Abstract
Objectives
Connective tissue consists of fibroblasts and extracellular matrix (ECM) with collagen
and elastic fibers, glycoproteins and proteoglycans (PGs) and it is considered an
important factor of the supportive structures of the genitourinary region. Since PGs
are essential for the organization of the collagen fibrils in the ECM, we investigated
the presence of two PGs, fibromodulin and lumican, and of collagen type I in the periurethral
connective tissue from women with stress urinary incontinence (SUI), compared to asymptomatic
controls.
Methods
Thirty-two patients participated in the study and they were divided into four groups:
premenopausal incontinents, premenopausal controls, postmenopausal incontinents and
postmenopausal controls. All patients underwent gynaecologic surgical procedures and
punch biopsies from the periurethral tissue were obtained. Immunohistochemistry for
collagen type I, fibromodulin and lumican was performed on the histological slides.
Results
In premenopausal incontinents the immunoreactivity for collagen type I was weaker
with an irregular distribution compared to premenopausal controls; while for fibromodulin,
the staining was stronger in premenopausal incontinents than in premenopausal controls.
Between the two postmenopausal groups there was not a significant difference in the
intensity of collagen type I and fibromodulin staining that instead were less strong
than in premenopausal groups. Lumican staining had the same distribution in the four
groups.
Conclusions
Our results suggest an altered remodelling of connective tissue in the periurethral
region of premenopausal patients with SUI, with a significant decrease of collagen
content and an irregular organization and distribution of the collagen fibrils, compared
to premenopausal controls. In the SUI patients this abnormal ECM remodelling, mainly
related to the observed change in PGs expression, might affect significantly the tensile
strength of the connective tissue and consequently the support that is provided by
the urogenital suspensory apparatus to urethra and bladder base. Moreover, the significant
decrease in collagen type I content in postmenopausal patients respect to premenopausal
patients, suggests that age and hormonal factors could contribute to the pathological
modifications of the supportive genitourinary connective tissues in the SUI patients.
Keywords
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References
- Connective tissue in female urinary incontinence.Curr Opin Ostet Gynecol. 1999; 11: 509-515
- Female urinary stress incontinence in terms of connective tissue biochemistry.Eur J Obstet Gynecol. 1993; 49: 187-191
- Evaluation of parturition and other reproductive variables as risk factors for urinary incontinence in later life.Am J Obstet Gynecol. 1997; 90: 983-989
- Race as predictor of urinary incontinence and pelvic organ prolapse.Am J Obstet Gynecol. 2001; 185: 116-120
- An integral theory and its method for the diagnosis and management of female urinary incontinence.Scand J Urol Nephrol. 1993; 153: 1-93
- Collagen family of proteins.FASEB J. 1991; 5: 2814-2823
- Different biochemical composition of connective tissue in continent and stress incontinent women.Acta Obstet Gynecol Scand. 1987; 66: 455-457
- Role of fascial collagen in stress urinary incontinence.Am J Obstet Gynecol. 1998; 179: 1511-1514
- Changes in the quantity of collagen type I in women with genuine stress incontinence.Urol Res. 2000; 28: 323-326
- Changes of collagen type III in female patients with genuine stress incontinence and pelvic floor prolapse.Eur J Obs Gyn Reprod Biol. 2001; 97: 76-79
- Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse.Int Urogynecol J. 2002; 13: 80-87
- Collagen synthesis is not altered in women with stress urinary incontinence.Neurol Urodynam. 2004; 23: 367-373
- Structure and function of cell-associated proteoglycans.TIBS. 1987; 12: 406-411
- Negative regulation of transforming growth factor-β by the proteoglycan decorin.Nature. 1990; 346: 281-284
- Proteoglycans and the extracellular environment: clues from the gene and protein side offer novel perspectives in molecular diversity and function.FASEB J. 1996; 10: 598-614
- Specific inhibition of type I and type II collagen fibrillogenesis by the small proteoglycan of tendon.Biochem J. 1984; 223: 587-597
- A study of the interaction in vitro between type I collagen and a small dermatan sulphate proteoglycan.Biochem J. 1988; 251: 643-648
- Interaction of a 59 kDa connective tissue matrix protein with collagen I and collagen II.J Biol Chem. 1989; 264: 6898-6905
