 38 patients with prolapse, aged (64 +/- 3) (45 - 79), all menopausal, and 23 women, aged (50 +/- 2)(45-57), with obstetric or gynecologic diseases other than prolapse (as controls), all undergoing total hysterectomy. The 38 prolapse patients were divided into 2 groups: Group > or = 60, aged (66 +/- 6), and Group < 60, aged (52 +/- 5). Western blotting and immunohistochemistry were used to detect the expression of androgen receptor (AR) in the tissues. Peripheral blood samples were collected from all patients to examine the levels of serum testosterone and sex hormone binding globulin (SHBG) by chemiluminescent labeling. RESULTS There were no significant differences in the serum concentrations of testosterone and SHBG between the prolapse and the control groups. The AR positive rates in the cardinal ligament and vaginal wall tissues of the prolapse patients aged > or = 60 were (49 +/- 15)% and (49 +/- 10)% respectively, both not significantly different from those of the control group [(43 +/- 15)% and (42 +/- 3)% respectively, both P > 0.05]. ears, The AR expression rates in the tissues of cardinal ligament and vaginal wall of the prolapse patients were (42 +/- 3)% and (43 +/- 15)% respectively, both significantly higher than those of the control group [(29 +/- 7)% and (29 +/- 6)% respectively, both P < 0.001]. Western blotting showed that the positive rate of the AR with the relative molecular weight of 45 000 in the cardinal ligament of the prolapse group was 4.41%, significantly higher than that of the control group (2.1%, P = 0.02), however, the positive rate of the AR with the relative molecular weight of 45 000 in the vaginal wall tissue of the prolapse group was 3.34%, not significantly different from that of the control group (2.28%, P = 0.2). There were no significant differences in the in the straps of 110 000 and 90 000 detected by C-terminal polyantibodies of AR in the cardinal ligament and vaginal wall tissues between the prolapse patients and the control group (both P > 0.05). CONCLUSION The increasing expression of AR in the tissue of vaginal wall and cardinal ligament of the prolapse patients with pelvic floor dysfunction may play an important role in the etiology of pelvic floor dysfunction.
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Affiliation(s)
- Yi-song Chen
- Obstetrics and Gynecology Hospital, Fudan University, Shanghai 200011, China
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Zhang SQ, Zhang LL, Yu H. [Expression of elastin, lysyl oxidase and elafin in the cardinal ligament of women with pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi 2008; 43:675-679. [PMID: 19087518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate expression of elastin, lysyl oxidase (LOX) and elafin in cardinal ligament of women with pelvic organ prolapse (POP) so as to determine their contributions to POP. METHODS The cardinal ligament samples were obtained from 60 POP subjects and 60 non-POP control women undergoing hysterectomy. RT-PCR was used to verify the mRNA level of elastin, LOX and elafin. The protein concentration of the three genes was determined by western blotting technique, electrophoretic separation and quantification. RESULTS The premenopausal and postmenopausal POP groups demonstrated significantly decreased expressions of elastin in cardinal ligament both in mRNA and protein levels than control group (mRNA 0.42 +/- 0.22, 0.26 +/- 0.20 versus 0.79 +/- 0.30, 0.63 +/- 0.23; protein 0.44 +/- 0.32, 0.20 +/- 0.19 versus 0.89 +/- 0.27, 0.78 +/- 0.25; P < 0.05). There was an identical tendency in the expression of LOX (mRNA 0.37 +/- 0.18, 0.20 +/- 0.14 versus 0.65 +/- 0.22, 0.53 +/- 0.20; protein 0.45 +/- 0.27, 0.26 +/- 0.21 versus 0.85 +/- 0.39, 0.69 +/- 0.31; P < 0.05). In POP group, the mRNA and protein levels of elastin and LOX in postmenopausal patients were significantly lower than premenopausal patients (P < 0.05). Inversely, POP group demonstrated an increased expression of elafin in cardinal ligament both in mRNA and protein levels than corresponding control group (mRNA 1.33 +/- 0.35, 1.47 +/- 0.37 versus 0.62 +/- 0.25, 0.55 +/- 0.24; protein 0.85 +/- 0.30, 0.76 +/- 0.35 versus 0.21 +/- 0.15, 0.29 +/- 0.22; P < 0.05). There was no significant difference in the expression of elafin between premenopausal and postmenopausal POP groups either in mRNA or protein levels (P > 0.05). There was a positive correlation between elastin and LOX both in mRNA and protein levels in POP group(r = 0.9959, 0.9708; P < 0.05), but there was no correlation between elastin and elafin (r = -0.0402, -0.0365; P > 0.05). CONCLUSIONS The results suggest that the decreased expression of elastin and LOX and the increased expression of elafin in the cardinal ligaments may contribute to POP.
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Affiliation(s)
- Shi-Qian Zhang
- Department of Gynecology, Qilu Hospital of Shandong University, Jinan 250012, China.
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Luo X, Shuai HL, Wang XY, Jiang XF, Xie JY. [Changes of collagen content in uterine ligaments of perimenopausal women with relaxation of pelvic supports]. Zhonghua Fu Chan Ke Za Zhi 2008; 43:422-424. [PMID: 19035135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the changes in histological characteristics and collagen content in uterosacral and cardinal ligaments of perimenopausal women in relation to relaxation of pelvic supports. METHODS Twenty-eight subjects undergoing hysterectomies were selected, in which 14 cases were perimenopausal women with relaxation of pelvic support as the relaxation group and 14 women at perimenopausal age with leomyoma, cervical cancer, adenomyosis as the control group. Samples of cardinal ligaments and uterosacral ligaments were obtained at hysterectomies, and the tissues were sliced and stained by Masson's trichrome technique. Histological characteristics of the samples were studied and immunohistochemistry assay was applied to demonstrate the contents of collagen types I and III. RESULTS (1) The collagen in uterosacral ligaments and cardinal ligaments were stained blue by the Masson's trichome technique. In comparison to the control group, the relaxation group had milder positive stains of the collagen and the stains were distributed in unequal intensities. Collagen content was arranged in loose pattern. Focal arrangement of the collagen was dense but fragmented. Collagen fibers were atrophic. (2) In immunohistochemistry assay and image analysis, collagen was positive in light to deep brown areas. In the relaxation group, positive units of collagen types I and III in cardinal ligaments were 13.8 +/- 2.1 and 9.6 +/- 2.4 respectively. Positive units of collagen types I and III of cardinal ligaments in the control group were 27.4 +/- 3.5 and 17.7 +/- 4.0 respectively. Differences between these two groups were statistically significant (P<0.01). In the relaxation group, positive units of collagen types I and III in utero-sacral ligaments were 15. 8 +/- 2.5 and 10.3 +/- 3.6 respectively. Positive units of collagen types I and III of utero-sacral ligaments of the control group were 29.5 +/- 4.4 and 19.3 +/- 4.6 respectively. Differences between these two groups were statistically significant (P<0.01). CONCLUSIONS Reductions in collagen types I and III occur in pelvic floor tissue of perimenopausal patients who suffer from pelvic support relaxation. Atrophic and degenerative changes of collagen fibers may be the basic pathological structural alteration in pelvic floor.
