Relaxin and gonadal steroid receptors in uterosacral ligaments of women with and without pelvic organ prolapse

Int Urogynecol J. 2012 Apr;23(4):495-500. doi: 10.1007/s00192-011-1615-9. Epub 2011 Nov 29.


Introduction and hypothesis: This study evaluates the expression of estrogen receptor isoforms alpha (ERα) and beta (ERβ), progesterone receptor (PR), and relaxin receptor isoforms 1 and 2 (LGR7, LGR8) in uterosacral ligament (USL) tissue of women with pelvic organ prolapse and controls.

Methods: Tissue samples of USL from women with and without pelvic organ prolapse (POP) were subjected to immunohistochemistry against ERα, ERβ, PR, and LGR7 proteins. The respective mRNA expression as well as of LGR8 was assessed by quantitative real-time polymerase chain reaction.

Results: The cellular distribution of the receptor proteins was different due to cell types, independent of POP: ERα and PR were found in smooth muscle cells, but not in endothelial cells, whereas ERβ was found in endothelial cells, but not in connective tissue. ERα, ERβ, PR, and LGR7 mRNAs could be detected in all patients of both groups. ERα mRNA expression was significantly and ERβ mRNA borderline significantly higher in USL of patients with POP: ERα: p < 0.001, ERβ: p = 0.057.

Conclusions: Enhanced effects of estrogen via altered mRNA expression patterns of ERα and ERβ--but not those of progesterone--may exist in USL of patients affected by POP. A local effect of relaxin needs to be further clarified because of this first report of prevalent ligamental expression of LGR7.

MeSH terms

  • Adult
  • Biomarkers / metabolism
  • Case-Control Studies
  • Connective Tissue / metabolism
  • Endothelial Cells / metabolism
  • Estrogen Receptor alpha / metabolism
  • Estrogen Receptor beta / metabolism
  • Female
  • Humans
  • Ligaments / metabolism*
  • Ligaments / pathology
  • Middle Aged
  • Myocytes, Smooth Muscle / metabolism
  • Pelvic Organ Prolapse / metabolism*
  • Pelvic Organ Prolapse / pathology
  • RNA, Messenger / metabolism
  • Receptors, Progesterone / metabolism
  • Receptors, Steroid / metabolism*
  • Relaxin / metabolism*
  • Sacrum*
  • Uterus*


  • Biomarkers
  • Estrogen Receptor alpha
  • Estrogen Receptor beta
  • RNA, Messenger
  • Receptors, Progesterone
  • Receptors, Steroid
  • Relaxin