Effect of Vitamin D on Elastin and Collagen Expression: In Vitro Study of Pelvic Organ Prolapse Prevention


  •   . Rahajeng

  •   Tatit Nurseta

  •   Bambang Rahardjo

  •   Yahya Irwanto

  •   Daniel Alexander Suseno


Introduction: Pelvic organ prolapse is defined as abnormal protrusion of the pelvic organ beyond its normal anatomical site. It occurs due to the structural weakness of the connective tissue that plays a role in supporting the uterus on the pelvic floor, specifically elastin and collagen. Our study evaluated the effect of vitamin D [1,25(OH)2D3] in preventing pelvic organ prolapse by aggregating elastin and collagen expression.

Material and Methods: A true experimental research was carried out by assessing the cell cultures of sacro-uterine ligament from female patients who underwent hysterectomy. The cell cultures were divided into groups that were exposed to vitamin D at different concentrations of 100 µM, 200 µM, 400 µM, 800 µM, and control without any exposure. The expression of elastin and collagen was subsequently analyzed using immunofluorescence and ELISA method.

Results: This study showed that exposure to vitamin D significantly affected elastin expression (p-value <0.05). The concentration found to be the most effective to induce elastin expression is at 400 µM. Vitamin D also significantly affected the collagen expression (p-value <0.05), with the concentration found to be the most effective to induce collagen expression is at 800 µM.

Conclusion: This study suggested that vitamin D had a significant positive effect of increasing extracellular matrix expression and potentially become a preventive agent for pelvic organ prolapse. Vitamin D is widely available in tropical countries like Indonesia, so this preparation is considered very easy for Indonesian women to apply.

Keywords: Vitamin D, Elastin, Collagen, Extracellular Matrix


Maher, C., Feiner, B., Baessler, K., et al., “Surgical management of pelvic organ prolapse in women,” The Cochrane Database of Systematic Reviews, no. 4, pp. CD004014, April 2013.

Kerkhof, M.H., Hendriks, L., Brölmann, H.A., “Changes in connective tissue in patients with pelvic organ prolapse-a review of the current literature,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 20, no. 4, pp. 461–474, April 2008.

Wibisono, J., Hermawan, G., “Prolaps Organ Panggul,” Medicinus, vol. 7, no. 1, pp. 27–32, January 2018.

Megadhana, I.W., Suwiyoga, K., “Stage III-IV uterine prolapse risk factors: sacrouterine ligaments high estrogen receptor alpha and collagen III expression and low elastin expression,” Bali Medical Journal, vol. 5, no. 1, pp. 91–97, August 2016.

Jelovsek, J.E., Maher, C., Barber, M.D., “Pelvic organ prolapse,” Lancet, vol. 369, no. 9566, pp. 1027–1038, March 2007.

Jo, H.C., Baek, J.C., Park, J.E., et al., “Clinicopathologic characteristics and treatment patterns of pelvic organ prolapse in South Korea,” The Pan African Medical Journal, vol. 34, no. 14, September 2019.

Anne, M.W., “An overview of pelvic organ prolapsed,” in Office Urogynecology, Anne, M.W., Linda, B., Joseph, S., et al.: Mc Graw-Hill, 2004, pp. 189–196.

Maldonado, P.A., Wai, C.Y., “Pelvic Organ Prolapse: New Concepts in Pelvic Floor Anatomy,” Obstetrics and Gynecology Clinics of North America, vol. 43, no. 1, pp. 15–26, March 2016.

Salvatore, S., Siesto, G., Serati, M., “Risk factors for recurrence of genital prolapse,” Current Opinion in Obstetrics & Gynecology, vol. 22, no. 5, pp. 420–424, October 2010.

Gabriel, B., Denschlag, D., Göbel, H., et al., “Uterosacral ligament in postmenopausal women with or without pelvic organ prolapse,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 16, no. 6, pp. 475–479, December 2005.

Liu, X., Zhao, Y., Pawlyk, B., et al., “Failure of elastic fiber homeostasis leads to pelvic floor disorders,” The American Journal of Pathology, vol. 168, no. 2, pp. 519–528, February 2006.

Machin, S.E., Mukhopadhyay, S., “Pelvic organ prolapse: review of the aetiology, presentation, diagnosis and management,” Menopause International, vol. 17, no. 4, pp. 132–136, December 2011.