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Affiliation(s)
- Xin Luo
- Department of Obstetrics and Gynecology, People's Hospital of Wuhan University, Wuhan 430060, China
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Hong X, Huang L, Song Y. Role of vasoactive intestinal peptide and pituitary adenylate cyclase activating polypeptide in the vaginal wall of women with stress urinary incontinence and pelvic organ prolapse. Int Urogynecol J 2008; 19:1151-7. [PMID: 18351280 DOI: 10.1007/s00192-008-0585-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 02/02/2008] [Indexed: 12/22/2022]
Abstract
Pelvic floor connective tissue degeneration is closely associated with retrogradation of its dominating nerve fibers. We hypothesized that some neuropeptides from pelvic floor tissue might be involved in the pathological progress of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women. Thirty premenopausal and 31 postmenopausal patients participated in the study. The morphological appearance in the vaginal tissue was examined. The vasoactive intestinal peptide (VIP) and pituitary adenylate cyclase activating polypeptide-38 (PACAP) immunoreactivities (ir-VIP, ir-PACAP) were tested by immunohistochemistry and radioimmunoassay. We found that the VIP and PACAP immunostainings were weaker and sparser, and ir-VIP and ir-PACAP levels were significantly decreased in the anterior vaginal wall in the premenopausal and postmenopausal SUI or POP patients. Ir-VIP and ir-PACAP levels were reversely correlated with the age and menopausal status in the SUI or POP patients. Our data suggest that VIP and PACAP may participate in the pathophysiological process of SUI and POP.
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Affiliation(s)
- Xinru Hong
- Department of Obstetrics and Gynecology, Fuzhou General Hospital, Fuzhou, Fujian 350025, People's Republic of China.
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Reisenauer C, Shiozawa T, Oppitz M, Busch C, Kirschniak A, Fehm T, Drews U. The role of smooth muscle in the pathogenesis of pelvic organ prolapse—an immunohistochemical and morphometric analysis of the cervical third of the uterosacral ligament. Int Urogynecol J 2007; 19:383-9. [PMID: 17912473 DOI: 10.1007/s00192-007-0447-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/07/2007] [Accepted: 08/09/2007] [Indexed: 01/04/2023]
Abstract
The uterosacral ligament (USL) is part of the pelvic floor connecting the uterus to the dorsal body wall and stabilizing it. In samples obtained from hysterectomy patients, the smooth muscle component of the cervical third of the USL was studied by smooth muscle actin (SMA) immunohistochemistry as indicator for structural abnormalities and by morphometric determination of nuclear size as measure for the functional state. From a total of 40 patients, 18 were matched according to age, parity, and premenopausal status. Immunohistochemistry showed a granular patchy distribution of SMA in the pelvic organ prolapse (POP) group. In patients with POP, the size of smooth muscle cell nuclei was significantly reduced in comparison to patients without POP (25.45+/-1.92 microm(2) vs 28.87+/-2.92 microm(2), p<0.05). We conclude that the smooth muscle component of the USL is impaired in POP patients, indicating a possible role of smooth muscle in the pathogenesis of POP.
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Affiliation(s)
- Christl Reisenauer
- Department of Obstetrics and Gynecology, University of Tuebingen, Calwerstr. 7, 72076 Tuebingen, Germany.
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Abstract
PURPOSE OF REVIEW The cause of pelvic organ prolapse is multifactorial and many inciting, promoting and decompensating factors play a role in developing pelvic organ prolapse. Various clinical parameters have been studied quite extensively, but estrogen and collagen metabolism and cell proliferation and apoptosis have not been widely evaluated. This review focuses on assessing the roles of estrogen and its receptor, relationship with collagen metabolism and cell proliferation and cell apoptosis in development and progression of pelvic organ prolapse. RECENT FINDINGS Differential expressions of sex steroid receptors in various suspensory ligaments of prolapsed uteri have been studied. How different subtypes of estrogen receptor play a role in inducing and aggravating pelvic organ prolapse has yet to be defined. The role of estrogen in collagen metabolism and cell proliferation related to development of pelvic organ prolapse is still under study. Studies on the proliferation of fibroblasts in ligaments of pelvic organ prolapse have yielded conflicting results. SUMMARY There is still a need for additional research on precise roles of sex steroids, their receptors and cell cycle regulatory proteins and cell proliferation in pathogenesis of pelvic organ prolapse. Some of them could be the cause of pelvic organ prolapse and some of them the direct result of tissue trauma in pelvic organ prolapse.
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Affiliation(s)
- Da Jung Chung
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seodaumun-gu, Seoul, Korea
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Abstract
PURPOSE OF REVIEW Pelvic organ prolapse is a common disease that negatively affects the lives of women. To date, basic science research into the pathogenesis of prolapse has been limited. The vagina and its supportive connective tissues provide one of the primary mechanisms of support to the pelvic organs. This review summarizes our current understanding of the alterations in these tissues in women with prolapse. RECENT FINDINGS Current research suggests that the vagina and its supportive tissues actively remodel in response to different environmental stimuli. The literature has many shortcomings due to restricted access to tissue, absence of longitudinal data, and limited animal models. Nevertheless, recent studies indicate that within prolapsed tissue metabolism of collagen and elastin is altered. Thus, not only the synthesis of those structural proteins but also the balance between the activity of the major proteolytic enzymes that degrade them and the inhibitors of proteolysis are important components to consider in studies on the pathogenesis of pelvic organ prolapse. SUMMARY Biochemical studies of the vagina and its supportive connective tissues have improved understanding of the contribution of altered connective tissue to the pathogenesis of prolapse. It is important to continue research in this area, as the knowledge gained from these studies will allow for the development of innovative reconstructive procedures and the establishment of preventive measures.
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Affiliation(s)
- Marianna Alperin
- Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Gynecological Specialties, Magee-Women's Hospital and Magee Research Institute, University of Pittsburgh, Pittsburgh, PA 15213, USA
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Paladini D, Di Spiezio Sardo A, Mandato VD, Guerra G, Bifulco G, Mauriello S, Nappi C. Association of cutis laxa and genital prolapse: a case report. Int Urogynecol J 2007; 18:1367-70. [PMID: 17453126 DOI: 10.1007/s00192-007-0362-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 03/13/2007] [Indexed: 11/26/2022]
Abstract
Cutis laxa (CL) is an extremely inherited or acquired connective tissue disorder characterised by a markedly reduced systemic elastin content. Genital abnormalities in patients with CL have been rarely reported. We report such a case in a 48-year-old CL patient affected by genital prolapse, focusing on immunohistological and molecular biology assessment of elastin and collagen type I, III, VI content in the main uterine ligaments. The woman was referred to our department for the onset of a rapidly progressing genital prolapse and urinary incontinence. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and sacrocolpopexy. Punch biopsies from both cardinal and uterosacral ligaments revealed a dramatic reduction in elastin and an increase in collagen type VI content. The present report seems to underline the central role exerted primarily by elastin in the supportive connective tissue and might contribute to the knowledge of extracellular matrix abnormalities at the basis of genital abnormalities in CL patients.
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Affiliation(s)
- Dario Paladini
- Department of Gynecology and Obstetrics and Pathophysiology of Human Reproduction, University of Naples Federico II, Via Pansini 5, Naples, Italy
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Hanifi-Moghaddam P, Boers-Sijmons B, Klaassens AHA, van Wijk FH, den Bakker MA, Ott MC, Shipley GL, Verheul HAM, Kloosterboer HJ, Burger CW, Blok LJ. Molecular analysis of human endometrium: short-term tibolone signaling differs significantly from estrogen and estrogen + progestagen signaling. J Mol Med (Berl) 2007; 85:471-80. [PMID: 17226044 PMCID: PMC2707858 DOI: 10.1007/s00109-006-0146-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2006] [Revised: 11/13/2006] [Accepted: 11/23/2006] [Indexed: 11/04/2022]
Abstract
Tibolone, a tissue-selective compound with a combination of estrogenic, progestagenic, and androgenic properties, is used as an alternative for estrogen or estrogen plus progesterone hormone therapy for the treatment of symptoms associated with menopause and osteoporosis. The current study compares the endometrial gene expression profiles after short-term (21 days) treatment with tibolone to the profiles after treatment with estradiol-only (E2) and E2 + medroxyprogesterone acetate (E2 + MPA) in healthy postmenopausal women undergoing hysterectomy for endometrial prolapse. The impact of E2 treatment on endometrial gene expression (799 genes) was much higher than the effect of tibolone (173 genes) or E2 + MPA treatment (174 genes). Furthermore, endometrial gene expression profiles after tibolone treatment show a weak similarity to the profiles after E2 treatment (overlap 72 genes) and even less profile similarity to E2 + MPA treatment (overlap 17 genes). Interestingly, 95 tibolone-specific genes were identified. Translation of profile similarity into biological processes and pathways showed that ER-mediated downstream processes, such as cell cycle and cell proliferation, are not affected by E2 + MPA, slightly by tibolone, but are significantly affected by E2. In conclusion, tibolone treatment results in a tibolone-specific gene expression profile in the human endometrium, which shares only limited resemblance to E2 and even less resemblance to E2 + MPA induced profiles.
