title: Alteration of elastin metabolism in women with pelvic organ prolapse.
abstract: OBJECTIVE
  Although there are many studies about the effects of vaginal birth, the effects of menopause on pelvic floor support have not been identified. We compared elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse, and defined the menopausal regulation of this process.
  
  
  METHODS
  The study group consisted of 35 women who underwent hysterectomy for pelvic organ prolapse. The control group consisted of 39 women without pelvic organ prolapse. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of mRNA, and protein for neutrophil elastase, matrix metalloproteinase-2, and matrix metalloproteinase-9 were determined by real-time quantitative polymerase chain reaction and ELISA, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin, an inhibitor of neutrophil elastase, was also determined. ANOVA, the Kruskal-Wallis test and multivariate linear regression were used for statistical analysis.
  
  
  RESULTS
  Expression of neutrophil elastase and matrix metalloproteinase-2 mRNA was higher in women with pelvic organ prolapse than in those without pelvic organ prolapse. Compared to before menopause, neutrophil elastase and matrix metalloproteinase-2 showed a significant decrease in postmenopausal women without pelvic organ prolapse, although these remained increased in postmenopausal women with pelvic organ prolapse. Alpha-1-antitrypsin was significantly less in postmenopausal women with pelvic organ prolapse than in postmenopausal women without pelvic organ prolapse. The activities of neutrophil elastase, matrix metalloproteinase-2 and matrix metalloproteinase-9 were increased in women with pelvic organ prolapse, and these trends were similar to neutrophil elastase and matrix metalloproteinase-2 expression even after adjustment for age, parity and menopausal status.
  
  
  CONCLUSIONS
  After menopause increased elastolytic protease has a significant role in the development of pelvic organ prolapse.
authors.affiliation: Department of Obstetrics and Gynecology, Yonsei University Health System, Seoul, Korea.
authors.forename: Yeo Jung
authors.initials: YJ
authors.lastname: Moon
authors.forename: Jong Rak
authors.initials: JR
authors.lastname: Choi
authors.forename: Myung Jae
authors.initials: MJ
authors.lastname: Jeon
authors.forename: Sei Kwang
authors.initials: SK
authors.lastname: Kim
authors.forename: Sang Wook
authors.initials: SW
authors.lastname: Bai
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015992:Body Mass Index; D016022:Case-Control Studies; D004549:Elastin / Q000378:metabolism*; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007044:Hysterectomy; D019272:Leukocyte Elastase / Q000378:metabolism; D008022:Ligaments / Q000378:metabolism*; D016014:Linear Models; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism; D010298:Parity; D056887:Pelvic Organ Prolapse / Q000378:metabolism*; D016133:Polymerase Chain Reaction; D017698:Postmenopause / Q000378:metabolism*; D017697:Premenopause / Q000378:metabolism*; D012333:RNA, Messenger / Q000378:metabolism; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires
chemical_list: D012333:RNA, Messenger; D004549:Elastin; D019272:Leukocyte Elastase; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9