title: Elastin density: Link between histological and biomechanical properties of vaginal tissue in women with pelvic organ prolapse?
abstract: OBJECTIVE
  The aim of the study was to correlate histological and biomechanical characteristics of the vaginal wall in women with pelvic organ prolapse (POP).
  
  
  METHODS
  Tissue samples were collected from the anterior [point Ba; POP Questionnaire (POP-Q)] and/or posterior (point Bp; POP-Q) vaginal wall of 15 women who underwent vaginal surgery for POP. Both histological and biomechanical assessments were performed from the same tissue samples in 14 of 15 patients. For histological assessment, the density of collagen and elastin fibers was determined by combining high-resolution virtual imaging and computer-assisted digital image analysis. For biomechanical testing, uniaxial tension tests were performed to evaluate vaginal tissue stiffness at low (C0) and high (C1) deformation rates.
  
  
  RESULTS
  Biomechanical testing highlights the hyperelastic behavior of the vaginal wall. At low strains (C0), vaginal tissue appeared stiffer when elastin density was low. We found a statistically significant inverse relationship between C0 and the elastin/collagen ratio (p = 0.048) in the lamina propria. However, at large strain levels (C1), no clear relationship was observed between elastin density or elastin/collagen ratio and stiffness, likely reflecting the large dispersion of the mechanical behavior of the tissue samples.
  
  
  CONCLUSIONS
  Histological and biomechanical properties of the vaginal wall vary from patient to patient. This study suggests that elastin density deserves consideration as a relevant factor of vaginal stiffness in women with POP.
authors.affiliation: Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium. ldelandsheere@chu.ulg.ac.be.|Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium. ldelandsheere@chu.ulg.ac.be.
authors.forename: Laurent
authors.initials: L
authors.lastname: de Landsheere
authors.affiliation: LML, CNRS UMR 8107, Ecole centrale de Lille, University Nord de France, Lille, France.
authors.forename: Mathias
authors.initials: M
authors.lastname: Brieu
authors.affiliation: Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Silvia
authors.initials: S
authors.lastname: Blacher
authors.affiliation: Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Carine
authors.initials: C
authors.lastname: Munaut
authors.affiliation: Laboratory of Connective Tissues Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Betty
authors.initials: B
authors.lastname: Nusgens
authors.affiliation: Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, n°2, 59037, Lille Cedex, France.
authors.forename: Chrystèle
authors.initials: C
authors.lastname: Rubod
authors.affiliation: Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Agnès
authors.initials: A
authors.lastname: Noel
authors.affiliation: Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium.|Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Foidart
authors.affiliation: Department of Obstetrics and Gynecology, University of Liège, CHR La Citadelle, Boulevard du 12e de ligne, n°1, 4000, Liège, Belgium.|Laboratory of Tumor and Development Biology, GIGA-Cancer, University of Liège, CHU Sart-Tilman, Avenue de l'Hôpital, 4000, Liège, Belgium.
authors.forename: Michelle
authors.initials: M
authors.lastname: Nisolle
authors.affiliation: Department of Gynecologic Surgery, Hôpital Jeanne de Flandre, Centre Hospitalier Régional Universitaire de Lille, Avenue Oscar Lambret, n°2, 59037, Lille Cedex, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Cosson
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D003094:Collagen / Q000502:physiology; D004548:Elasticity; D004549:Elastin / Q000502:physiology*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000473:pathology* / Q000503:physiopathology* / Q000601:surgery; D013314:Stress, Mechanical; D014621:Vagina / Q000473:pathology* / Q000503:physiopathology*
chemical_list: D003094:Collagen; D004549:Elastin
keywords: Biomechanics; Collagen; Connective tissue; Elastin; Pelvic organ prolapse; Vagina