Oxidative Stress: A Possible Trigger for Pelvic Organ Prolapse.

Radu Dragos Marcu,Dan Liviu Dorel Mischianu,Lucian Iorga,Carolina Constantin,Mihaela Surcel,Adriana Narcisa Munteanu,Ovidiu Gabriel Bratu,Camelia Cristina Diaconu,Gheorghita Isvoranu

doi:10.1155/2020/3791934

Abstract

Pelvic organ prolapse is a frequent health problem in women, encountered worldwide, its physiopathology being still incompletely understood. The integrity of the pelvic-supportive structures is a key element that prevents the prolapse of the pelvic organs. Numerous researchers have underlined the role of connective tissue molecular changes in the pathogenesis of pelvic organ prolapse and have raised the attention upon oxidative stress as an important element involved in its appearance. The advancements made over the years in terms of molecular biology have allowed researchers to investigate how the constituent elements of the pelvic-supportive structures react in conditions of oxidative stress. The purpose of this paper is to underline the importance of oxidative stress in the pathogenesis of pelvic organ prolapse, as well as to highlight the main oxidative stress molecular changes that appear at the level of the pelvic-supportive structures. Sustained mechanical stress is proven to be a key factor in the appearance of pelvic organ prolapse, correlating with increased levels of free radicals production and mitochondrial-induced fibroblasts apoptosis, the rate of cellular apoptosis depending on the intensity of the mechanical stress, and the period of time the mechanical stress is applied. Oxidative stress hinders normal cellular signaling pathways, as well as different important cellular components like proteins, lipids, and cellular DNA, therefore significantly interfering with the process of collagen and elastin synthesis.

Highlights

Pelvic organ prolapse (POP) is one of the most common female pathologies, encountered especially in patients over 50 years old
Tissue samples have been taken from the uterosacral ligaments during surgery, in order to evaluate the expression of collagen, elastin, matrix metalloproteinases (MMPs) 2, MMP 9, tissue inhibitors of matrix metalloproteinases (TIMP) 2, transforming growth factor- (TGF-)β1, and Smad
OS is an important factor involved in pelvic organ prolapse pathogenesis, being responsible for numerous molecular changes at the level of pelvic-supportive structures that weaken the integrity and the resistance of pelvic muscles, fascias, and ligaments, favoring the development of this pathology

Summary

Introduction

Pelvic organ prolapse (POP) is one of the most common female pathologies, encountered especially in patients over 50 years old. The support of the pelvic organs is ensured by the levator ani muscles, pelvic fascias, and ligaments. The dysfunctions of these structures have been shown to alter their supportive role, favoring the descent of the pelvic organs and other associated pathologies and symptoms [6]. The pelvic connective tissue consists of fibrous elements like collagen and elastin, which are the principal components of the extracellular matrix (ECM) and of the elastogenic cells, represented by smooth muscles cells and fibroblasts [8]. Integrins are indispensable for the ECM proteins metabolism, as well as for the cellular turnover, this being a constant process [10, 11]

Collagen and Elastin

Molecular Events Related to Oxidative Stress in POP

Findings

Conclusions