International Urogynecology Journal

, Volume 20, Issue 12, pp 1423–1429

Is lysyl oxidase-like protein-1, alpha-1 antitrypsin, and neutrophil elastase site specific in pelvic organ prolapse?

  • Weng Chi Man
  • Jason Yen-Ping Ho
  • Yan Wen
  • Eric R. Sokol
  • Mary L. Polan
  • Bertha Chen
Original Article


Introduction and hypothesis

We investigated whether the expression of alpha-1 antitrypsin (ATT), neutrophil elastase (NE), and lysyl oxidase-like protein 1 (LOXL-1) vary within the vagina in subjects with pelvic organ prolapse (POP).


Biopsies were obtained from the anterior and posterior vaginal wall of 22 women with POP (≥stage 2 by POP-Q). The subjects were grouped by the most prominent defect: cystocele, cystocele plus uterine prolapse, and rectocele. Comparative real-time PCR, Western blotting, and NE enzyme activity assay were performed.


The ratio of anterior and posterior vaginal wall ATT, NE, and LOXL-1 expression varied between individuals within the same defect group.


ATT, NE, and LOXl-1 expression was variable among different biopsy sites in the vagina. No consistent pattern was present when the subjects were grouped by the most prominent defect. We recommend careful consideration of biopsy sites in future studies on POP to enhance reproducibility of data.


Pelvic organ prolapse Lysyl oxidase-like protein 1 Neutrophil elastase Alpha-1 antitrypsin 


