Comparison of Insulin-Like Growth Factor-1 (IGF-1) and Transforming Growth Factor-β1 (TGF-β1) Protein Expression Between Patients with Pelvic Organ Prolapse With and Without Cervical Elongation

Abstract

Objective: Pelvic organ prolapse (POP) is a condition caused by weakened pelvic support structures and is often associated with cervical elongation. The role of growth factors, particularly insulin-like growth factor-1 (IGF-1) and transforming growth factor-β1 (TGF-β1), in the pathogenesis of cervical elongation remains unclear.
Methods: This study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, involving patients with pelvic organ prolapse with or without cervical elongation selected by consecutive sampling. Cervical IGF-1 and TGF-β1 expression was assessed by immunohistochemistry, and prolapse severity by POP-Q. Each group included 23 subjects. Data were analyzed using the Shapiro–Wilk and Mann–Whitney U tests.
Results: Most participants were ≥ 50 years old, and the POP without cervical elongation group had a significantly higher proportion of postmenopausal women (95.7% vs. 65.2%; p = 0.02). IGF-1 expression did not differ significantly between the two groups (mean 6.39 vs. 7.01; p>0.05). In contrast, TGF-β1 expression was significantly lower in the POP with cervical elongation group than in the POP without cervical elongation group (2.62 ± 1.08 vs. 5.48 ± 2.41; p < 0.001).
Conclusion: Decreased TGF-β1 expression may contribute to cervical elongation in POP through impaired extracellular matrix remodeling, while IGF-1 does not clearly distinguish this phenotype. These findings suggest cervical elongation as a distinct biological entity within the POP spectrum, with implications for its pathophysiology and surgical management.

Perbandingan Ekspresi Protein Insulin-Like Growth Factor-1 (IGF-1) dan Transforming Growth Factor-β1 (TGF-β1) antara Pasien Prolaps Organ Panggul dan tanpa Elongasi Serviks

Abstrak
Tujuan: Prolaps organ panggul (POP) merupakan kondisi akibat kelemahan jaringan penunjang pelvis yang sering disertai elongasi serviks. Peran growth factor, khususnya insulin-like growth factor-1 (IGF-1) dan transforming growth factor-β1 (TGF-β) dalam patogenesis elongasi serviks belum sepenuhnya dipahami.
Metode: Penelitian ini dilakukan di RSUP Dr. Hasan Sadikin Bandung dengan melibatkan pasien prolaps organ panggul dengan atau tanpa elongasi serviks yang dipilih secara consecutive sampling. Ekspresi IGF-1 dan TGF-β1 pada jaringan serviks dinilai menggunakan imunohistokimia, sedangkan derajat prolaps dinilai dengan sistem POP-Q. Masing-masing kelompok terdiri dari 23 subjek. Data dianalisis menggunakan uji Shapiro–Wilk dan Mann–Whitney U.
Hasil: Sebagian besar subjek berusia ≥50 tahun, dengan proporsi menopause lebih tinggi pada kelompok POP tanpa elongasi serviks dibandingkan kelompok POP dengan elongasi serviks (95,7% vs. 65,2%; p=0,02). Tidak terdapat perbedaan bermakna pada ekspresi IGF-1 antara kedua kelompok (6,39 vs. 7,01; p>0,05). Sebaliknya, ekspresi TGF-β1 secara signifikan lebih rendah pada kelompok POP dengan elongasi serviks dibandingkan dengan kelompok POP tanpa elongasi serviks (2,62 ± 1,08 vs. 5,48 ± 2,41; p < 0,001).
Kesimpulan: Penurunan ekspresi TGF-β1 dapat berkontribusi terhadap elongasi serviks pada POP melalui gangguan remodeling matriks ekstraseluler, sedangkan IGF-1 tidak secara jelas membedakan fenotipe ini. Temuan ini menunjukkan bahwa elongasi serviks merupakan entitas biologis tersendiri dalam spektrum POP, dengan implikasi terhadap patofisiologi dan tata laksana bedah.