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Affiliation(s)
- P. Hanifi-Moghaddam
- Department of Reproduction and Development, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - B. Boers-Sijmons
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A. H. A. Klaassens
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F. H. van Wijk
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M. A. den Bakker
- Department of Pathology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - G. L. Shipley
- Department of Integrative Biology and Pharmacology, University of Texas Houston Health Science Center, Houston, TX USA
| | | | | | - C. W. Burger
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - L. J. Blok
- Department of Reproduction and Development, Erasmus University Medical Center, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Suzme R, Yalcin O, Gurdol F, Gungor F, Bilir A. Connective tissue alterations in women with pelvic organ prolapse and urinary incontinence. Acta Obstet Gynecol Scand 2007; 86:882-8. [PMID: 17611836 DOI: 10.1080/00016340701444764] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Alterations in collagen synthesis and metabolism have previously been reported in patients with pelvic organ prolapse (POP) and/or urodynamic stress incontinence (USI). Since urinary incontinence does not always associate with POP, the objective of this study was to examine connective tissues from patients with USI plus POP, and patients with prolapse only. METHODS Biopsies from the uterosacral ligaments were obtained during the operation from POP patients (n =28), and from continent women (control group, n =12) who underwent surgery for other benign reasons. POP patients were classified following urodynamic tests and symptom questionnaire with respect to the presence (n =14) or absence (n =14) of USI. N-terminal propeptides of collagen (PINP and PIIINP), TGF-beta and leptin were measured in plasma. Hydroxyproline and glycosaminoglycan (GAGs) concentrations and total hexosaminidase activity were measured in tissue samples. Histological sections were prepared using Masson's trichrome technique, and digitised solutions were used for imaging provided by Soft Imaging System GmBh. Statistical evaluations were made by the Kruskal-Wallis test. RESULTS A significant decrease in hydroxyproline content was found in USI+POP women in comparison to controls (p<0.05). In contrast, histopathological examination revealed an increased density of collagen in USI+POP patients. Hexosaminidase activity was decreased in both groups with POP, but no change in the amount of GAGs was observed. Markers of collagen synthesis (PINP, PIIINP), and factors related to the collagen synthesis (TGF-beta, leptin) remained unaltered. CONCLUSION Our biochemical and morphological findings suggest a different organisation of collagen fibres in tissues of patients with USI+POP, when compared with both the controls and the POP patients.
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Affiliation(s)
- Rafi Suzme
- Department of Biochemistry, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Capa, Turkey
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16
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Rechberger T, Skorupski P. The controversies regarding the role of estrogens in urogynecology. Folia Histochem Cytobiol 2007; 45 Suppl 1:S17-S21. [PMID: 18292824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Estrogens are crucial for the proper functioning of genitourinary tract. Hypoestrogenism related to menopause could be linked to numerous disturbances of lower urinary tract. However, the results of most well designed clinical studies do not support use of estrogen or hormone replacement therapy for the treatment of genitourinary symptoms. According to evidence base medicine stress urinary incontinence, overactive bladder syndrome or pelvic organ prolapse are best treated by the surgery or non-hormonal drug therapy.
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Jin L, Zhang XH, Wang JL, Yu YZ. [Expression of estrogen receptor alpha and beta subtypes in the vaginal wall of women with anterior vaginal prolapse]. Zhonghua Fu Chan Ke Za Zhi 2007; 42:18-21. [PMID: 17331415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To observe the expression of estrogen receptor (ER) alpha and ERbeta in the vaginal wall of women with anterior vaginal prolapse, and to investigate the relationships of ER subtypes with the development of pelvic organ prolapse (POP). METHODS Seven premenopausal women and 33 postmenopausal women with anterior vaginal prolapse who underwent surgery in our hospital from July 1999 to July 2004 were analyzed. Nine premenopausal and 8 postmenopausal women with squamous carcinoma of cervix who underwent surgery served as controls. The expression of ERalpha and ERbeta in squamous epithelium (SE), lamina propria (LP) and muscular layer (ML) of anterior vaginal wall were studied by immunohistochemical staining. RESULTS (1) Both ERalpha and ERbeta were expressed in SE, LP, ML of vaginal wall of premenopausal and postmenopausal women. (2) The expression of ERalpha was not significantly different in premenopausal and postmenopausal women; the expression of ERbeta was not significantly different in premenopausal and postmenopausal women with POP; however, it was decreased in postmenopausal women without POP (P < 0.05). (3) The expression of ERbeta was significantly higher in postmenopausal POP group than in postmenopausal control group (P < 0.05). The expression of ERalpha was not significantly different in postmenopausal control and postmenopausal POP group. CONCLUSIONS ERalpha and ERbeta are expressed in vaginal wall of premenopausal and postmenopausal women. In vaginal wall of postmenopausal women with POP, the expression of ERbeta is not decreased; on the contrary, it is increased compared with that of postmenopausal control. ERalpha is not changed significantly.
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Affiliation(s)
- Ling Jin
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
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Nikolova G, Lee H, Berkovitz S, Nelson S, Sinsheimer J, Vilain E, Rodríguez LV. Sequence variant in the laminin gamma1 (LAMC1) gene associated with familial pelvic organ prolapse. Hum Genet 2006; 120:847-56. [PMID: 17021862 DOI: 10.1007/s00439-006-0267-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 09/07/2006] [Indexed: 01/30/2023]
Abstract
Pelvic organ prolapse is a common condition, affecting up to a third of women throughout their lifetime. Genetic factors are believed to account for about 30% of the incidence, and are the least understood component of the disorder. Familial cases, particularly those in which prolapse manifests in young women, are especially valuable in the effort to find the genes involved. We recently reported autosomal dominant transmission as the most likely mode of inheritance, based on a collection of families with high incidence of prolapse. Of greatest interest was a family in which three generations of female relatives suffered from prolapse at a very young age. A genome-wide linkage scan performed using the Affymetrix GeneChip Human mapping 10K array identified ten regions with a LOD score of 1.5, the maximum possible for this family. Candidate genes within those regions were analyzed for expression in vaginal tissue by RT-PCR. Of the genes confirmed to be expressed, LAMC1 was further evaluated by sequencing and select single nucleotide polymorphism (SNP) genotyping for causative sequence variants in affected family members. We identified one such SNP, rs10911193. The rare T variant segregating with the condition is present at a frequency of 4.9% in the general population and 22% among probands from our cohort of families. It affects the binding site for NFIL3, a transcription factor that we verified to be co-expressed in vaginal tissue. Altogether these data suggest that a polymorphism in the promoter of LAMC1 may increase the susceptibility to early-onset pelvic organ prolapse.
