Peritoneal fluid concentrations of matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and transforming growth factor-beta in women with pelvic adhesions

Objective: To establish whether the concentration of matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metal loproteinase-1 (TIMP-1), and transforming growth factor-beta (TGF-beta) is influenced by the presence or absence of adhesions, and whether the concentration of these mediators vary throughout the menstrual cycle. Design: Prospective case-control study. Setting: Women undergoing laparoscopy in a university hospital in the United Kingdom. Patient(s): Women undergoing laparoscopy for benign gynecological conditions. Intervention(s): Samples of peritoneal fluid were collected at diagnostic laparoscopy in one group, and at laparoscopy and serially during the first 48 hours after laparoscopic adhesiolysis in a second group. We correlated the concentrations of mediators in serially sampled peritoneal fluid during the 48 hours following laparoscopic adhesiolysis to the adhesion formation and reformation found during second-look laparoscopy. Main Outcome Measure(s): The concentrations of MMP-9, TIMP-1, and TGF-beta in peritoneal fluid. Result(s): MMP-9 concentration was lower in the follicular phase than the luteal phase of the menstrual cycle. MMP-9 concentration was significantly lower in women with pelvic adhesions than in women with a normal pelvis. The MMP-9/TIMP-1 ratio is significantly higher in women with significant adhesions at second-look laparoscopy compared to women with minimal or no adhesions. Conclusion(s): The components of extracellular matrix remodeling may play an important part in the adhesion formation/reformation process. (C) 2003 by American Society for Reproductive Medicine.