  1. 1.
    Chen B, Wen Y, Yu X, Polan ML (2005) Elastin metabolism in pelvic tissues: is it modulated by reproductive hormones? Am J Obstet Gynecol 192:1605–1613CrossRefPubMedGoogle Scholar
  2. 2.
    Nygaard I, Bradley C, Brandt D (2004) Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol 104:489–497PubMedGoogle Scholar
  3. 3.
    Samuelsson EC, Victor FT, Tibblin G, Svardsudd KF (1999) Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol 180:299–305CrossRefPubMedGoogle Scholar
  4. 4.
    Swift SE, Pound T, Dias JK (2001) Case-control study of etiologic factors in the development of severe pelvic organ prolapse. Int Urogynecol J Pelvic Floor Dysfunct 12:187–192CrossRefPubMedGoogle Scholar
  5. 5.
    Graham CA, Mallett VT (2001) Race as a predictor of urinary incontinence and pelvic organ prolapse. Am J Obstet Gynecol 185:116–120CrossRefPubMedGoogle Scholar
  6. 6.
    Buchsbaum GM, Duecy EE, Kerr LA, Huang LS, Perevich M, Guzick DS (2006) Pelvic organ prolapse in nulliparous women and their parous sisters. Obstet Gynecol 108:1388–1393PubMedGoogle Scholar
  7. 7.
    Weber AM, Richter HE (2005) Pelvic organ prolapse. Obstet Gynecol 106:615–634PubMedGoogle Scholar
  8. 8.
    Liu X, Zhao Y, Pawlyk B, Damaser M, Li T (2006) Failure of elastic fiber homeostasis leads to pelvic floor disorders. Am J Pathol 168:519–528CrossRefPubMedGoogle Scholar
  9. 9.
    Alperin M, Moalli PA (2006) Remodeling of vaginal connective tissue in patients with prolapse. Curr Opin Obstet Gynecol 18:544–550CrossRefPubMedGoogle Scholar
  10. 10.
    Kielty CM, Sherratt MJ, Shuttleworth CA (2002) Elastic fibres. J Cell Sci 115:2817–2828PubMedGoogle Scholar
  11. 11.
    Chen B, Wen Y, Polan ML (2004) Elastolytic activity in women with stress urinary incontinence and pelvic organ prolapse. Neurourol Urodyn 23:119–126CrossRefPubMedGoogle Scholar
  12. 12.
    Yamamoto K, Yamamoto M, Akazawa K, Tajima S, Wakimoto H, Aoyagi M (1997) Decrease in elastin gene expression and protein synthesis in fibroblasts derived from cardinal ligaments of patients with prolapsus uteri. Cell Biol Int 21:605–611CrossRefPubMedGoogle Scholar
  13. 13.
    Jackson SR, Avery NC, Tarlton JF, Eckford SD, Abrams P, Bailey AJ (1996) Changes in metabolism of collagen in genitourinary prolapse. Lancet 347:1658–1661CrossRefPubMedGoogle Scholar
  14. 14.
    Chen B, Wen Y, Yu X, Polan ML (2006) The role of neutrophil elastase in elastin metabolism of pelvic tissues from women with stress urinary incontinence. Neurourol Urodyn 26:274–279CrossRefGoogle Scholar
  15. 15.
    Chen BH, Wen Y, Li H, Polan ML (2002) Collagen metabolism and turnover in women with stress urinary incontinence and pelvic prolapse. Int Urogynecol J Pelvic Floor Dysfunct 13:80–87 discussion 87CrossRefPubMedGoogle Scholar
  16. 16.
    Kagan HM, Li W (2003) Lysyl oxidase: properties, specificity, and biological roles inside and outside of the cell. J Cell Biochem 88:660–672CrossRefPubMedGoogle Scholar
  17. 17.
    Liu X, Zhao Y, Gao J, Pawlyk B, Starcher B, Spencer JA, Yanagisawa H, Zuo J, Li T (2004) Elastic fiber homeostasis requires lysyl oxidase-like 1 protein. Nat Genet 36:178–182CrossRefPubMedGoogle Scholar
  18. 18.
    Romero N, Tinker D, Hyde D, Rucker RB (1986) Role of plasma and serum proteases in the degradation of elastin. Arch Biochem Biophys 244:161–168CrossRefPubMedGoogle Scholar
  19. 19.
    Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P, Shull BL, Smith AR (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175:10–17CrossRefPubMedGoogle Scholar
  20. 20.
    Wen Y, Polan ML, Chen B (2006) Do extracellular matrix protein expressions change with cyclic reproductive hormones in pelvic connective tissue from women with stress urinary incontinence? Hum Reprod 21:1266–1273CrossRefPubMedGoogle Scholar
  21. 21.
    Yoshimura K, Nakagawa S, Koyama S, Kobayashi T, Homma T (1994) Roles of neutrophil elastase and superoxide anion in leukotriene B4-induced lung injury in rabbit. J Appl Physiol 76:91–96PubMedGoogle Scholar
  22. 22.
    Drewes PG, Yanagisawa H, Starcher B, Hornstra I, Csiszar K, Marinis SI, Keller P, Word RA (2007) Pelvic organ prolapse in fibulin-5 knockout mice: pregnancy-induced changes in elastic fiber homeostasis in mouse vagina. Am J Pathol 170:578–589CrossRefPubMedGoogle Scholar
  23. 23.
    Kobak W, Lu J, Hardart A, Zhang C, Stanczyk FZ, Felix JC (2005) Expression of lysyl oxidase and transforming growth factor beta2 in women with severe pelvic organ prolapse. J Reprod Med 50:827–831PubMedGoogle Scholar
  24. 24.
    Wieslander CK, Marinis SI, Keller P, Boreham MK, Drewes PG, Schaffer JI, Word RA (2006) Elastic fiber homeostasis in vaginal tissues from women with pelvic organ prolapse. Int Urogynecol J 17:S407–S408CrossRefGoogle Scholar
  25. 25.
    Shull BL (1999) Pelvic organ prolapse: anterior, superior, and posterior vaginal segment defects. Am J Obstet Gynecol 181:6–11CrossRefPubMedGoogle Scholar

Copyright information

© The International Urogynecological Association 2009

Authors and Affiliations

  • Weng Chi Man
    • 1
  • Jason Yen-Ping Ho
    • 1
  • Yan Wen
    • 1
  • Eric R. Sokol
    • 1
  • Mary L. Polan
    • 1
  • Bertha Chen
    • 1
  1. 1.Department of Obstetrics and GynecologyStanford University School of MedicineStanfordUSA

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