Alterations of the Extracellular Matrix of the Connective Tissue in Inguinal Herniogenesis

  • Gemma Pascual
  • Juan M. BellónEmail author


Inguinal hernia is still today one of the most common procedures performed by general surgeons. The techniques for abdominal wall surgical repair are around 20% of all general surgery procedures.

The etiology and pathogenesis are complex, with multiple factors contributing to its development, including individual predisposition and certain birth defects. The development level of hernias of the abdominal wall and its recurrence has been shown to occur more frequently in patients with connective tissue disorders, such as patients with aortic aneurysm, Marfan and Ehlers-Danlos syndrome, and cutis laxa, among other diseases. The etiology of inguinal hernia involves changes in the expression of different extracellular matrix constituents, affecting especially at the level of the transversalis fascia (TF), such as collagen, elastic component, and metalloproteinases (MMPs).

This review paper aims to collect all the experience and previous results of our group in the study of the constituents of the abdominal wall extracellular matrix of connective tissue, in the development of inguinal herniogenesis.

In previous studies, we were able to demonstrate the overexpression of MMP-2 in the transversalis fascia of young patients with direct inguinal hernia correlated with the overexpression of TGF-beta1 showing an attempt to counterbalance the enhanced matrix degradative process observed in these patients. At the level of the elastic constituents of the TF, direct inguinal hernia patients show low levels of tropoelastin (TE), precursor to the elastin molecule and lysyl oxidase like-1 (LOXL-1), an enzyme involved in cross-linking of elastin. In contrast, these patients showed significantly higher elastase expression, main enzyme involved in the process of degradation of elastin. Significantly lower LOXL-1 mRNA levels were also observed in cells obtained from the TF of patients with direct inguinal hernia.

All these alterations highlight a disorder at the level of the extracellular matrix of connective tissue in patients with inguinal hernias, which together with other exogenous factors would partly explain the genesis of this pathology.


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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Medicine and Medical Specialties, Faculty of Medicine and Health SciencesNetworking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of AlcaláMadridSpain
  2. 2.Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health SciencesNetworking Biomedical Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), University of AlcaláMadridSpain

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