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Biology of Reproduction 66, 1743-1748 (2002)
© 2002 Society for the Study of Reproduction, Inc.


Regular Article

Relaxin Gene and Protein Expression and Its Regulation of Procollagenase and Vascular Endothelial Growth Factor in Human Endometrial Cells1

Smita Palejwalaa, Linda Tsengb, Andrea Wojtczuka, Gerson Weissa, and Laura T. Goldsmith2,,a

a Department of Obstetrics, Gynecology & Women's Health, New Jersey Medical School, Newark, New Jersey 07103 b Department of Obstetrics, Gynecology and Reproductive Medicine, State University of New York Health Sciences Center at Stony Brook, Stony Brook, New York 11794


    ABSTRACT
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Extensive evidence demonstrates pronounced effects of relaxin on the differentiation of human endometrial cells in vitro. In vivo data in rhesus monkeys suggest a role for relaxin in the development of endometrial vascular architecture. In women, pregnancy can be established and maintained in the absence of circulating relaxin. Thus, local synthesis by the endometrium is necessary if relaxin plays a physiological role in human endometrial function. Although relaxin protein and the prorelaxin C peptide have been localized to human endometrium, no data for relaxin synthesis have been provided to date. We therefore assessed relaxin mRNA and protein levels in cultured, defined human endometrial cells. Reverse transcriptase-polymerase chain reaction (RT-PCR) techniques were used to demonstrate the presence of relaxin mRNA in human stromal and glandular epithelial cells. Secretion of the protein into the media of cultured cells of both types was also detected. Relaxin stimulated the expression of vascular endothelial growth factor in glandular epithelial and stromal cells that were isolated from tissue that had been taken during the secretory phase of the cycle. Relaxin inhibited the expression of procollagenase from both glandular epithelial cells, with a more marked inhibition demonstrated from cells that were isolated from tissue that had been taken during the secretory phase, and from stromal cells. These data demonstrate that human endometrial cells synthesize relaxin, and they support the concept that relaxin fosters endometrial conditions that are required for implantation in women.

decidua, implantation, pregnancy, progesterone, relaxin


    INTRODUCTION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
A large body of evidence exists to demonstrate that relaxin has definitive effects on human endometrial cells in vitro [112]. In addition, studies in rhesus monkeys suggest that relaxin exerts pronounced effects on endometrial architecture in vivo [13, 14]. However, a physiological role for relaxin in human endometrium has not yet been demonstrated. That pregnancy in women can be established and maintained in the absence of circulating relaxin is demonstrated in women who do not have functioning ovaries and become pregnant following oocyte donation with steroid hormone support [15, 16]. Thus, demonstration of local synthesis is required to support the concept that relaxin has a physiological role in human endometrial function. Although relaxin protein and prorelaxin C peptide have been detected in human endometrium, no previous data demonstrate the presence of relaxin mRNA in human endometrium [17, 18]. Our studies were therefore performed to determine whether human endometrium synthesizes relaxin and to provide evidence for a potential physiological role for relaxin in women. The present data demonstrate that cultured human endometrial cells express relaxin mRNA and secrete relaxin protein, and that relaxin regulates expression of procollagenase (proMMP-1) and vascular endothelial growth factor (VEGF) from these cells.


    MATERIALS AND METHODS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Materials

Enhanced chemiluminescence reagents were purchased from Amersham (Arlington Heights, IL). Mouse monoclonal antibody to human proMMP-1 and peroxidase-conjugated goat anti-mouse immunoglobulin (Ig)G were from Calbiochem, San Diego, CA (i.e., Oncogene Research Products). Sheep anti-human proMMP-3 antibodies and pure proMMP-1 and proMMP-3 proteins were kindly provided by Dr. Hideaki Nagase, University of Kansas Medical Center, Kansas City, KS. Peroxidase-conjugated donkey anti-sheep IgG, polyvinylidine difluoride (PVDF) membranes, and electrophoresis reagents were from Sigma-Aldrich (St. Louis, MO). Pure porcine relaxin was a gift from Dr. David Sherwood, University of Illinois. Medroxyprogesterone acetate (MPA) was from Steraloids Inc. (Wilton, NH). The VEGF enzyme-linked immunosorbent assay (ELISA) was from R&D Systems (Minneapolis, MN). The GeneAmp RNA-PCR kit was from PE Applied Biosystems (Foster City, CA). PCR primers were synthesized by Sigma-Genosys (The Woodlands, TX). The QuantamRNA 18S internal standard kit was from Ambion, Inc. (Austin, TX). GelStar nucleic acid stain was from FMC Bioproducts (Rockland, ME).

