Expression And Significance Of OPN And Receptor Integrin(?v,?3),E-Cad And MMP-9 In Tissues Of Placenta Accrete

Placenta accrete is extremely serious complications of obstetric. It can cause postpartum hemorrhage, uterine rupture, hysterectomy, and maternal death. In recent years, cesarean section rate is rising; unwanted abortion rate is high; and the number of operations such as hysteromyoma resection is on the rise. They all increase the chances of endometrial lesions. Pregnant women with scar uterus are more commonly seen in obstetric clinic as the "two-child" policy promulgated. The incidence of placenta accrete also subsequently heighten. They bring huge challenges for the obstetrician.To investigate the roles in the pathogenesis of placenta accrete through analyzing the expression differences of osteoponin( OPN)?integrin ?v ? integrin?3 ? E-Cadherin( E-Cad)? and matrix metalloproteinase-9( MMP-9) in the tissues of accrete placenta and normal placenta. At the same time we observed the changes of morphology of accrete placenta and normal placenta with optical microscope and electron microscope.34 cases of late pregnancy placenta tissues from pregnant women with placenta accrete(Including 26 cases of placenta adhesion and 8 cases of placenta increta)were taken as the research group and 34 cases of late pregnancy placenta tissues from normal pregnancy women were taken as the control group. En Vision immunohistochemistry was to used to detect the protein expression of OPN ?integrin ?v?integrin ?3?E-Cad and MMP-9 in all of the specimen. SYBR Green PCR method was to used to detect the m RNA expression of OPN ?integrin ?v?integrin ?3?E-Cad and MMP-9 in all of the specimen. Conventional HE and electron microscope were performed. Observed morphology changes of placenta accrete and normal placenta.Through En Vision immunohistochemistry detection :( 1) The positive rate of OPN expression in placental tissues of the control group and the research group were 35.29%, 61.77% respectively. The protein expression of OPN in the research group was significantly higher than the control group. The differences were significant compared with the control group(P=0.029,P<0.05).(2)The strong positive rate of integrin ?v expression in placental tissues of the control group and the research group were 29.41%, 76.47% respectively. The protein expression of integrin ?v in the research group was higher than the control group. The differences were significant compared with the control group(P=0.000,P<0.01).(3)The positive rate of integrin ?3 expression in placental tissues of the control group and the research group were 41.18%,17.65% respectively.The protein expression of integrin ?3 in the research group was higher than the control group. The differences were significant compared with the control group(P=0.033,P<0.05).(4)The strong positive rate of E-Cad expression in placental tissues of the control group and the research group were 35.29%, 13.33% respectively. The protein expression of E-Cad in the research group was lower than the control group. The differences were significant compared with the control group(P=0.022,P<0.05).(5)The positive rate of MMP-9 expression in placental tissues of the control group and the research group were 14.71%, 47.06%respectively. The protein expression of MMP-9 in the research group was higher than the control group. The differences were significant compared with the control group(P=0.004,P<0.01). Immunohistochemistry results show the protein expression of OPN, integrin ?v and MMP-9 in the research group increase; the protein expression of integrin ?3 and E-cad in the research group decrease.Through SYBR Green PCR detection:(1)OPN m RNA expression in the research group was 1.57 times of the control group. OPN m RNA expression in placenta accrete increased by 57%.(2)Integrin ?v m RNA expression in the research group was 1.42 times of the control group.Integrin ?v m RNA expression in placenta accrete increased by 42%.(3)Integrin ?3 m RNA expression in the research group was 0.60 times of the control group. Integrin ?3 m RNA expression in placenta accrete decreased by 40%.(4)E-Cad m RNA expression in the research group was0.45 times of the control group. E-Cad m RNA expression in placenta accrete decreased by 55%.(5)MMP-9 m RNA expression in the research group was 1.20 times of the control group. MMP-9 m RNA expression in placenta accrete increased by 20%. SYBR Green PCR results show: The m RNA expression of OPN, integrin ?v and MMP-9 in the research group increase. OPN m RNA expression in placenta accrete tissues increase the most.The m RNA expression of integrin ?3 and E-cad in the research group decrease. E-Cad m RNA expression in placenta accrete tissues decrease the most.Through the analysis of Pearson correlation about immunohistochemistry results, we can see the expression of OPN and E-Cad in research group was negative correlated with each other(r=-0.313,P=0.009).The expression of OPN and integrin ?v, OPN and integrin ?3, OPN and MMP-9, integrin ?v and integrin ?3, integrin ?v and E-Cad, integrin ?v and MMP-9, integrin ?3 and E-Cad, integrin ?3and MMP-9, E-Cad and MMP-9were not correlated with each other(P>0.05).The morphology changes of placenta accrete was as follows. Under optical microscope, we found decidual layer of normal placenta was in good condition. The infiltration depth of placenta trophocyte was in decidual layer or 1/3 of myometrium. But decidual layer of placenta accrete reduced or even disappeared. Placental villi nourish cells invaded myometrium. The muscle fibers of uterine were loss of normal structure.Uterine muscle fibers changed with degeneration, fracture and separation and arranged in disorder. Smooth muscle cells distributed like clusters and groups. Small new blood vessels in the placenta tissues increased and arranged in disorder.Under electron microscope,we found the villus in the surface of normal placenta trophoblast arranged in radial orderly. The villus in the surface of placenta accrete trophoblast was increased and arranged disorderly. The morphology of villus arranged in disorder. The villus in the surface of placenta accrete syncytiotrophoblast was thicken,and went deep into uterine decidua basal layer, even reached the myometrium. The villus formed close connections with the uterus.It can be speculated through detecting the expression differences of OPN, integrin ?v, integrin ?3, E-Cad and MMP-9 in the tissues of placenta accrete and normal placenta with En Vision immunohistochemistry and SYBR Green PCR: OPN, integrin ?v, integrin?3, E-cad and MMP-9 were expressed in placenta accrete and normal placenta. The expression of OPN, integrin ?v and MMP-9 in placenta accrete increased; the expression of integrin ?3 and E-cad in placenta accrete decreased. It proves OPN, integrin ?v, integrin ?3, E-cad and MMP-9 participating in invasive activity of trophoblast cells. They may be related to the pathogenesis of placenta accrete. OPN m RNA expression in placenta accrete tissues increase the most and E-Cad m RNA expression in placenta accrete tissues decrease the most. The expression of OPN and E-Cad in research group was negative correlated with each other. It speculates that further study on the relationship between OPN and E-Cad may provide evidence for the pathogenesis of placenta accrete and clinical prediction.