Matrix Metalloproteinase-1 Expression in Women With and Without Pelvic Organ Prolapse: A Systematic Review and Meta-analysis

The difference in extracellular matrix metabolism in women with and without pelvic organ prolapse: A systematic review and meta-analysis

BACKGROUND

Studies on the changes of extracellular matrix (ECM) in pelvic organ prolapse (POP) are still controversial.

OBJECTIVE

To identify the changes in the ECM in POP patients.

SEARCH STRATEGY

Comprehensive searching in Embase, PubMed, Web of Science and the Cochrane Library was carried out until 23 February 2023.

SELECTION CRITERIA

Studies comparing the protein levels of ECM-related components between women with and without POP.

DATA COLLECTION AND ANALYSIS

Quality and risk of bias were assessed using the Agency for Healthcare Research and Quality assessment. Indicators were pooled with random or fixed effect meta-analysis based on heterogeneity and sub-grouped analysed by the biopsy site.

MAIN RESULTS

Thirty cross-sectional studies were included, comprising 840 POP cases and 755 controls. Overall results showed that the expression of type III collagen (COLIII) and several matrix metalloproteinases (MMP-1, -2 and -9) were increased, whereas those of type I collagen (COLI), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) were decreased in patients with POP. Subgroup analysis showed that the expression of COLIII in the anterior vaginal wall (AVW) and COLIII, MMP-2 and -9 in the uterosacral ligament (USL) were consistent with the overall results. However, the expression of COLI and MMP-1 in the AVW showed no difference and the expression of COLI and MMP-1 in the USL is still controversial based on current studies.

CONCLUSIONS

Patients with POP have lower expression of COLI and TIMP-1 and higher expression of COLIII and MMPs compared with non-POP cases, but further studies are required to investigate in specified anatomical sites.

Factors associated with pelvic organ prolapse: case-control study in two hospitals of Bon-Berger and Saint Georges of the city of Kananga in the Democratic Republic of the Congo

Introduction

pelvic organ prolapse is a disease or disorder of the pelvic floor that can both worsen or regress, especially in the postpartum period. It carries a high risk of recurrence after surgical treatment. The objective of this study is to identify the factors associated with pelvic organ prolapse in the two hospitals of Bon-Berger and Saint-Georges in the town of Kananga in the Democratic Republic of Congo.

Methods

this is a case-control study that is carried out on the medical records of 134 patients admitted to the gynecology departments of the Bon-Berger Hospitals of Tshikaji and Saint Georges of Katoka, from January 1st to July 31st, 2023 and based on non-probability convenience sampling for case selection. The ANOVA test, Chi-test and logistic regression with adjustment are used in the statistical analyses.

Results

the factors associated with the occurrence of pelvic organs prolapse are heavy physical work (aOR: 4.031, 95% CI: 2.760-9.212; p: 0.004), malnutrition in the form of BMI less than 18.5 (aOR: 2.550, 95% CI: 1.360-5.840; p: 0.023), multiparity (aOR: 1.520, 95% CI: 1.234-4.320; p: 0.015), vaginal delivery (aOR: 3.020, 95% CI: 0.063-14.470; 0.002), fetal macrosomia (aOR: 4.290, 95% CI: 3.320-5.550; p: 0.032), pelvic tears (aOR: 2.910, 95% CI: 2.090-5.930, p: 0.006) and menopause (aOR: 3.110, 95% CI: 1.040-9.250, p: 0.001).

Conclusion

these results can serve as a basis for screening women at high risk of suffering from pelvic organ prolapse during gynecological and obstetrical consultations and for in-depth studies seeking the matrix metalloproteinases associated with pelvic organ prolapse to improve its treatment in hospitals of our town of Kananga.

The difference in collagen type-1 expression in women with and without pelvic organ prolapse: a systematic review and meta-analysis

INTRODUCTION AND HYPOTHESIS

This study was aimed at identifying the difference in collagen type-1 expression in women with and without pelvic organ prolapse (POP).

