Collagen composition in different ethnic groups and changes in pelvic floor dysfunction

Abstract

Black women have a much lower incidence of stress incontinence (SI) and pelvic organ prolapse (POP) compared to white women.

Paraurethral vaginal skin of matched white and black women from South Africa with and without SI was obtained and structural collagens I and III, collagen XVII mRNA expression and active matrix metalloproteinase 2 (MMP2) were analyzed. Further samples were obtained from stretched and non stretched vaginal skin of white women affected by prolapse and similarly collagen XVII mRNA expression and active MMP2 were measured as well as total MMP2.

White women with SI had significantly reduced collagen I:III ratio (an indication of increased elasticity) compared to their controls. Interestingly, black controls had a significantly lower collagen I:III ratio compared to white controls. A significant up-regulation of collagen VXII, a marker of adhesiveness, was seen in the white SI group (p<0.02) compared to their respective control groups. Interestingly, again following the white SI pattern, collagen SVII expression was significantly increased in the black control group compared to white controls. There were no racial differences in MMP2 activity per unit of protein (ng/mg). In vaginal prolapse, collagen XVII expression in stretched vaginal tissue was significantly lower compared to the matched non-stretched group and a significant decrease in the active MMP2 per unit of protein in the stretched tissue compared to non-stretched was also noted.

These findings indicate that black women have a more elastic and adhesive tissue as reflected in lower collagen I:III ratio and increased collagen XVII representing an advantage when confronted with tissue insults and protecting the tissue from damage. It appears white women with stress incontinence try to change their collagen composition to a more advantageous tissue similar to the properties of a black women by increasing tissue elasticity and adhesiveness, but obviously not always with success.

As an insult increases as in vaginal prolapse, increased active MMP2 expression occurs but in the more stretched vaginal areas adhesiveness becomes lost (lower collagen XVII) and also some tissue remodelling.

Finding ways to increase elasticity and adhesiveness of vaginal skin further may provide remedies for preventing or alleviating PFD.

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