Endometrial Cell Culture and Treatment

Human endometrium was obtained from premenopausal women at various phases of the menstrual cycle who had undergone hysterectomy for medical reasons such as uterine prolapse, uterine fibroids, or adenomyosis, but not endometrial hyperplasia or endometrial cancer. Endometrial samples were diagnosed histologically and classified as either proliferative or secretory endometrium. Protocols were approved by the Human Subjects Committee of the State University of New York Health Sciences Center at Stony Brook in accordance with U.S. Department of Health and Human Services regulations. All samples were obtained after informed consent was provided by the subjects. Primary cultures of stromal and glandular epithelial cells were prepared from the samples using well-established methods previously described in detail [17, 1921]. Each experiment used tissue from a single individual. Replicate wells of cells were incubated without or with pure porcine relaxin (3000 GPU/mg) at 50 or 100 ng/ml or MPA (0.1 µM) for 1 or 2 days. Conditioned medium samples were collected and maintained frozen at -80°C.

Assessment of Relaxin mRNA by Reverse Transcriptase-Polymerase Chain Reaction

Determination of human relaxin specific mRNA in primary cultures of endometrial stromal and glandular epithelial cells was performed using a nested reverse transcriptase-polymerase chain reaction (RT-PCR) method. Cultured cells of endometrial tissue from 6 women taken during the secretory (n = 3) or proliferative phase (n = 3) were studied.

Total RNA was isolated from the endometrial cells using an acid guanidinium thiocyanate extraction procedure as described previously [7]. Total RNA from each sample was reverse transcribed into first-strand cDNA using cloned MuLV reverse transcriptase and random hexamers. The resulting cDNA was used as the template to amplify (by PCR) a 306-base pair (bp) DNA segment corresponding to amino acids 31–132 in the C peptide of the prorelaxin protein.

The primer pair we used, which spanned the exon 1-intron-exon 2 boundary such that products of the correct size could only have arisen from mRNA templates, was a 19-nucleotide forward primer with the sequence 5'-TCTCTGAGCCAGGAAGATG-3', corresponding to amino acids 31–36, and a 22-nucleotide reverse primer with the sequence 5'-CTTAGGCTTGGATACTCATTCT-3', which was complementary to the 3' end of the relaxin mRNA amino acids 126–132.

RNA from human corpus luteum taken at term pregnancy was used as a positive control. RNA from human lung (Clontech Inc., Palo Alto, CA) was used as a negative control. Two percent of the resulting DNA product was further amplified using the following pair of nested exon-intron boundary spanning primers: an 18-nucleotide forward primer with the sequence 5'-CCAGTGGCAGAAATTGTG-3', corresponding to amino acids 43–48; and a 22-nucleotide reverse primer with the sequence 5'-GATTCCAGTCTTCTCTTTGAAG-3', corresponding to amino acids 96–102. This nested PCR reaction yielded a 181-bp DNA product (corresponding to amino acids 43–102). The location of the primers used is shown in Figure 1.



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FIG. 1. Nested PCR strategy for analysis of human relaxin gene expression. A linear representation of the human relaxin gene is shown indicating the location of the primers used.

Primer pairs were selected using the Wisconsin Package version 9.1 (Genetics Computer Group, Madison, WI) software using stringent specifications for the intron/exon junction spanning region of human prorelaxin cDNA. The primers were selected based on their guanine cytosine content and melting and annealing temperatures. In addition, because the primer pair was not intended to distinguish between the H1 and H2 transcripts, the pair used for the first PCR reaction was one that would amplify both H1 and H2 relaxin cDNA, and the sequence of the primer pair used for the nested reaction corresponded to H2 cDNA.

