Vaginal wall smooth muscle underpins pelvic support. In pelvic organ prolapse, smooth muscle cells are depleted and shift from a contractile phenotype to remodelling programmes, paralleling stress-induced switching in vascular disease. Defining trajectories and drivers could yield biomarkers and translatable, locally deliverable therapies to curb progression and recurrence.
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References
Friedman, T., Eslick, G. D. & Dietz, H. P. Risk factors for prolapse recurrence: systematic review and meta-analysis. Int. Urogynecol. J. 29, 13–21 (2018).
De Landsheere, L. et al. Histology of the vaginal wall in women with pelvic organ prolapse: a literature review. Int. Urogynecol. J. 24, 2011–2020 (2013).
Sferra, R. et al. Neurovascular alterations of muscularis propria in the human anterior vaginal wall in pelvic organ prolapse. J. Anat. 235, 281–288 (2019).
Mei, S. et al. The role of smooth muscle cells in the pathophysiology of pelvic organ prolapse. Female Pelvic Med. Reconstr. Surg. 19, 254–259 (2013).
Northington, G. M., Basha, M., Arya, L. A., Wein, A. J. & Chacko, S. Contractile response of human anterior vaginal muscularis in women with and without pelvic organ prolapse. Reprod. Sci. 18, 296–303 (2011).
Li, Y. et al. Single-cell transcriptome profiling of the vaginal wall in women with severe anterior vaginal prolapse. Nat. Commun. 12, 87 (2021).
White, S. E. et al. Remodelling of murine vaginal smooth muscle function with reproductive age and elastic fiber disruption. Acta Biomater. 175, 186–198 (2024).
Chakraborty, R. et al. Targeting smooth muscle cell phenotypic switching in vascular disease. JVS Vasc. Sci. 2, 79–94 (2021).
Thenappan, T., Chan, S. Y. & Weir, E. K. Role of extracellular matrix in the pathogenesis of pulmonary arterial hypertension. Am. J. Physiol. Heart Circ. Physiol. 315, H1322–H1331 (2018).
Tan, B. et al. Endothelial progenitor cells control remodelling of uterine spiral arteries for the establishment of utero-placental circulation. Dev. Cell 59, 1842–1859.e12 (2024).
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Tong, H., Lin, L., Zhang, M. et al. Smooth muscle cell plasticity in pelvic organ prolapse. Nat Rev Urol (2026). https://doi.org/10.1038/s41585-026-01131-0
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DOI: https://doi.org/10.1038/s41585-026-01131-0
