Transforming growth factor a1 and extracellular matrix protease expression in the uterosacral ligaments of patients with and without pelvic organ prolapse

Ava Leegant, Lisa C. Zuckerwise, Keith Downing, Jurriaan Brouwer-Visser, Changcheng Zhu, Maria Jose Cossio, Felix Strube, Xianhong Xie, Erika Banks, Gloria S. Huang

Research output: Contribution to journalArticle

2 Scopus citations


Objectives: This study was undertaken to evaluate the expression of transforming growth factor β1 (TGF-β1) and matrix metalloproteinase 9 (MMP-9), key regulators of the extracellular matrix composition, in the uterosacral ligaments (USLs) of women with pelvic organ prolapse (POP) compared with controls. Methods: Under an institutional review board approval, USL samples were obtained from women undergoing vaginal hysterectomy for stage 2 or greater POP (cases, n = 21) and from women without POP undergoing vaginal hysterectomy for benign indications (controls, n = 19). Hematoxylin and eosin and trichrome staining were performed on the USL sections, and the distribution of smooth muscle and fibrous tissue were quantified. Immunohistochemical staining was performed using anti-TGF-β1 and anti-MMP-9 antibodies. The expressions of TGF-β1 and MMP-9 were evaluated by the pathologist, who was blinded to all clinical data. Results: Transforming growth factor β1 expression positively correlated with MMP-9 expression (R = 0.4, P = 0.01). The expressions of TGF-β1 and MMP-9 were similar in subjects with POP versus controls. There was a significant increase in fibrous tissue (P = 0.008) and a corresponding decrease in smooth muscle (P = 0.03), associated with increasing age. The TGF-β1 expression, but not MMP-9 expression, also significantly increased with age (P = 0.02). Discussion: Although our study uncovered age-related alterations in USL composition and TGF-β1 expression, there was no difference in the expression of TGF-β1 or MMP-9 in the subjects with POP versus controls.

Original languageEnglish (US)
Pages (from-to)53-58
Number of pages6
JournalFemale Pelvic Medicine and Reconstructive Surgery
Issue number1
Publication statusPublished - Jan 1 2015



  • MMP-9
  • Pelvic organ prolapse
  • TGF-β1
  • Uterosacral ligament

ASJC Scopus subject areas

  • Surgery
  • Obstetrics and Gynecology
  • Urology

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