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Affiliation(s)
- Ganka Nikolova
- Department of Human Genetics, University of California, 695 Charles Young Drive South, Gonda Room 5506, Los Angeles, CA, 90095-7088, USA
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Klaassens AHA, van Wijk FH, Hanifi-Moghaddam P, Sijmons B, Ewing PC, Ten Kate-Booij MJ, Kooi GS, Kloosterboer HJ, Blok LJ, Burger CW. Histological and immunohistochemical evaluation of postmenopausal endometrium after 3 weeks of treatment with tibolone, estrogen only, or estrogen plus progestagen. Fertil Steril 2006; 86:352-61. [PMID: 16828477 DOI: 10.1016/j.fertnstert.2005.12.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 12/21/2005] [Accepted: 12/21/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate histological and immunohistochemical parameters of short-term (21 days) tibolone, estrogen-only, and estrogen+progestagen treatment in the human postmenopausal endometrium. DESIGN An observational, open, nonrandomized, controlled study. SETTING Three collaborating centers: Amphia Hospital in Breda, Albert Schweitzer Hospital in Dordrecht, Erasmus Medical Center in Rotterdam, the Netherlands. PATIENT(S) Thirty healthy, postmenopausal women. INTERVENTION(S) Control group (n = 9), no hormonal treatment; tibolone group (n = 8), patients were treated with 2.5 mg of tibolone (administered orally) every day, starting 21 days before surgery; estrogen group (n = 7), patients were treated with 2 mg of E(2) (Zumenon, administered orally; Zambon, Amerfoort; The Netherlands) every day, starting 21 days before surgery; estrogen+progestagen group (n = 6), patients were treated with 2 mg of E(2) (Zumenon, administered orally) and 5 mg of medroxyprogesterone acetate (administered orally) every day, starting 21 days before surgery. MAIN OUTCOME MEASURE(S) Uterine tissues were collected, and two pathologists independently assessed histology. Immunohistochemical parameters measured were estrogen receptor alpha, progesterone receptor A/B, Hoxa10, Ki67, and Bcl-2. RESULT(S) On the basis of a number of histological and immunohistochemical parameters measured after 21 days of treatment, it was observed that tibolone displays clearly less stimulation (proliferation) of the human postmenopausal endometrium than estrogen at the beginning of a treatment, but the stimulation is higher than with estrogen+progestagen. CONCLUSION(S) Short-term (21 days) tibolone treatment results in a small stimulation of proliferation of the endometrium, and because long-term treatment with tibolone has been demonstrated to lead to an atrophic endometrium, it may be concluded that the stimulatory effect, as observed in this study, is transient in nature. It is hypothesized that tibolone first displays a more estrogenic mode of action, which over time, is counterbalanced by the induction of its progestagenic properties.
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Affiliation(s)
- Anet H A Klaassens
- Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Feldner PC, Kati LM, Sartori MGF, Baracat EC, Rodrigues de Lima G, Nader HB, Dietrich CP, Girão MJBC. Sulfated glycosaminoglycans of the periurethral tissue in women with and without stress urinary incontinence, according to genital prolapse stage. Eur J Obstet Gynecol Reprod Biol 2006; 126:250-4. [PMID: 16314024 DOI: 10.1016/j.ejogrb.2005.08.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2004] [Revised: 02/18/2005] [Accepted: 08/05/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective was to determine sulfated glycosaminoglycans (GAG) of the extracellular matrix (ECM) in women with and without stress urinary incontinence according to genital prolapse stage. STUDY DESIGN Periurethral tissue was obtained from 30 women who underwent surgery for urinary incontinence, for pelvic organ prolapse, or for other benign gynecologic conditions. Biopsy specimens were assessed by biochemical methods to characterize and quantify sulfated glycosaminoglycans. Measurements were made of total glycosaminoglycans, chondroitin sulfate, dermatan sulfate, and of heparan sulfate. Data were compared using the t-test. RESULTS In two groups, dermatan sulfate was the most predominant glycosaminoglycan. Women with stress urinary incontinence had significantly more total sulfated glycosaminoglycans (p<0.05) and dermatan sulfate (p<0.05) than women without stress urinary incontinence. We did not observe any differences in chondroitin sulfate and heparan sulfate. CONCLUSIONS Women with stress urinary incontinence showed quantitative and qualitative differences in the biochemical characteristics of the extracellular matrix in periurethral tissue by analysis of sulfated glycosaminoglycans, according to genital prolapse stage.
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Affiliation(s)
- Paulo Cezar Feldner
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua dos Otonis 567, Vila Clementino, São Paulo, SP, Brazil.
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Hundley AF, Yuan L, Visco AG. Skeletal muscle heavy-chain polypeptide 3 and myosin binding protein H in the pubococcygeus muscle in patients with and without pelvic organ prolapse. Am J Obstet Gynecol 2006; 194:1404-10. [PMID: 16579921 DOI: 10.1016/j.ajog.2006.01.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Revised: 10/27/2005] [Accepted: 01/13/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare gene expression of skeletal muscle heavy-chain polypeptide 3 (MYH3) and myosin binding protein H (MyBP-H) in the pubococcygeus muscle of patients with pelvic organ prolapse and controls. STUDY DESIGN Genes previously identified by microarray genechip analysis of pubococcygeus muscle biopsies were examined using real-time quantitative reverse transcriptase polymerase chain reaction (RT-PCR) analysis. Specimens were obtained from 17 patients with stage III or IV pelvic organ prolapse and 23 controls with minimal to no prolapse. Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) was used as the housekeeping gene. Samples and controls were run in triplicate in separate wells, and the levels of gene expression were analyzed quantitatively using the comparative critical threshold (Ct) method. Differences in gene expression were analyzed using Wilcoxon rank-sum testing. RESULTS Significant differences in gene expression were observed between patients with prolapse and controls for both genes. Skeletal muscle myosin heavy-chain polypeptide 3 was 6.5 times underexpressed in patients with pelvic organ prolapse compared to controls (P = .028). Similarly, myosin binding protein H was 3.2 times underexpressed in patients with prolapse (P = .042). Overall, patients had a mean age of 62.4 +/- 6.5 years compared with controls with a mean age of 45.3 +/- 7.4 years (P < .001), so analysis was also performed on an age-matched subset of 8 patients and controls (mean ages of 58.1 +/- 5.4 years and 53.3 +/- 5.0 years, respectively, P = .02) with similar results. Prolapse patients in this subset were similar in parity and race to controls but had lower body mass index (23.2 vs 29.9, P = .04). MYH3 was 10.9 times underexpressed in patients with pelvic organ prolapse compared to controls (P = .027). MyBP-H was 10.4 times underexpressed in patients with prolapse (P = .036). CONCLUSION These findings suggest that the differences between patients with advanced pelvic organ prolapse and controls may be related to differential gene expression of structural proteins related to myosin. Specifically, advanced pelvic organ prolapse may be related to down-regulation of skeletal muscle heavy-chain polypeptide 3 and myosin binding protein H.
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Affiliation(s)
- Andrew F Hundley
- Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA.
