Matrix metalloproteinases-1, -2 expression in uterosacral ligaments from women with pelvic organ prolapse

Circulating matrix metalloproteinases and their tissue inhibitors as markers for ethnic variation in pelvic floor tissue integrity

“…This may result from differences in the frequency of reporting of symptoms as well as diagnosis, parity, BMI, lifestyle including diet, occupation, smoking and athletic exercise, position at delivery, micturition or defecation, socio-economic status and life expectancy (10). It may also be due to considerable genetic and ethnic variation in collagen metabolism of the pelvic floor connective tissue determined by the balance between MMP and TIMP activity (1)(2)(3)(4)(5)(6)(7). A relative increase in MMP/TIMP ratio may increase collagen turnover and decrease integrity, which could be responsible for the observed Caucasian vulnerability to support-related female pelvic floor dysfunctions.…”

“…Support-related pelvic floor dysfunctions including pelvic organ prolapse (POP), stress urinary incontinence (SUI) and faecal incontinence are caused by structural defects in the complex supportive apparatus formed by the connective tissue and striated muscles of the pelvic floor (1)(2)(3)(4)(5)(6)(7). The role of the connective tissue component is to counteract both stretch and compression of the pelvic floor exerted by the gravitational and inertial forces of the intra-abdominal pressure and to repair damaged tissues (2,4,6).…”

“…The role of the connective tissue component is to counteract both stretch and compression of the pelvic floor exerted by the gravitational and inertial forces of the intra-abdominal pressure and to repair damaged tissues (2,4,6). This supportive function is determined by the tensile strength of collagen in the extracellular matrix that is maintained by continuous remodelling of collagen (1,3). The latter depends on a critical balance between collagen degradation and production that is controlled by a group of enzymes, matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) (1,3,5).…”

“…This supportive function is determined by the tensile strength of collagen in the extracellular matrix that is maintained by continuous remodelling of collagen (1,3). The latter depends on a critical balance between collagen degradation and production that is controlled by a group of enzymes, matrix metalloproteinases (MMPs) and their respective tissue inhibitors (TIMPs) (1,3,5). The prevalence of support-related pelvic floor dysfunctions is affected by racial and ethnic origin, with a higher risk observed in Caucasians than in other populations (8)(9)(10).…”

“…Ethnic variation in the integrity of the pelvic floor connective tissue may be the possible genetic mechanism (10). This factor has been traditionally assessed by measuring the tissue levels of MMPs, particularly types 2 and 9, and their TIMPs, particularly types 1 and 2, in the fascial components of the pelvic floor (1)(2)(3)(4)(5)(6). However, to the best of our knowledge, circulating MMP and TIMP levels as surrogate biomarkers of pelvic floor tissue have not been previously measured in women with POP or correlated with tissue levels.…”