To normalize for RNA variability, an internal standard PCR reaction for 18S RNA was performed. Relative quantitative PCR was performed by amplifying 18S RNA using QuantamRNA 18S internal standards in a reaction setup parallel to the second (nested) relaxin reaction. The products of both the relaxin amplification (181 bp) and the 18S amplification (488 bp) were resolved on 2% agarose gels containing GelStar nucleic acid stain and photographed under UV light. Image analysis of the gels was performed using an AlphaImager 2000 Documentation and Analysis System (Alpha Innotech Corporation, San Leandro, CA). Nucleotide sequences of the purified PCR products from endometrial and corpus luteum samples were authenticated by determining the precise nucleotide sequence using an ABI Prism automated DNA Sequencer. Sequences were compared with the reported sequences of human H2 relaxin listed in GenBank.

Immunoassays

Relaxin concentrations in conditioned medium samples were determined using a human relaxin-specific radioimmunoassay previously described [22], which uses recombinant human H2 relaxin protein (kindly provided by Genentech Inc., South San Francisco, CA), 125I-labeled H2 human relaxin as radioligand, and a rabbit polyclonal anti-human H2 relaxin antibody. All samples were assessed in two assays. The sensitivity of the assay is 10–25 pg/tube. The intraassay variation was 8.7% (n = 11 observations).

VEGF content in conditioned medium samples was assessed using a human VEGF-specific ELISA (R&D Systems). Interassay and intraassay variations were 5.0% (n = 5 assays) and 4.1% (n = 10 observations), respectively, and the precision of the assay was 94%–98%.

Western Blot Analysis

Expression of procollagenase (proMMP-1) and prostromelysin (proMMP-3) in conditioned medium were determined by Western blot analysis using specific, well-characterized, primary antibodies and methods described previously [23]. Briefly, conditioned medium samples were treated with SDS-PAGE buffer and electrophoresed on 10% SDS-PAGE gels. Broad-range kaleidoscope molecular weight markers were used to estimate molecular weights. Pure proMMP-1 and proMMP-3 proteins were used as positive controls. Proteins were electroblotted onto PVDF membranes, which were then blocked with 3% BSA-Tris-buffered saline, Tween 20 (TBST) for 30 min at room temperature. After washing twice with TBST, the blots were incubated overnight at 4°C with primary antibody diluted in 2% BSA-TBST. Membranes were then washed three times with TBST during a 30-min period and incubated for 1 h with horseradish peroxidase-conjugated secondary antibody. Subsequently, the blots were washed three times with TBST over a 30-min period and developed by the enhanced chemiluminescence method. Intensities of the signals obtained on developed films were determined using a computing densitometer (Molecular Dynamics 300B, Sunnyvale, CA) using the volume integration method with appropriate corrections for background absorption, as we described previously [23, 24].

Statistical Analyses

Densitometric values for control untreated conditioned cell media were set at 100, and values for relaxin-treated conditioned cell media are expressed as a percentage of control. Data determined to be normally distributed after assessment using the Shapiro-Wilk test were then analyzed using two-tailed t-tests. All data were normally distributed, except for the proMMP-1 levels from glandular epithelial cells isolated from tissue taken during the secretory phase. These data were therefore assessed using the Wilcoxon signed-rank test. All comparisons were performed using JMP statistical software (SAS Institute, Inc., Cary, NC) written for the Macintosh Computer (Apple Computers, Cupertino, CA).


    RESULTS
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Detection of Relaxin-Specific mRNA by RT-PCR

Total RNAs from cultured human endometrial stromal and glandular epithelial cells from tissue taken at both proliferative and secretory phases were subjected to RT-PCR, and the 182-bp relaxin-specific product was seen following reactions programmed by RNA from all 6 endometrial samples and corpus luteum as shown in Figure 2. This product was not detectable when RNA from human lung was used, although the 488-bp 18S RNA-specific product was clearly detected. Nucleotide sequences of the PCR products from endometrium and corpus luteum RNAs were determined to be sequences of the H2 human relaxin gene. Because the PCR primers spanned the intron in the relaxin gene, products of the correct size could have arisen only from mRNA templates, not from DNA contamination.



