Journal of Human Reproductive Science
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ORIGINAL ARTICLE Table of Contents   
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 303-309
Novel Technique of Vaginoplasty Developing Normal Vagina, Role of Stemness Markers and Translational Genes


1 Department of Obstetrics and Gynecology, Seth G S Medical College, KEM Hospital, N. Wadia Hospital; Department of Genetic, Kedar Hospital, Parel, Mumbai, Maharashtra, India
2 Department of Reproductive and Genetic Toxicology, National Institute for Research in Reproductive Health, Parel, Mumbai, Maharashtra, India
3 Department of Genetic Research Centre, National Institute for Research in Reproductive Health, Mumbai, Maharashtra, India
4 Department of Obstetrics and Gynecology, Seth G S Medical College, KEM Hospital, N. Wadia Hospital, Parel, Mumbai, Maharashtra, India

Correspondence Address:
Prof. Pravin Mhatre
9/2nd Floor, Mohan Niwas, Keluskar Road, Shivaji Park, Mumbai - 400 028, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhrs.JHRS_68_20

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Aims and Objectives: To study development of neo-vagina by metaplastic conversion of peritoneum, To identify translational Stemness markers using NANOG/OCT4/SOX2 from serial neo-vaginal mRNA, cDNA and to study role of WNT and HOXA genes in patients undergoing vaginoplasty. Material and Methods: 75 MRKH Syndrome women underwent laparoscopic peritoneal vaginoplasty (LPV). Two patients underwent serial neo-vaginal biopsies on day 0, 7-9, 12-14, 21 and 33. Fifteen MRKHS and twelve controls were subjected for neo-vaginal biopsy to detect genes upregulation. Remaining patients were evaluated anatomically and functionally. Results: The translational stemness markers NANOG, OCT4 and SOX2 responsible for neo-vaginal formation were identified. Their appearance, concentration at different stages of conversion were demonstrated. The neo-vagina has shown up-regulation of these translational stemness markers. The study demonstrates expression of the specific genes (WNT4, WNT5A and WNT7A) and their role in formation of the neo-vagina. In the subjects stemness markers (NANOG, OCT4 and SOX2) appeared from day 9 to 14 of the neo-vaginal biopsies and after achieving the peak declined later. Genetic analysis showed low values in HOXA 9,10,11,13 and up-regulation of WNT 4A,5A,7 genes in neo-vagina. Conclusions: Study shows peritoneal metaplastic conversion to normal vagina, identified the translational stemness markers and genes responsible. The neo-vagina has shown up-regulation of these genes. The study demonstrates expression of the specific genes (WNT4, WNT5A and WNT7A) and their role in formation of the neo-vagina. Furthering this research, activating these genes may lead to treatment of developmental defects of Mullerian duct, obviating the need of transplant.


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