Development of a Tissue-Based Extracellular Matrix Vulnerability Score (ECM-V) for Women Undergoing Primary Pelvic Organ Prolapse Surgery.
A three-marker tissue panel distinguished pelvic organ prolapse from controls with near-perfect accuracy
Development of a Tissue-Based Extracellular Matrix Vulnerability Score (ECM-V) for Women Undergoing Primary Pelvic Organ Prolapse Surgery.
Pelvic organ prolapse (prolapse) is increasingly recognized as a localized extracellular matrix (extracellular matrix) remodeling disorder.
This study aimed to characterize the extracellular matrix failure phenotype in surgically obtained pelvic support tissue and to derive an exploratory tissue-based extracellular matrix Vulnerability (extracellular matrix-V) score.
This single-center exploratory translational biomarker derivation study included 121 women: 60 undergoing primary reconstructive surgery for prolapse with or without concomitant stress urinary incontinence, and 61 benign gynecological controls.
correctly told apart nearly every prolapse case from controls
Tissue biomarkers demonstrated substantially stronger discrimination than plasma biomarkers.
Surgical cases showed reduced COL1 (AUC 0.898) and ELN (AUC 0.846), elevated COL3 (AUC 0.818), MMP2 (AUC 0.958) and MMP9 (AUC 0.977) (all p < 0.001).
The ECM Vulnerability score demonstrated derivation-level AUC of 0.995, sensitivity of 0.967 and specificity of 0.967.
Tissue MMP9 and MMP2 correlated strongly with POP-Q severity and validated symptom scores (rho up to 0.806, p < 0.001).
Women undergoing primary prolapse surgery demonstrate a distinct localized extracellular matrix failure phenotype.
The exploratory COL3-MMP2-MMP9 framework provides a biologically coherent basis for the extracellular matrix-V score requiring prospective validation with longitudinal recurrence outcomes.