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FIG. 2. Expression of relaxin-specific mRNA in cultured human endometrial cells. Total RNAs from cultured glandular epithelial and stromal endometrial cells were reverse transcribed into first-strand cDNAs, which were then amplified using the described nested PCR method. PCR products were resolved on GelStar stained 2% agarose gels, which were photographed under UV light. The top panel shows the 181-bp relaxin specific product from RNA from cultured endometrial cells from six subjects taken during the proliferative (P) and secretory (S) phases and the positive (human corpus luteum, hCL) control. As shown, this product was not detected when RNA from human lung was used. The bottom panel shows the 488-bp 18S RNA specific product from each of the corresponding RNAs including the negative control

Detection of Relaxin Protein

Immunoreactive relaxin was undetectable (<20 pg/ml) in culture medium that had not been exposed to cells. In distinct contrast, immunoreactive relaxin was detected in conditioned medium from cultures of both endometrial stromal and glandular epithelial cells as shown in Table 1. Conditioned medium from cultures of endometrial stromal cells from tissue taken during the secretory phase contained mean levels of 63 ± 20 pg/ml (± SEM, n = 4 experiments, 6 replicate wells). Levels detected in medium from glandular epithelial cells of tissue taken during the proliferative phase were 174 ± 53 pg/ml (n = 4 experiments, each using a specimen from 1 individual, 7 replicate wells). Relaxin was detected in medium from glandular epithelial cells of tissue taken during the secretory phase in 3 (n = 6 replicate wells) of 4 experiments, each using a specimen from 1 individual. Although conditioned medium from proliferative phase glandular epithelial cells appears to have higher relaxin levels, no significant differences between these values and those of the other categories were seen.


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TABLE 1. Immunoreactive relaxin (pg/ml) concentrations in conditioned medium.*

Relaxin Regulation of VEGF Expression

Both stromal and glandular epithelial cells expressed ample quantities of VEGF and both cell types responded to relaxin as shown in Figure 3. In cultures of glandular epithelial cells from tissue taken during the proliferative phase, relaxin caused a significant inhibition of VEGF expression to 66.3% ± 6% of control (mean ± SEM, P = 0.03, n = 4 experiments; Fig. 3A). In distinct contrast, in cultures of glandular epithelial cells from tissue taken during the secretory phase, relaxin caused a significant increase of VEGF expression to 169.5% ± 11% of control (P = 0.003, n = 5 experiments). Similarly, in stromal cell cultures, relaxin significantly increased VEGF expression to 229% ± 28% of control (P = 0.04, n = 3 experiments; Fig. 3B).



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FIG. 3. Regulation of endometrial VEGF expression. Conditioned medium from untreated and relaxin-treated or progestin-treated cells were assessed for VEGF as described in Materials and Methods. Values for controls were set at 100 and data for relaxin or progestin treated cells are expressed as a percentage of the control. A) Inhibitory effect of relaxin on VEGF expression from glandular epithelial cells taken during the proliferative phase (P = 0.03, n = 4 experiments) and the stimulatory effect of relaxin upon VEGF expression from glandular epithelial cells taken during the secretory phase (P = 0.003, n = 5 experiments). B) Stimulatory effect of relaxin on VEGF expression from stromal cells taken during the secretory phase (P = 0.04, n = 3 experiments). C) Inhibitory effect of progestin on VEGF expression from stromal cells taken during the secretory phase (P = 0.03, n = 6 experiments). *A statistically significant effect on VEGF expression by relaxin

Effect of Progestin on VEGF Expression

In contrast to the effect of relaxin, progestin inhibited VEGF expression from stromal cells taken during the secretory phase to 65.1% ± 11 % of control (P = 0.03, n = 6 experiments) as shown in Figure 3C.

Relaxin Regulation of MMP Expression

Relaxin significantly inhibited expression of endometrial proMMP-1, as shown in Figure 4. Relaxin significantly inhibited expression by glandular epithelial cells isolated from endometrial tissue taken at both phases of the menstrual cycle (Fig. 4A); a more marked inhibitory effect on cells isolated from tissue taken during the secretory phase (16.4% ± 5% of control (mean ± SEM), P < 0.0001, n = 5 experiments) than on cells from tissue taken during the proliferative phase (50.2% ± 6% of control, P = 0.004, n = 4 experiments) was seen. In addition, expression by stromal cells from tissue taken during the secretory phase was inhibited by relaxin to 67.2% ± 8% of control (P = 0.05, n = 3 experiments; Fig. 4B).