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Abstract
OBJECTIVE As pelvic organ prolapse progresses, the morphology of the vagina dramatically changes. The objective of this study was to determine whether these changes observed clinically correlate with histologic and biochemical evidence of tissue remodeling METHODS After informed consent, full-thickness biopsies of the vaginal apex were obtained at the time of surgery from 77 women. The tissue of 15 premenopausal women with less than stage II prolapse (controls) was compared with that of 62 women with prolapse divided according to their menopausal status. All specimens were examined histologically. Scanning confocal microscopic analysis of fluorescent micrographs was used to quantitate collagen subtypes I, III, and V. Collagen fiber orientation was analyzed by scanning electron microscopy. Gelatin zymography was used to quantitate the expression of the proenzyme and active forms of matrix metalloproteinases (MMP) -2 and -9. Median values were compared using Mann-Whitney U or Kruskal-Wallis tests, where appropriate RESULTS Vaginal collagen fibers are arranged in a whorled pattern, with collagen III as the predominant fibrillar collagen. The amount of total collagen in the vagina was increased in women with prolapse relative to women without prolapse (P = .054) primarily due to increased expression of collagen III (P = .031). There was no difference in the expression of proMMP-2, active MMP-2, or proMMP-9; however, active MMP-9 was increased in patients with prolapse (P = .030) CONCLUSION: The increase in collagen III and active MMP-9 expression in the vaginal tissues of patients with prolapse suggests that this tissue is actively remodeling under the biomechanical stresses associated with prolapse. LEVEL OF EVIDENCE II-2.
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Affiliation(s)
- Pamela A Moalli
- Magee-Womens Research Institute and the Department of Obstetrics & Gynecology at Magee Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA.
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Abstract
OBJECTIVE To compare tissue markers of collagen metabolism in the uterosacral ligaments with those in vaginal tissue in women with uterine prolapse. DESIGN Prospective observational experimental study. SETTING A tertiary urogynaecology unit. POPULATION Women referred for hysterectomy for prolapse or benign gynaecological disease. METHODS Matrix metalloproteinase (MMP)-2 and -9 expression, tissue inhibitors of metalloproteinase (TIMP)-2 expression and hydroxyproline content were measured in the uterosacral ligaments and vaginal tissue from 14 women with prolapse compared with 14 controls. MAIN OUTCOME MEASURES Levels of MMP, TIMP and hydroxyproline in the uterosacral ligaments and vaginal tissue of women with prolapse and controls. RESULTS Fourteen women with prolapse and 14 women without prolapse (controls) were included. A significant increase in pro MMP-2 expression was seen in vaginal tissue from women with prolapse (P < 0.05) but not activated MMP-2, MMP-9 and TIMP-2. For uterosacral ligaments, the differences were not statistically significant. No significant difference in hydroxyproline content was found between control and prolapse in either tissue. Significant correlations exist in expression of pro-MMP-2, activated MMP-2, MMP-9 and TIMP-2 in vaginal tissue with that in uterosacral ligaments. CONCLUSIONS Correlations existed between markers of collagen metabolism in the vaginal and uterosacral tissues. This suggests vaginal tissue reflects the endopelvic fascia. The changes which are more pronounced in vaginal tissue may be as a result of prolapse rather than cause.
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Affiliation(s)
- Christian H Phillips
- Faculty of Medicine Maternal, Fetal & Neonatal Physiology Group, Department of Gynecology, Princess Anne Hospital, Southampton, Hampshire, UK
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Bai SW, Chung DJ, Yoon JM, Shin JS, Kim SK, Park KH. Roles of estrogen receptor, progesterone receptor, p53 and p21 in pathogenesis of pelvic organ prolapse. Int Urogynecol J 2005; 16:492-6. [PMID: 15915319 DOI: 10.1007/s00192-005-1310-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2004] [Accepted: 03/07/2005] [Indexed: 11/25/2022]
Abstract
The aim of this study is to compare the levels of estrogen receptor (ER), progesterone receptor (PR), p53 and p21 between pelvic organ prolapse (POP) and control groups in order to evaluate their roles in pathogenesis of POP, and to find out the relationship among these proteins. Through the year of 2002, uterosacral ligaments were obtained from 20 prolapsus and 24 non-prolapsus hysterectomized uteruses. ER, PR, p53, and p21 proteins were extracted by Western blot analysis and relative levels of proteins were compared by Student t-test and Pearson correlation coefficient. P value <0.05 was considered statistically significant. All patients were postmenopausal and had never taken hormone replacement therapy. ER, PR, p53, and p21 were significantly lower in the study than control group (p<0.0001). Positive correlations were found among all proteins in the prolapse group. Further researches are needed to elucidate the interrelationship among these proteins and their precise roles in pathogenesis of POP.
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Affiliation(s)
- Sang Wook Bai
- Department of Obstetrics and Gynecology, Institute of Women's Life Science, Yonsei University College of Medicine, Shinchon-dong 134 Seodaemun-gu, Seoul, 120-752, Korea.
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Ewies AAA, Thompson J, Al-Azzawi F. Changes in gonadal steroid receptors in the cardinal ligaments of prolapsed uteri: immunohistomorphometric data. Hum Reprod 2004; 19:1622-8. [PMID: 15142996 DOI: 10.1093/humrep/deh282] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The precise mechanism of uterine prolapse is poorly understood. This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate the differential expression of gonadal steroid receptors in human cardinal ligaments of prolapsed uteri compared with non-prolapsed controls. METHODS Specimens from women with pelvic organ prolapse (POP) stage III (n = 33), together with the appropriate controls (n = 25), were stained for estrogen receptor alpha (ERalpha), ERbeta, progesterone receptor (PR), androgen receptor (AR) and Ki-67. The control materials were samples of the cardinal ligaments obtained from pre- and post-menopausal women with no prolapse, who were not using hormonal therapy. RESULTS The prolapsed ligaments expressed 1.5-2.5 times more ERalpha-positive cells (statistically significant in post-menopausal women not taking HRT, P < 0.001), a 3-4 times greater percentage of AR-positive cells (P = 0.004 and P = 0.008 in pre-menopausal and post-menopausal women not taking HRT, respectively) and twice the percentage of PR-positive cells (statistically significant in the pre-menopausal group, P = 0.03) compared with the no prolapse group. Expression of ERbeta was twice as high in the ligaments of pre-menopausal women with no prolapse compared with those with prolapse (P = 0.02), and no significant difference was found in the post-menopausal groups. The use of HRT was significantly associated with low AR and high PR expression. Ki-67 expression was not detected in these specimens. CONCLUSIONS The clearly discernible levels of expression of ERalpha, ERbeta, AR and PR in the prolapsed cardinal ligaments may suggest a relationship to the process of tissue stretch 'trauma', rather than an effect of the menopausal status, HRT use or cell proliferation. The use of HRT in post-menopausal women appears to offset some of the changes observed with the prolapse.
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Abstract
OBJECTIVE Tissue ischemia-hypoxia can activate the calpain proteolytic system. Mechanical trauma to the upper vaginal wall and pelvic floor could compromise vascular perfusion and could also result in calpain expression. The aims of this investigation were to assess the expression messenger RNA and proteins for m-calpain and micro-calpain in the vaginal walls of women with and without uterovaginal prolapse. METHODS The anterior vaginal walls of 22 women with and without uterovaginal prolpase were evaluated using a reverse transcription polymerase chain reaction and western blotting for detecting calpain expression. RESULTS The number of messenger RNA transcripts of m- and micro-calpain was significantly less in women with uterovaginal prolapse than in women without uterovaginal prolapse (two of 11 and zero of 11 versus eight of 11 and five of 11, P < .05). All women had m-calpain protein expression in the anterior vaginal wall. However, the concentration of m-calpain protein was less, but not significantly different, in women with uterovaginal prolapse than in the women without uterovaginal prolapse (0.386 +/- 0.018 versus 0.439 +/- 0.011 optical density/mm2, P > .05). None of the women with uterovaginal prolapse had expression of micro-calpain mRNA or protein (zero of 11). Expression of protein of calpains in the anterior vaginal wall is not consistent with mRNA transcripts. CONCLUSION Calpain expression may be compromised in the anterior vaginal wall of women with uterovaginal prolapse who have abnormal histologic changes in the vaginal connective tissues or have anterior vaginal laxity.
