Study On The Role Of Collagen And Decorin And Transform Growth Factor On Pelvic Floor Dysfunction Mechanism

ObjectiveTo observe the relativity of expression of decorin and TGF-β1 and the variability of typeâ… collagen in the connective tissue of the anterior vaginal wall from patients with pelvic organ prolapse(POP) and stress urinary incontinence(SUI). To detected the possible biochemical changes in the connective tissue of the anterior vaginal wall. To explore whether the alteration in the expression of collagen concentration and decorin might contribute to the development of POP and SUI.MethodsTransvaginal biopsies were obtained from the anterior vaginal wall in POP, POP+SUI and controls. sixty-two women participated in the study and they were divided into six groups as follow: 10 premenopausal patients with POP (group 1), 11 premenopausal patients with POP+SUI(group 2), 12 premenopausal patients with neither UI nor POP(group 3),10 postmenopausal patients with POP (group 4),9 postmenopausal patients with POP+SUI (group 5),9 postmenopausal patients with neither UI nor POP(group 6).In the specimens, the concentration of collagen typeâ… was determined by ELISA technique. Relative real-time quantification PCR (RT-qPCR) was used to verify the mRNA levels of the decorin and TGF-β1. The t-test was used for statistical analysis. A p＜0.05 was considered statistically significant.ResultsThe mean concentration of typeâ… collagen was significantly reduced (p＜0.01) in both premenopausal and postmenopausal patients with POP with and without SUI, compared to the control group. The mean concentration of typeâ… collagen was 23% lower in the premenopausal women with POP than those in the control group.31% lower in the postmenopausal women with POP than those in the control group, 27% lower in the premenopausal women with POP+SUI than those in the control group, and 30% lower in postmenopausal women with POP+SUI than those in the control group. In the premenopausal women ,we found that the expression of decorin was significantly high(p＜0.01) in both POP(2.21 times) and POP+SUI(1.73 times) patients, and with high relativity to the variability of typeâ… collagen, and the correlation coefficients are 0.765 and 0.846 respectively, the expression of TGF-β₁ was significantly decreased (p＜0.05),and they are significantly relatived to the variability of typeâ… collagen too, and the correlation coefficients are 0.677(p＜0.05) and 0.769(p＜0.01) respectively.In the postmenopausal women, the expression of decorin decreased in the patients with POP(0.81 times,p＞0.05),and TGF-betal was increased(1.48 times ,p＞0.05), compared to the control group.But in the patients with POP+SUI,the expression of decorin was significantly indecreased(1.64 times ,p＜0.05),and TGF-β1 decreased (0.84 times ,p＞0.05).A similar(p＞0.05) expression of decorin and TGF-β1 in the paraurethral connective tissue biopsies was found in both POP patients with and without SUI, compared to the corresponding control group. As to age and parity, a significant difference was found (p＜0.05) between postmenopausal patients with POP and postmenopausal patients without POEConclusionIn this study, we found that both the premenopausal and the postmenopausal women with POP with/without SUI had a significant decrease typeâ… collagen in the connective tissue of the anterior vaginal wall, suggesting POP probably is associated with a change in collagen metabolism resulting in a low concentration of collagen.In the premenopausal women with POP with and without SUI, the expression of decorin and TGF-β1is significantly correlative to collagen. This suggest that A higher level of mRNA for decorin indicates that the differences can be related to an altered collagen metabolism. These alterations should result in a less tenacity of excellular matrix, suggesting a connective tissue with impaired mechanical function. Those tissues probably are less tensile strength and more likely to prolapse and break, which suggests that decorin and some cellular factor might be involved in the pathogenesis of PFD.In this study, we also found that the expression of decorin was decrease in the postmenopausal women with POP, and expression of TGF-β1 was increase contrarily, due to the decrease of all excellular matrix in the connective tissue of anterior vaginal wall in postmenopausal patients with POE Meantime, we found that the postmenopausal patients with POP had a significantly more age and parity, compared to control group, we reach the conclusion that the collagen metabolism in the connective tissue of anterior vaginal wall in postmenopausal patients with POP might be modulated by aging process, higher parity previous pelvic trauma and reproductive hormones, which suggests that age and parity might be involved in the pathogenesis of POP.