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FIG. 4. Relaxin inhibits endometrial proMMP-1 expression. Conditioned medium from untreated and relaxin-treated cells were subjected to Western blot analyses as described in Materials and Methods. Densitometric values for controls were set at 100 and data for relaxin treated-cells are expressed as a percentage of control. A) Inhibitory effect of relaxin on expression by glandular epithelial cells taken at proliferative (P = 0.004, n = 4 experiments) and secretory (P < 0.0001, n = 5 experiments) phases of the menstrual cycle. B) Inhibitory effect of relaxin on expression by stromal cells taken at the secretory phase (P = 0.05, n = 3 experiments). A film developed after exposure to a blot from a representative experiment is shown above. *A statistically significant decrease in proMMP-1 expression by relaxin

In contrast, relaxin had no effect on proMMP-3 expression from either glandular epithelial or stromal endometrial cells (Fig. 5). Expression of proMMP-3 by relaxin-treated glandular epithelial cells from tissue taken during the proliferative phase was 105% ± 12% of control (n = 4 experiments) and by cells from tissue taken during the secretory phase was 82% ± 11% of control (n = 5 experiments). Expression of proMMP-3 by relaxin treated stromal cells from tissue taken during the secretory phase was 91% ± 5% of control (n = 3 experiments).



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FIG. 5. Relaxin does not affect endometrial proMMP-3 expression. Data are expressed as described in Figure 4. A) Lack of effect of relaxin on expression by glandular epithelial cells taken at proliferative (P = 0.71, n = 4 experiments) and secretory (P = 0.17, n = 5 experiments) phases of the menstrual cycle. B) Lack of effect of relaxin on expression by stromal cells taken at the secretory phase (P = 0.23, n = 3 experiments)


    DISCUSSION
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
The present data identify relaxin mRNA in cultured human endometrial stromal and glandular epithelial cells from tissue taken during the proliferative and secretory phases, and demonstrate that these cells secrete relaxin into culture medium. These data for the first time document synthesis of relaxin in human endometrial cells. Previous data demonstrated that relaxin is present in human endometrium [17, 18], yet no previous data have provided definitive evidence for the synthesis of relaxin in human endometrium. Immunohistochemical studies of endometrium from patients at different stages of the menstrual cycle have demonstrated localization of relaxin to endometrial glandular epithelial cells using antibodies to the native hormone and to the human prorelaxin C-peptide [17, 18]. Because localization may be due to sequestration of circulating relaxin or the prorelaxin C-peptide, which is present in circulation, these data are not evidence for relaxin synthesis. Local synthesis of relaxin in the endometrium is an important finding because circulating relaxin is not required for the establishment or maintenance of human pregnancy. Women who have ovarian failure and become pregnant following oocyte donation and administration of exogenous estrogen and progesterone have no circulating relaxin, yet they maintain their pregnancies [15, 16]. Thus, synthesis in human endometrium is required for relaxin to play a role in human endometrial function. The present data, which demonstrate synthesis, now allow for the hypothesis that relaxin is important in human endometrial function in vivo.

The data presented here suggest that this function is to support endometrial conditions needed for implantation and to maintain pregnancy. The data demonstrate that relaxin stimulates VEGF expression from both stromal and glandular epithelial cells isolated from tissue taken during the secretory phase, and inhibits expression of procollagenase, with its most marked inhibitory effect on glandular epithelial cells isolated from tissue taken during the secretory phase. Our data are in agreement with those of Unemori et al. [12] who demonstrated that relaxin stimulates VEGF expression in a cell line of human endometrial cells. However, the present studies are the first to examine the effects of relaxin on VEGF expression in well-characterized, specific human endometrial cell types. Also, no previous studies have assessed the effects of relaxin on any endometrial matrix metalloproteinase. The present studies demonstrate that relaxin inhibits expression of proMMP-1, with its most marked inhibitory effect on glandular epithelial cells isolated from tissue taken during the secretory phase. Relaxin regulation of VEGF expression suggests a novel mechanism by which relaxin can regulate endometrial vascularization, and in concert with the dramatic inhibitory effects of relaxin on MMP-1 during the secretory phase, suggests a role for relaxin in endometrial support of implantation.

