Immunohistochemical expression of Matrix Metalloproteinase-2 (MMP-2) in inguinal hernia

Sruti Mary, Joseph (2018) Immunohistochemical expression of Matrix Metalloproteinase-2 (MMP-2) in inguinal hernia. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.

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Abstract

INTRODUCTION: Abdominal wall hernias are regarded as a mechanical problem with a local defect, probably due to weakening of the transversalis fascia. Now a days, hernias are hypothesised as a local manifestation of a systemic disease, which could be proved with an increased expression of MMP-2. A close association between inguinal hernia and impaired collagen metabolism are widely studied. Many experiments have proved that a decrease in collagen type I/ collagen type III is found in adult patients with abdominal wall hernias. This finding is further emphasised with the increased risk of hernia in patients with other connective tissue disorders like abdominal aortic aneurysm, Ehler Danlos syndrome and polycystic kidney disease .This decrease in collagen type I /collagen type III is attributed either to an abnormal collagen metabolism or an altered collagen synthesis. Collagen type I forms a highly stable and extensively cross linked mature form of collagen. On the other hand collagen type III is an unstable and less cross linked collagen synthesised during the early phases of wound healing. As a result of decreased collagen type I /collagen type III ratio, there is weakening of the transversalis fascia and thereby explaining the pathophysiology of inguinal hernia. In our study, we focus on the imbalanced breakdown of collagen. The cleavage is regulated by the matrix metalloproteinase’s (MMPs). The MMPs belong to the family of zinc endopeptidases. More than 20 different MMPs are known. This study, focuses on increased immunohistochemical expression of MMP-2 in the fibroblasts of skin and transversalis fascia in patients with inguinal hernia and thereby proving that inguinal hernia is a local manifestation of a systemic disease rather than a mere mechanical defect. AIMS & OBJECTIVES : 1. To establish a causal association between MMP-2 and inguinal hernia. 2. To test the hypothesis that inguinal hernia is a local manifestation of a systemic disease rather than a mere mechanical defect. MATERIALS AND METHODS: Biopsy specimens of skin and transversalis fascia from 20 patients of hernia group and 20 patients of control group were received in the pathology laboratory of PSGIMSR. These biopsies which was received in our laboratory were allotted a specific reference number, which aids in their later identification from the archives. Inclusion criteria: Patients admitted with non recurrent inguinal hernia and undergoing laparoscopic or open hernioplasty Exclusion criteria: 1. Age <18 and >75 years. 2. Patients taking corticosteroids. 3. Smokers. 4. Patients who had undergone previous nfraumbilical abdominal procedures. 5. Recurrent hernias. 6. Patients with known connective tissue disorders. 7. Non consenting patients. These specimens were processed and submitted for hematoxylin and eosin (H&E) stain. To confirm the presence of collagen bundles, a special stain called Massons trichrome was also used. As our study included the use of antibodies to detect MMP-2 antigens, the tissues were also processed separately in Poly- L- Lysine coated slides. The slides stained with hematoxylin and eosin were used for routine histological examination, while the Massons trichrome stain was used to confirm the presence of collagen fibres. The slides coated with Poly-L-Lysine, underwent immunohistochemistry staining for detection of MMP-2 in the fibroblasts of skin and transversalis fascia.These were scored as follows; 1+; 0-25% of fibroblasts show MMP-2 staining, 2+; 25-50% of fibroblasts show MMP-2 stianing, 3+; 50-75% of fibroblasts show MMP-2 staining, 4+; 75-100% of fibroblasts show MMP-2 staining. RESULT: Within the result, we have included the following • A general comparison of MMP-2 expression among the skin and transversalis fascia of cases and controls. • Percentage analysis of MMP-2 scoring pattern in the skin and transversalis fascia of cases and controls. • Percentage analysis of MMP-2 scoring pattern in the skin and transversalis fascia of patients with direct and indirect inguinal hernia. • Age-wise distribution of MMP-2 scoring in skin and transversalis fascia of cases and controls. The results are as follows; In the age group of 15-35 years, 50% of hernia patients showed a high (4+) MMP-2 score in the fibroblasts of transversalis fascia. Among the control population only 0% showed a similar MMP-2 expression. Among the age group of 35-55years, a high MMP-2 score (4+) was expressed by 41.66% of hernia cases in the fibroblasts of transversalis fascia as, while none of the controls showed a similar MMP-2 expression b . Therefore the findings in this age group were almost similar to that obtained in the age group of 15-35 years, which further highlights on the increased expression of MMP-2 in inguinal hernia patients. In the age group of 55-75 years, a higher (4+) score of MMP-2 expression in the skin fibroblasts were found in 33.33% of hernia patients and 16.66% of control population . This mild increase in MMP-2 scoring in the control population could be attributed to the presence of patients with acute appendicitis and malignancy, all of which are associated with an increased expression of MMP-2. CONCLUSION: Our study was a prospective case control study, which included 20 cases of inguinal hernia and 20 controls. • Inguinal hernia patients showed a considerable increase in the expression of MMP-2 in the fibroblasts of skin and transversalis fascia as compared to their control group. • This proves the hypothesis that inguinal hernia is a local manifestation of a systemic disease rather than a mere local mechanical defect and also emphasises on the role of MMP-2 in the pathophysiology of hernias. • An increase in MMP-2 expression was also noted in the controls with malignancy and acute appendicitis, both of which conditions are proved to have an elevated MMP-2 levels. However, a larger population based study is required to emphasize on the pathophysiological role of MMP-2 in inguinal hernia.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Matrix metalloproteinase-2 (MMP-2) ; inguinal and abdominal wall hernia ; collagen type I and collagen type III ratio ; connective tissue disorders like abdominal aortic aneurysm ; peptidase-antipeptidase imbalance ; MMP-2 and cancer.
Subjects: MEDICAL > Pathology
Depositing User: Subramani R
Date Deposited: 19 Aug 2018 08:30
Last Modified: 19 Aug 2018 08:30
URI: http://repository-tnmgrmu.ac.in/id/eprint/9324

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