Abstract
Groin hernias emerge at the myopectineal orifice of Fruchaud which is closed off by the fascia transversalis. Our previous studies showed structural and quantitative changes of the fascia transversalis elastic fibers of inguinal hernia patients and elderly people. The present study used single-strand conformation polymorphism (SSCP) elastin (analysis to investigate the 34 exons of the ELN gene of 49 inguinal hernia patients (7 females, 42 males aged 58.7 ± 19.82 years) and 75 non-herniated controls (35 females, 40 males aged 46.2 ± 14.32 years). We found that 47 patients and 24 controls had an abnormal exon 20 pattern caused by a g28197A > G missense mutation leading to an S422G amino acid substitution in the elastin hydrophobic domain. The g28197A > G allele frequency was 0.71 ± 0.045 in hernia patients and 0.21 ± 0.030 in controls and 23 patients and 7 controls were g28197A > G homozygous and 24 patients and 17 controls were heterozygous. This point-mutation showed a statistically significant association with inguinal hernia, chi-squared being 46.89 (p < 0.001) and the odds ratio 49.93 (95% confidence interval of <FONT FACE=Symbol>@</FONT>11 to 223). These results indicate that the g28197A > G mutation is involved in the genesis of inguinal hernia (possibly due to abnormal elastic fiber production) and explains impaired fascia transversalis function.
Highlights
Groin hernias emerge at the myopectineal orifice of Fruchaud which is closed off by the fascia transversalis
These results indicate that there is a loss of tensile resistance and elasticity in the fascia transversalis tissue which may explain the high incidence of inguinal hernia after the fifth decade of life
Mutations in the elastin (ELN) gene may be responsible for disorders of the elastic fiber system because they have been observed in cases of supravalvular aortic stenosis and autosomal dominant cutis laxa, individuals with either of these conditions may show smooth and soft skin, hernias, gastrointestinal diverticula and genital prolapse (Ewart et al, 1994; Li et al, 1997; Meng et al, 1998; Tassabehji et al, 1998)
Summary
Groin hernias emerge at the myopectineal orifice of Fruchaud which is closed off by the fascia transversalis. The elastic fibers are composed of microfibrils and elastin and are responsible for the resilience of the fascia transversalis.
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