Remodeling of vaginal connective tissue in patients with prolapse.
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.


METHODS
II-2.
Moalli
Pamela A
PA
Magee-Womens Research Institute and the Department of Obstetrics & Gynecology at Magee Womens Hospital, 300 Halket Street, Pittsburgh, PA 15213, USA. RSIPAM@mail.magee.edu
Shand
Stuart H
SH
Zyczynski
Halina M
HM
Gordy
Susan C
SC
Meyn
Leslie A
LA
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003238:Connective Tissue / Q000378:metabolism* / Q000473:pathology; D015914:Estrogen Replacement Therapy; D005260:Female; D024022:Fibrillar Collagens / Q000378:metabolism*; D006801:Humans; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism*; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism*; D008875:Middle Aged; D014596:Uterine Prolapse / Q000378:metabolism* / Q000473:pathology; D014621:Vagina / Q000378:metabolism* / Q000473:pathology
D024022:Fibrillar Collagens; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9