Alteration of elastin metabolism in women with pelvic organ prolaspe

Abstract

[한글]

[영문]Objective: To compare elastin metabolism in the uterosacral ligament of women with and without pelvic organ prolapse (POP), and to define the menopausal regulation of this process.Methods: The study group consisted of 35 women who underwent hysterectomy for advanced (stage III-IV) POP. The control group consisted of 39 women without POP. A questionnaire was administered to assess age, parity, body mass index, and menopausal status. Expression levels of the mRNA and protein for elastolytic proteases, including neutrophil elastase (NE), matrix metalloproteinase (MMP)-2, and MMP-9, were determined by real-timequantitative polymerase chain reaction and enzyme-linked immunosorbentassay, respectively, using uterosacral ligament samples from each patient. Expression of alpha-1-antitrypsin (AAT), an inhibitor of NE, was also determined. ANOVA, Kruskal-Wallis test, and multivariate linear regression were utilized for statistical analysis.Results: Expression of NE and MMP-2 mRNA was higher in women with POP than without POP. Compared to premenopause, NE and MMP-2 showed a significant decrease in postmenopausal women without POP, although these remained elevated in postmenopausal women with POP. AAT was significantly less in postmenopausal women with POP than postmenopausal women without POP. The activities of NE, MMP-2, and MMP-9 were increased in women withPOP, and these trends were similar to NE and MMP-2 expression, even after adjustment for age, parity, and menopausal status.Conclusion: After menopause, elevated elastolytic protease activity could play a significant role in the development of POP.