Results of studies by Hisaw and colleagues [13, 14] were the first to suggest a role for relaxin in endometrial vascularization. The results of these studies in the rhesus monkey suggest that relaxin induces marked proliferation of endothelial cells in endometrial blood vessels, and dilatation of the superficial endometrial blood vessels [14]. Results from these in vivo studies suggest that relaxin stimulates an intensified differentiation of the endometrial stromal cells into predecidual cells [13]. Relaxin appears to be necessary for maintaining endothelial proliferation and vascular dilatation in the endometrium of the rhesus monkey. Animals in which administration of relaxin-containing extracts was discontinued, but steroids were continued, showed reduced endothelial proliferation and dilatation [14]. Regulation of VEGF expression in endometrium provides an explanation for these findings.

Extensive and detailed studies of the effects of relaxin in human endometrial differentiation have found that relaxin appears to be a significant modulator that regulates differentiation of the human endometrium [112]. Relaxin stimulates the production of several secretory products, including prolactin, insulin-like growth factor, and insulin-like growth factor binding protein-1 (IGFBP-1) in progestin-primed endometrial stromal cells [24]. Prolactin and IGFBP-1 are considered to be the major secretory proteins of decidual cells, and the induction of expression of these secretory proteins has been widely used as a biochemical marker of decidualization of endometrial stromal cells in vitro [25]. IGFBP-1 is the major protein secreted from endometrial stromal cells during hormone stimulation. IGFBP-1 plays an essential role in regulating the mitogenic activity during growth and differentiation phases of endometrial stromal cell decidualization [21]. Detailed studies of regulation of IGFBP-1 gene promoter activity in endometrial stromal cells demonstrate that relaxin, not progestin, is the major inducer of IGFBP-1 gene transcription [5]. Thus, relaxin appears to be a more powerful regulator of human endometrial decidualization than progesterone. Studies have also shown that relaxin significantly increases total cellular protein and inhibits progestin-induced DNA synthesis, and it dramatically alters the ultrastructure of progestin-treated endometrial stromal cells [6]. No evidence of secretory activity was shown by cells treated with progesterone and estradiol, although secretory activity appears to be a prominent feature of decidualized endometrial stromal cells in vivo. Cells in the stromal cultures that were treated with relaxin in addition to progestin exhibited ultrastructural features that were characteristic of secretory cells. Thus in stromal cell cultures, progesterone alone is inadequate to induce full cellular function; relaxin is necessary as well.

Relaxin is an important agent in the remodeling of connective tissue in several reproductive tract tissues [26]. Relaxin markedly modulates the connective tissue phenotype of human fibroblasts of several target organs. Relaxin is a positive regulator of matrix metalloproteinase (MMP) expression in human cervical fibroblast cell models, increasing procollagenase and prostromelysin expression, and decreasing the expression of tissue inhibitor of metalloproteinase 1 (TIMP-1) [23]. Relaxin also decreases the synthesis and secretion of interstitial collagens in normal human dermal fibroblasts in a dose-dependent manner [27]. No previous studies have been done to determine the effects of relaxin in the modulation of endometrial connective tissue despite considerable evidence that endometrial maturation involves remodeling of the interstitial extracellular matrix [28]. The effect of relaxin on MMP expression varies with cell type; inhibition of procollagenase by relaxin in endometrial cells is in distinct contrast to the stimulatory effect of relaxin on procollagenase expression in cervical fibroblasts [23].

In summary, the findings presented here provide definitive evidence for endometrial synthesis of relaxin and support the hypothesis that relaxin, in conjunction with other regulatory agents, is involved in the secretory phase remodeling of the endometrium, which supports implantation. Relaxin appears to be an important regulator of endometrial maturation via mechanisms (in addition to the previously documented regulation of stromal cell differentiation) that involve regulation of angiogenesis and endometrial connective tissue composition.


    FOOTNOTES
 
First decision: 10 October 2001.

1 This work was supported by National Institutes of Health grants HD-22338 and HD-19247 to L.T. Back

2 Correspondence: Laura T. Goldsmith, Department of Obstetrics, Gynecology & Women's Health, New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103. FAX: 973 972 4574; goldsmit{at}umdnj.edu Back

Accepted: January 8, 2002.

Received: September 17, 2001.


    REFERENCES
 TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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