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Affiliation(s)
- Gin-Den Chen
- Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan
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Zhu L, Lang J, Feng R, Chen J, Wong F. Estrogen receptor in pelvic floor tissues in patients with stress urinary incontinence. Int Urogynecol J 2004; 15:340-3. [PMID: 15580421 DOI: 10.1007/s00192-004-1178-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Accepted: 04/25/2004] [Indexed: 10/26/2022]
Abstract
Our study is to investigate the presence of estrogen receptor (ER) and its possible etiological relationship with the development of stress urinary incontinence (SUI). Thirty-one biopsy specimens from pelvic floor tissues were obtained from 31 patients categorized into three groups: pelvic organ prolapse (POP), SUI and control groups. ER in the pelvic muscles tissues was evaluated quantitatively after immunohistochemical staining to visualize the ER in the tissue. The sampling rate of levator ani (striated) muscle was 6.7% in total sample from the pelvic floor tissues, with the remaining showing connective tissues, smooth muscles and nerve fibers. ER positive staining was found in the in the nuclei of connective tissue, smooth muscles and nerve fibers. The positive rates of ER staining in tissues were 1.4%, 4.7% and 5.7%, respectively in control group versus 1.1%, 2.8% and 2.7% in SUI group and 4.1%, 9.5% and 11.6% in POP group. The positive rates of ER staining in connective tissue, smooth muscle and nerve fibers in SUI group were significantly lower than that in control and POP group (P<0.01). Our study suggests that a decrease of ER in the pelvic floor tissues might be related to the occurrence of SUI and implies that hormone replacement therapy might not be effective in treatment for SUI.
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Affiliation(s)
- Lan Zhu
- Dept of O/G, Peking Union Medical College Hospital, 100730, Beijing, P.R of China
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Ewies AAA, Al-Azzawi F, Thompson J. Changes in extracellular matrix proteins in the cardinal ligaments of post-menopausal women with or without prolapse: a computerized immunohistomorphometric analysis. Hum Reprod 2004; 18:2189-95. [PMID: 14507843 DOI: 10.1093/humrep/deg420] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The precise mechanism of uterine prolapse is poorly understood. There is evidence to suggest that abnormalities of connective tissue structure or its repair mechanism may predispose women to prolapse. METHODS AND RESULTS This immunohistochemical study was performed on paraffin-embedded sections of the cardinal ligaments in an attempt to evaluate differences in the expression of extracellular matrix (ECM) proteins: collagen I, collagen III, elastin and tenascin, in the cardinal ligaments of prolapsed compared to non-prolapsed uteri. There appear to be discernable differences in the level of expression of ECM proteins in prolapsed compared to non-prolapsed cardinal ligaments. We found that the ligaments of the prolapsed uteri are characterized by a higher expression of collagen III and tenascin, and lower quantities of elastin. It appears that the use of HRT in post-menopausal women reverses some of the changes observed in cases of prolapse. Collagen I expression is directly related to the age and menopausal status rather than to prolapse. CONCLUSIONS In contrast to collagen I, our findings clearly indicate that collagen III expression is directly related to the presence of prolapse rather than age or menopausal status and is suppressed with the use of HRT. The pattern of change may fit a picture of healing phase of traumatized tissue as evidenced by the raised tenascin expression. The trauma itself may have been initiated by events such as childbirth, and that the lack of estrogen following the menopause results in decompensation. In spite of ameliorating some of the changes such as suppression of collagen III expression, treatment with estrogen falls short of rectifying the expression of other necessary proteins. If these mechanisms can be elucidated, a supplementary drug therapy may help along with estrogens to rebuild these ligaments.
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Bezerra LRPS, Feldner PC, Kati LM, Girão MJBC, Sartori MG, Baracat EC, de Lima GR, Nader HB, Dietrich CP. Sulfated glycosaminoglycans of the vagina and perineal skin in pre- and postmenopausal women, according to genital prolapse stage. Int Urogynecol J 2004; 15:266-71. [PMID: 15517672 DOI: 10.1007/s00192-004-1150-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to analyze the amount and types of sulfated glycosaminoglycans (GAGs) of the extracellular matrix (ECM) in the posterior vaginal wall and perineal skin in menacme and postmenopausal women, according to genital prolapse stage. Samples of vaginal tissue and perineal skin were obtained from 40 women who underwent vaginal surgery. Sulfated glycosaminoglycans were extracted by extensive tissue maxatase digestion, submitted to electrophoresis on agarose gel, and their concentrations were determined by densitometry. Dermatan sulphate (DS) was the predominant GAG, followed by chondroitin sulfate (CS) and heparan sulfate (HS). In the vagina there was a significant decrease in total GAGs, CS, DS and HS in postmenopausal women with prolapse stage 2 and 3 compared to the premenopausal group, independent of the stage. In stage 2 and 3 postmenopausal patients there was a significant decrease of DS and HS compared to the stage 1 postmenopausal group. In perineal skin there was no significant difference between total GAG amount, DS and HS. However, the amount of CS in premenopausal stage 1 patients was significantly than that in postmenopausal patients stage 1 and stages 2 and 3. In conclusions, there are quantitative and qualitative differences in GAGs of the ECM in vaginal wall and perineal skin between women in menacme and the postmenopause, according to genital prolapse stage.
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Affiliation(s)
- Leonardo R P S Bezerra
- Section of Urogynecology and Pelvic Surgery, Department of Gynecology, Federal University of São Paulo, Rua dos Otonis 567, Vila Clementino, São Paulo, Brazil.
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Barbiero EC, Sartori MGF, Girão MJBC, Baracat EC, de Lima GR. Analysis of type I collagen in the parametrium of women with and without uterine prolapse, according to hormonal status. Int Urogynecol J 2003; 14:331-4; discussion 334. [PMID: 14618310 DOI: 10.1007/s00192-003-1076-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2002] [Accepted: 05/29/2003] [Indexed: 10/26/2022]
Abstract
The content and quality of type I collagen in the parametrium of women with and without uterine prolapse was evaluated. Forty-four consecutive patients were selected and divided into two groups: A, 21 women without uterine prolapse, and B, 23 with uterine prolapse. Patients in group A had uterine leiomyoma and were submitted to abdominal hysterectomy; in those from group B, vaginal hysterectomy was performed for correction of the uterine prolapse. During surgery, fragments of the parametrium were removed and processed for immunohistochemical analysis using polyclonal antibodies for type I collagen. A system of computerized digital imaging analysis was used for the quantification of collagen fibers. There was no difference between collagen content in patients either with or without prolapse, nor between pre- and postmenopausal women with prolapse. A modification of the quality of the collagen fiber was observed, it being longer and more compact in the group without uterine prolapse. In contrast, in the group with prolapse, the fibers were shorter and thinner and areas with large spaces between fibers were found at several points of the parametrium. The conclusion was that patients with uterine prolapse have the same type I collagen content as those without, but the quality of the fiber is modified. The hormonal status also did not affect collagen content.