METHODS

A systematic review and meta-analysis was carried out women with and without pelvic organ prolapse. This meta-analysis was conducted on research articles describing the evaluation of collagen type-1 expression between patients with and without POP. The articles were obtained from PubMed, EBSCO, and ProQuest, and were published between January 2000 and June 2021. Pooled mean difference (MD) and pooled odds ratio (OR) were calculated using fixed effect models. Review Manager (RevMan 5.4) was used to analyze the data. The main outcome measures were pooled MD and pooled OR of collagen type-1 expression in patients with and without POP.

RESULTS

A total of seven case-control studies were included in the meta-analysis using the effect size of the MD and two case-control studies were included in the meta-analysis using the effect size of the OR. A total of 247 POP cases and 132 non-POP cases were identified from the studies. Our study indicated that patients with POP had a lower level of collagen type-1 expression than non-POP patients (MD = -6.77; 95% CI: -8.37, -5.17, p < 0.00001). Patients with low expression of collagen type-1 in pelvic support tissue are at a more than 3 times higher risk of suffering from pelvic organ prolapse (OR = 3.23, 95% CI: 1.52 to 6.87, p = 0.002).

CONCLUSION

The results of this study showed that patients with pelvic organ prolapse have lower expression of collagen type-1 than nonpelvic organ prolapse patients.

Alterations of elastin in female reproductive tissues arising from advancing parity

Female reproductive tissues undergo significant alterations during pregnancy, which may compromise the structural integrity of extracellular matrix proteins. Here, we report on modifications of elastic fibers, which are primarily composed of elastin and believed to provide a scaffold to the reproductive tissues, due to parity and parturition. Elastic fibers from the upper vaginal wall of virgin Sprague Dawley rats were investigated and compared to rats having undergone one, three, or more than five pregnancies. Optical microscopy was used to study fiber level changes. Mass spectrometry, ¹³C and ²H NMR, was applied to study alterations of elastin from the uterine horns. Spectrophotometry was used to measure matrix metalloproteinases-2,9 and tissue inhibitor of metalloproteinase-1 concentration changes in the uterine horns. Elastic fibers were found to exhibit increase in tortuosity and fragmentation with increased pregnancies. Surprisingly, secondary structure, dynamics, and crosslinking of elastin from multiparous cohorts appear similar to healthy mammalian tissues, despite fragmentation observed at the fiber level. In contrast, elastic fibers from virgin and single pregnancy cohorts are less fragmented and comprised of elastin exhibiting structure and dynamics distinguishable from multiparous groups, with reduced crosslinking. These alterations were correlated to matrix metalloproteinases-2,9 and tissue inhibitor of metalloproteinase-1 concentrations. This work indicates that fiber level alterations resulting from pregnancy and/or parturition, such as fragmentation, rather than secondary structure (e.g. elastin crosslinking density), appear to govern scaffolding characteristics in the female reproductive tissues.

Expression changes in pelvic organ prolapse: a systematic review and in silico study

Pelvic organ prolapse (POP) is a highly disabling condition common for a vast number of women worldwide. To contribute to existing knowledge in POP pathogenesis, we performed a systematic review of expression studies on both specific gene and whole-genome/proteome levels and an in silico analysis of publicly available datasets related to POP development. The most extensively investigated genes in individual studies were related to extracellular matrix (ECM) organization. Three premenopausal and two postmenopausal sets from two Gene Expression Omnibus (GEO) studies (GSE53868 and GSE12852) were analyzed; Gene Ontology (GO) terms related to tissue repair (locomotion, biological adhesion, immune processes and other) were enriched in all five datasets. Co-expression was higher in cases than in controls in three premenopausal sets. The shared between two or more datasets up-regulated genes were enriched with those related to inflammatory bowel disease (IBD) in the NHGRI GWAS Catalog. ECM-related genes were not over-represented among differently expressed genes. Up-regulation of genes related to tissue renewal probably reflects compensatory mechanisms aimed at repair of damaged tissue. Inefficiency of this process may have different origins including age-related deregulation of gene expression.