Chow, D., Rodríguez, L.V., “Epidemiology and prevalence of pelvic organ prolapse,” Current Opinion in Urology, vol. 23, no. 4, pp. 293–298, July 2013.

Bao, R., Liu, X., Zhou, J., “Primary culture and identification of human fibroblasts,” Journal of Xinxiang Medical College, vol. 28, no. 5, pp. 577–579, 2011.

Budatha, M., Roshanravan, S., Zheng, Q., et al., “Extracellular matrix proteases contribute to progression of pelvic organ prolapse in mice and humans,” The Journal of Clinical Investigation, vol. 121, no. 5, pp. 2048–2059, May 2011.

Drewes, P.G., Yanagisawa, H., Starcher, B., et al., “Pelvic organ prolapse in fibulin-5 knockout mice: pregnancy-induced changes in elastic fiber homeostasis in mouse vagina,” The American Journal of Pathology, vol. 170, no. 2, pp. 578–589, February 2007.

Wen, Y., Polan, M.L., Chen, B., “Do extracellular matrix protein expressions change with cyclic reproductive hormones in pelvic connective tissue from women with stress urinary incontinence?,” Human Reproduction, vol. 21, no. 5, pp. 1266–1273, May 2006.

Crescioli, C., Morelli, A., Adorini, L., et al., “Human bladder as a novel target for vitamin D receptor ligands,” The Journal of Clinical Endocrinology and Metabolism, vol. 90, no. 2, pp. 962–972, February 2005.

Ryan, Z.C., Craig, T.A., McGee-Lawrence, M., et al., “Alterations in vitamin D metabolite, parathyroid hormone and fibroblast growth factor-23 concentrations in sclerostin-deficient mice permit the maintenance of a high bone mass,” The Journal of Steroid Biochemistry and Molecular Biology, vol. 148, pp. 225–231, April 2015.

Ghanbari, Z., Karamali, M., Mirhosseini, N., et al., “Vitamin D status in women with pelvic floor disorders: a meta-analysis of observational studies,” Journal of Mid-life Health, vol. 10, no. 2, pp. 57–62, June 2019.

Allott, B.S., Dittmer, K.E., Kenyon, A.G., et al., “Preliminary investigation of the effect of treating sheep during pregnancy with a vitamin A, D, E formulation on the incidence of vaginal prolapse,” New Zealand Veterinary Journal, vol. 68, no. 3, pp. 193–197, May 2020.

Kaur, H., Bala, R., Nagpal, M., “Role of Vitamin D in urogenital health of geriatric participants,” Journal of Mid-life Health, vol. 8, no. 1, pp. 28–35, March 2017.

Moon, Y.J., Choi, J.R., Jeon, M.J., et al., “Alteration of elastin metabolism in women with pelvic organ prolapse,” The Journal of Urology, vol. 185, no. 5, pp. 1786–1792, May 2011.

Stevenson, S., Thornton, J., “Effect of estrogens on skin aging and the potential role of SERMs,” Clinical Interventions in Aging, vol. 2, no. 3, pp. 283–297, 2007.

Klein, T., Bischoff, R., “Physiology and pathophysiology of matrix metalloproteases,” Amino Acids, vol. 41, no. 2, pp. 271–290, July 2011.

Skowrońska, P., Pastuszek, E., Kuczyński, W., et al., “The role of vitamin D in reproductive dysfunction in women - a systematic review,” Annals of Agricultural and Environmental Medicine, vol. 23, no. 4, pp. 671–676, December 2016.

Grinnell F., “Fibroblast biology in three-dimensional collagen matrices,” Trends in Cell Biology, vol. 13, no. 5, pp. 264–269, May 2003.

Barrea, L., Savanelli, M.C., Di Somma, C., et al., “Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist,” Reviews in Endocrine & Metabolic Disorders, vol. 18, no. 2, pp. 195–205, June 2017.

Christakos, S., Hewison, M., Gardner, D.G., et al., “Vitamin D: beyond bone,” Annals of the New York Academy of Sciences, vol. 1287, no. 1, pp. 45–58, May 2013.


Download data is not yet available.


How to Cite
Rahajeng, ., Nurseta, T., Rahardjo, B., Irwanto, Y., & Suseno, D. A. (2021). Effect of Vitamin D on Elastin and Collagen Expression: In Vitro Study of Pelvic Organ Prolapse Prevention. European Journal of Medical and Health Sciences, 3(1), 37-41. https://doi.org/10.24018/ejmed.2021.3.1.657