The Role of EMMPRIN Levels in Uterine Ligaments in Pelvic Organ Prolapse

IMPORTANCE: Collagen cannot be underestimated in maintaining the structural integrity of the ligaments and connective tissue, as it plays a crucial role in pelvic organ support. OBJECTIVE: In this study, extracellular matrix metalloproteinase inducer (EMMPRIN) levels in the uterosacral ligament, cardinal ligament, and ligamentum rotundum tissues of women with pelvic organ prolapse (POP) were compared with women without POP. The aim was to investigate the role of EMMPRIN in the etiopathogenesis of POP. STUDY DESIGN: Our study was planned as a prospective cohort study between August and November 2023. Women who underwent vaginal hysterectomy for POP and women with similar demographic data who underwent hysterectomy for benign reasons other than POP were included in the study. Tissue samples were taken from the cardinal ligament, uterosacral ligament, and ligamentum rotundum; total protein was analyzed, EMMPRIN levels were measured, and the 2 groups were compared. RESULTS: A total of 85 patients, including 41 with POP and 44 without, were included in the study. Uterosacral ligament, cardinal ligament, and ligamentum rotundum EMMPRIN values were found to be significantly lower in the POP group compared with the control group. In the multiple regression model, uterosacral-rotundum EMMPRIN, body mass index, and parity were found to have a statistically significant effect on the development of POP. CONCLUSION: EMMPRIN levels in the uterosacral ligament, cardinal ligament and ligamentum rotundum were significantly lower in patients with POP. EMMPRIN deficiency may be one mechanism underlying the development of POP, but multicenter studies with larger patient numbers are needed.