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Affiliation(s)
- Eliana Cristina Barbiero
- Sector of Urogynecology and Vaginal Surgery, Department of Gynecology, Escola Paulista de Medicina (UNIFESP/EPM), Universidade Federal de São Paulo, Avenida Onze de Junho, 1006 apto. 51, 04041-003 São Paulo, SP, Brazil
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Abstract
The aim of this study was to investigate quantitative mRNA expression of matrix metalloproteinases MMP-1, MMP-2, MMP-9, and their inhibitors, the tissue inhibitors of metalloproteinases TIMP-1, TIMP-2 and TIMP-3, in vaginal wall tissue from women with stress urinary incontinence compared to continent controls. Vaginal wall tissues were obtained from 7 women with stress urinary incontinence/severe pelvic prolapse and 15 continent controls. RNA was then extracted and quantified. Quantitative competitive reverse transcription (QC-RT-PCR) was carried out with oligonucleotide primers to quantify MMP-1, MMP-2, MMP-9, TIMP-1, TIMP-2 and TIMP-3 mRNA expression. Stress continent women demonstrated a significant decrease in TIMP-1 and mRNA expression (P = 0.03). There was no difference in TIMP-2, TIMP-3, MMP-2 or MMP-9 mRNA expression between stress incontinent women and controls. However, MMP-1 mRNA expression was significantly increased (P = 0.05) in the incontinent group and the MMP-1/TIMP-1 ratio (P = 0.04) was consistent with increased collagen degradation in the stress incontinence. Stress incontinent women demonstrated an increase in MMP-1 mRNA expression and a decrease in the inhibitor TIMP-1 mRNA expression. Both these findings are consistent with increased collagen breakdown as a pathologic etiology of incontinence.
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Affiliation(s)
- B H Chen
- Department of Gynecology and Obstetrics, Stanford University Medical School, California 94305-5317, USA.
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Bai SW, Jung BH, Chung BC, Kim SU, Kim JY, Rha KH, Kim SK, Park KH. Steroid hormone metabolism in women with pelvic organ prolapse. J Reprod Med 2002; 47:303-8. [PMID: 12012882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To identify whether endogenous steroid hormone metabolism in women with pelvic organ prolapse (POP) is different from that in normal women and the relationship between endogenous steroid hormone metabolites and POP stage. STUDY DESIGN Twenty postmenopausal women who were clinically diagnosed as having POP and 20 volunteer postmenopausal women without prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of endogenous steroids and degree of prolapse. Urinary profiles of endogenous steroids were assayed by gas chromatography/mass spectrometry. RESULTS The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the body mass index was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and normal subjects, respectively. The number of patients were 4 at stage I, 4 at stage II, 6 at stage III and 6 at stage IV. 5-Androstene-3 beta,16 beta,17 beta-triol (5-AT), 11 beta-hydroxy an and 17 beta-estradiol were significantly increased in the POP group as compared with the control group (0.76 +/- 0.67 vs. 0.06 +/- 0.03 mumol/g creatinine, P = .002, 1.16 +/- 0.83 vs. 0.65 +/- 0.23 mumol/g creatinine, P = .04; and 15.08 +/- 9.81 vs. 8.53 +/- 6.19 mumol/g creatinine, P = .04). However, tetrahydrocortisone (THE) was significantly increased in the control group as compared with the patient group (9.80 +/- 6.21 vs. 5.22 +/- 4.89 mumol/g creatinine, P = .04). Androgen metabolites 5-AT and THE significantly correlated with the pelvic organ prolapse quantitation (POP-Q) stage (R = .418; P = .027; R = .46, P = .016). Among the estrogen metabolites, 17 beta-estradiol correlated with POP-Q stage, but not significantly so (R = .38, P = .05), and the 17 beta-estradiol/estrone ratio weakly correlated with stage (R = .14, P = .49). CONCLUSION The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of POP.
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Affiliation(s)
- Sang Wook Bai
- Departments of Obstetrics and Gynecology and of Urology, College of Medicine, Yonsei University, Seoul, Korea 120-752.
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Abstract
OBJECTIVE The purpose of this study was to characterize the pelvic floor of the rhesus macaque as an experimental model for human pelvic organ prolapse and to initiate an evaluation of the effects of estradiol and progesterone on the rhesus paravaginal attachment. STUDY DESIGN Histologic specimens were prepared from the paravaginal attachment of 13 oophorectomized rhesus macaques. Three animals were treated with estradiol; 6 animals were treated with estradiol and progesterone, and 4 animals were untreated (hormone deprived). Immunocytochemistry was used to localize steroid receptors in the paravaginal attachment. RESULTS Spontaneous pelvic organ prolapse was observed in rhesus macaques. The paravaginal attachment is comprised of dense collagen and elastic fibers that infiltrate the levator ani muscle. The fibroblasts of this attachment are estrogen and progesterone receptor positive, and the receptors are hormone responsive. CONCLUSION The rhesus macaque has pelvic floor anatomy that is similar to women and makes an excellent experimental model for the study of prolapse. The rhesus paravaginal attachment is ligamentous and hormone sensitive. Its fibroblast activity may be modified by estrogen treatment in a manner similar to that reported in human pelvic connective tissue. The connective tissue of the paravaginal attachment interdigitates with the levator ani muscle cells, which suggests that this muscle plays a critical role in pelvic floor support.
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Affiliation(s)
- Lesley N Otto
- Division of Urogynecology and Reproductive Pelvic Surgery, Department of Obstetrics and Gynecology, Oregon Health Science University, Portland 97201, USA
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Liapis A, Bakas P, Pafiti A, Frangos-Plemenos M, Arnoyannaki N, Creatsas G. Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse. Eur J Obstet Gynecol Reprod Biol 2001; 97:76-9. [PMID: 11435014 DOI: 10.1016/s0301-2115(00)00478-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Objective of this study was to determine possible changes in the quantity of type III collagen in women with genuine stress incontinence (GSI) and with pelvic relaxation or not. MATERIAL AND METHODS Ninety-four women participated in the study and they were divided in to three groups as follow: 34 patients with GSI and pelvic relaxation (group 1), 32 patients with pelvic relaxation but without GSI (group 2) and 28 patients with neither pelvic relaxation nor GSI (group 3). All the women underwent a complete pre-operative urodynamic evaluation. The presence of collagen type III was determined by immunohistochemical technique. The X-test was used for statistical analysis. A P<0.05 was considered statistically significant. RESULTS Collagen type III was significantly reduced (p<0.05) in patients with GSI and pelvic relaxation in both sites of biopsy (group 1), compared to patients in groups 2 and 3. Specimens from women without GSI (group 2 and group 3) had a similar density of collagen type III in both sites of biopsy. CONCLUSION In this study, we found that women with GSI had less collagen type III around the urethra regardless of the degree of pelvic relaxation. It appears that collagen has a significant role in the maintenance of urinary continence but the mechanism by which collagen metabolism is altered remains unknown.
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Affiliation(s)
- A Liapis
- 2nd Department of Obstetrics and Gynecology, Aretaieio Hospital, University of Athens, Athens, Greece
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Yamamoto M, Akazawa K, Aoyagi M, Yamamoto K. Changes in biological characteristics during the cellular aging of ligament fibroblasts derived from patients with prolapsus uteri. Mech Ageing Dev 2000; 115:175-87. [PMID: 10906511 DOI: 10.1016/s0047-6374(00)00121-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Prolapsus uteri in pelvic support disorders are common in elderly women. The etiology is unclear and more likely to be multifactorial. We examined changes in biological characteristics and responsiveness to growth factors during the in vitro cellular aging of cardinal ligamental fibroblasts derived from patients with prolapsus uteri (HPLiF), and compared them with those of cells from age-matched control subjects (HCLiF). HPLiF and HCLiF had almost the same in vitro life span and the age-related patterns of biological parameters were essentially the same. However, the saturation density was significantly higher in HPLiF than in HCLiF. Furthermore, the high proliferative activity of HPLiF to serum mitogens, especially to platelet-derived growth factor, was retained throughout the in vitro life span. p53 protein levels in HPLiF increased at late passages, but were significantly less than in aged HCLiF. These results indicate that the higher proliferative activity in prolapsus fibroblasts may result from the decreased expression of p53 protein and may lead to a decrease in the synthesis and deposition of extracellular matrix components. These results support the hypothesis that functional alterations in ligament fibroblasts are involved in the mechanism of the development of prolapsus uteri.