- Binding of fibromodulin and decorin to separate sites on fibrillar collagens.J Biol Chem. 1993; 268: 27307-27312
- Regulation of corneal collagen fibrillogenesis in vitro by corneal proteoglycan (lumican and decorin) core proteins.Exp Eye Res. 1993 Jun; 56: 635-648
- Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis.Am J Obstet Gynecol. 1994; 170: 1713-1723
- Regulation of Fas ligand expression by estradiol and progesterone in human endometrium.Biol Reprod. 2001; 65: 979-985
- Expression and distribution of notch protein members in human placenta throughout pregnancy.Placenta. 2007; 28: 118-126
- Analysis of collagen status in premenopausal nulliparis women with genuine stress incontinence.Br J Obstet Gynaecol. 1997; 104: 994-998
- Changes in paraurethral connective tissue at menopause are counteracted by estrogen.Maturitas. 1996; 24: 197-204
- Paraurethral connective tissue in stress-incontinent women after menopause.Acta Obstet Gynecol Scand. 1998; 77: 95-100
- Hormone replacement therapy and the skin.Maturitas. 2000 May 29; 35: 107-117
- The ageing of connective tissue.Academic Press, 1976 (70)
- Evidence for progressive, age-related structural changes in post-mature human collagen.Biochim Biophys Acta. 1971; 236: 458-467
- Different organitation of collagen fibrils in stress-incontinent women of fertile age.Acta Obstet Gynecol Scand. 1998; 77: 87-94
- Decreased collagen synthesis in stress-incontinent women.Obstet Gynecol. 1994; 84: 583-586
- Correlation of urethral physiology and skin collagen in postmenopausal.Br J Obstet Gynecol. 1988; 95: 147-152
- Changes in the quantity of collagen type I in women with genuine stress incontinence.Urol Res. 2000; 28: 323-326
- Biochemical composition of collagen in continent and stress urinary incontinent women.Gynecol Obstet Invest. 1994; 37: 48-51
- Differences in the quantity of elastic fibres and collagen type I and type III in endopelvic fascia between women with stress urinary incontinence and controls.Urol Res. 2003; 31 (Epub 2003 Apr 2): 61-65
- Mice deficient in small leucine-rich proteoglycans: novel in vivo models for osteoporosis, osteoarthritis, Ehlers-Danlos syndrome, muscular dystrophy, and corneal diseases.Glycobiology. 2002; 12: 107R-116R
- The role of decorin in collagen fibrillogenesis and skin homeostasis.Glycoconj J. 2002; 19: 249-255
- Targeted disruption of decorin leads to abnormal collagen fibril morphology and skin fragility.J Cell Biol. 1997; 136: 729-743
- A role for decorin in the structural organization of periodontal ligament.Lab Invest. 2000; 80: 1869-1880
- Fibromodulin-null mice have abnormal collagen fibrils, tissue organization, and alterd lumican deposition in tendon.J Biol Chem. 1999; 274: 9636-9647
- Corneal opacity in lumican-null mice: defects in collagen fibril structure and packing in the posterior stroma.Invest Ophthalmol Vis SCi. 2000; 41: 3365-3373
- Lumican regulates collagen fibril assembly, skin fragility and corneal opacity in the absence of lumican.J Cell Biol. 1998; 141: 1277-1286
- Abnormal collagen fibrils in tendons of biglycan/fibromodulin-deficient mice lead to gait impairment, ectopic ossification, and osteoarthritis.FASEB J. 2002 May; 16: 673-680
- Effect of adenovirus-mediated overexpression of decorin on metalloproteinases, tissue inhibitors of metalloproteinases and cytokines secretion by human gingival fibroblasts.Matrix Biol. 2003; 22: 251-258
- A role for decorin in the structural organization of periodontal ligament.Lab Invest. 2000; 80: 1869-1880
- Immunohistochemical assessment of steroid hormone receptors in tissue of the anal canal implications for anal incontinence.Acta Obstet Gynecol Scand. 1996; 75: 892-895
- Estrogen and Progesteron receptors in the human vagina during the menstrual cycle, pregnancy and postmenopause.Maturitas. 1993; 16: 139-144
- Expression of estrogen receptor-α and –β in anterior vaginal walls of genuine stress incontinent women.Int Urogynecol J Pelvic Floor Dysfunct. 2003; 14: 276-281
- Estrogen levels and estrogen receptors in patients with stress urinary incontinence and pelvic organ prolapse.Int J Gynaecol Obstet. 2003; 80: 35-39
- Estrogen receptor in pelvic floor tissues in patients with stress urinary incontinence.Int Urogynecol J Pelvic Floor Dysfunct. 2004; 15: 340-343
- The role of Estrogen Receptor, Progesterone Receptor and p53 in Development of Stress Urinary Incontinence.Yonsei Med J. 2004; 45: 885-890
Article info
Publication history
Published online: October 17, 2007
Accepted:
September 11,
2007
Received in revised form:
September 10,
2007
Received:
October 23,
2006
Identification
Copyright
© 2007 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
