title: Endometrial breakdown in women using Norplant is associated with migratory cells expressing matrix metalloproteinase-9 (gelatinase B).
abstract: Norplant, subdermally implanted slow-release levonorgestrel, is an effective and widely used contraceptive agent but has a high rate of discontinuation due to unacceptable abnormal uterine bleeding. Matrix metalloproteinases (MMPs) are expressed in normal cycling endometrium and are postulated to be responsible for the tissue breakdown at menstruation. We have compared the immunolocalization of MMP-9 and migratory cells in endometrium from Indonesian women using Norplant with normal controls. Positive MMP-9 immunostaining was observed intracellularly within stromal and intravascular leukocytes and extracellularly in areas of tissue lysis adjacent to these migratory cells. The MMP-9 positive cells were identified as neutrophils, eosinophils, CD3+ T-cells and macrophages. Quantitative assessment revealed that the number of MMP-9 positive cells, neutrophils and eosinophils were significantly increased in those endometrial biopsies from Norplant users displaying a shedding morphology and in normal controls at menstruation. There was no correlation between the number of MMP-9 positive cells and the number of bleeding days reported. Endometrial immunostaining for tissue inhibitor of metalloproteinases was similar in Norplant users and normal controls. These results suggest that MMP-9, an enzyme capable of degrading basement membrane components, may be involved in endometrial breakdown in women using Norplant.
authors.affiliation: Prince Henry's Institute of Medical Research, Clayton, Victoria, Australia.
authors.forename: A J
authors.initials: AJ
authors.lastname: Vincent
authors.forename: N
authors.initials: N
authors.lastname: Malakooti
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: P A
authors.initials: PA
authors.lastname: Rogers
authors.forename: B
authors.initials: B
authors.lastname: Affandi
authors.forename: L A
authors.initials: LA
authors.lastname: Salamonsen
mesh_terms: D000328:Adult; D001706:Biopsy; D017252:CD3 Complex / Q000032:analysis; D002465:Cell Movement; D017364:Collagenases / Q000032:analysis* / Q000378:metabolism; D004343:Drug Implants; D004717:Endometrium / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D004804:Eosinophils / Q000201:enzymology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007214:Indonesia; D016912:Levonorgestrel / Q000009:adverse effects*; D008264:Macrophages / Q000201:enzymology; D020780:Matrix Metalloproteinase 9; D009504:Neutrophils / Q000201:enzymology; D013601:T-Lymphocytes / Q000201:enzymology; D019714:Tissue Inhibitor of Metalloproteinases / Q000032:analysis; D014592:Uterine Hemorrhage / Q000139:chemically induced / Q000473:pathology
chemical_list: D017252:CD3 Complex; D004343:Drug Implants; D019714:Tissue Inhibitor of Metalloproteinases; D016912:Levonorgestrel; D017364:Collagenases; D020780:Matrix Metalloproteinase 9