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Affiliation(s)
- M Yamamoto
- Department of Cell Biology, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, 173, Tokyo, Japan
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Buchanan S, Hocking PM. Relationships between vaginal collagen, plasma oestradiol and uterine prolapse in turkeys. Br Poult Sci 1999; 40 Suppl:S43-4. [PMID: 10661438 DOI: 10.1080/00071669986783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- S Buchanan
- Roslin Institute (Edinburgh), Midlothian, Scotland
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Yamamoto M, Aoyagi M, Akazawa K, Tajima S, Yamamoto K. Decrease in p53 protein in cultured cardinal ligament fibroblasts from patients with prolapsus uteri. Cell Biol Int 1998; 22:31-40. [PMID: 9828080 DOI: 10.1006/cbir.1997.0207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The authors examined the growth response of cardinal ligamental fibroblasts derived from patients with prolapsus uteri (HPLiF) and compared it with the response of those from control subjects (HCLiF). The growth rate during the logarithmic growth phase was not different between HPLiF and HCLiF, while the cell density at confluence (saturation density) was significantly higher in HPLiF than in HCLiF. When added alone, platelet-derived growth factor (PDGF), insulin-like growth factor-I (IGF-I), and epidermal growth factor (EGF) produced minimal effects on DNA synthesis in HCLiF. The simultaneous addition of PDGF, IGF-I and EGF synergistically stimulated the DNA synthesis. In contrast, PDGF alone was able to initiate DNA synthesis in HPLiF. The combination of PDGF, IGF-I, and EGF significantly stimulated the DNA synthesis of HPLiF compared with HCLiF. p53 protein and p53 gene transcripts decreased by 50% in HPLiF. The anti-WAF1 antibody reacted intensely with a 21-kDa protein in the homogenates of control fibroblasts, while the immunoreactive band in prolapsus fibroblasts was clearly reduced. These results indicate that the higher proliferative activity at near confluency in prolapsus fibroblasts may result from the decreased expression of p53 protein and p53 mRNA followed by the decrease in p21 protein. Furthermore, the failure of cells to enter quiescence may lead to a decrease in the synthesis and deposition of elastin and thus may contribute to the loss of supportive function in uterine connective tissues.
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Affiliation(s)
- M Yamamoto
- Department of Cell Biology, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173, Japan
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Yamamoto K, Yamamoto M, Akazawa K, Tajima S, Wakimoto H, Aoyagi M. Decrease in elastin gene expression and protein synthesis in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri. Cell Biol Int 1997; 21:605-11. [PMID: 9570896 DOI: 10.1006/cbir.1997.0192] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abnormal connective tissues may be a key factor in the development of pelvic supportive disorders. Elastin gene transcripts and elastin synthesis in cultured fibroblasts derived from cardinal ligaments of patients with prolapsus uteri and compared them with those in fibroblasts from age-matched control patients were examined. Elastin mRNA steady-state levels and elastin synthesis were significantly down-regulated in quiescent fibroblasts from prolapsus uteri patients compared with quiescent control fibroblasts. Although transforming growth factor beta 1 (TGF-beta 1) promoted elastin mRNA and protein levels in fibroblasts from both prolapsus uteri and control patients, the maximum levels of elastin gene transcripts and elastin synthesis in response to exogenous TGF-beta 1 were significantly lower in prolapsus uteri fibroblasts than control fibroblasts. These results suggest that the marked reduction in elastin gene transcripts and elastin production in fibroblasts cultured from elderly women with prolapsus uteri could lead to a paucity of ligament elastic fibres and thus may contribute to the loss of supportive function in uterine connective tissues.
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Affiliation(s)
- K Yamamoto
- Department of Cell Biology, Tokyo Metropolitan Institute of Gerontology, Japan
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Abstract
The endocrine effects of surgical trauma are incompletely understood. We have measured serum levels of cortisol, 17 alpha-hydroxyprogesterone (17-OHP), dehydroepiandrosterone (DHA), 4-androstene-3,17-dione (A4) and total (free + conjugated) estrone (tE1) before, during and up to 6 days after surgery in 30 postmenopausal women undergoing repair of vaginal prolapse. Anesthetic procedures were standardized. During surgery and the early postoperative hours the serum steroid pattern closely resembled that found during a diagnostic ACTH challenge test with a simultaneous increase in all adrenocortical steroids, while tE1 levels were unchanged. During the late postoperative period the levels of cortisol, 17-OHP and A4 were still elevated up to 24 h after surgery while the levels of DHA were normal or even decreased. The postoperative pattern of adrenocortical steroids may reflect a redistribution of the intra-adrenal steroid flux in favor of cortisol production. The tE1 levels were elevated in the early and, most pronounced, in the late postoperative phase. tE1 was positively correlated to A4, in the early but not in the late postoperative phase. The late increase in tE1 probably reflects an impaired bowel function in connection with surgery, leading to increased reabsorption during enterohepatic circulation.
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Affiliation(s)
- M Eriksson-Mjöberg
- Department of Anesthesiology and Intensive Care, Karolinska Institutet, Huddinge University Hospital, Sweden
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Abstract
BACKGROUND Genitourinary prolapse is a common problem, the pathophysiology of which is unknown. METHODS We analysed vaginal-epithelial tissue from premenopausal women with genitourinary prolapse and compared them with controls. FINDINGS We found that genitourinary prolapse is associated with a reduction in total collagen content and a decrease in collagen solubility. Both intermediate intermolecular cross-links and advanced glycation cross-links were increased in prolapse tissue. Collagen turnover, as indicated by matrix metalloproteinase activity, was up to four times higher in prolapse tissue. Collagen-type ratios, mature cross-link pyridinoline and total elastin content were similar in both prolapse and control tissues. Increased collagenolytic activity causes loss of collagen from prolapse tissue. INTERPRETATION Based on these findings, we have identified a probable mechanism for genitourinary prolapse. Development of agents to inhibit collagenolytic activity may help in the treatment of this condition.
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Affiliation(s)
- S R Jackson
- Bristol Urological Institute, Southmead Hospital, Bristol, UK
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Mäkinen J, Kähäri VM, Söderström KO, Vuorio E, Hirvonen T. Collagen synthesis in the vaginal connective tissue of patients with and without uterine prolapse. Eur J Obstet Gynecol Reprod Biol 1987; 24:319-25. [PMID: 3582717 DOI: 10.1016/0028-2243(87)90157-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The insufficiency of connective tissue in pelvic relaxation was studied in five patients with uterine descent and in five age-related controls. Samples from vaginal fascias were first studied by histology. Fibroblast cultures started from each sample were analysed for their collagen synthesis and content of type I procollagen messenger RNAs (mRNAs). The cellularity of the fascias in histological specimens and the biosynthesis of collagen in fibroblast cultures decreased with increasing age in both groups. Fibroblasts grown from patients with uterine descent exhibited rates of collagen synthesis similar to or slightly higher than those from age-matched controls. The histological and biochemical changes observed in connective tissue of uterine descent are most likely related to the age and hormonal status of the patients. The findings suggest that uterine descent is not related to defects in the capacity of vaginal fibroblasts to synthesize or process procollagen.
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Parra Carracosa JL, Sojo Aranda I, Díaz de León A, Carranco López A, Cortés Gallegos V. [Tissue hormonal concentration: estrogen uptake by the myometrium]. Ginecol Obstet Mex 1985; 53:153-5. [PMID: 4065664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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