Uterine contractions are important for the well-being of females. However, pathologically increased contractility may result in dysmenorrhea, especially in younger females. Here, we describe a simple ex vivo preparation allowing quick assessment of the efficacy of smooth muscle relaxants that may be used for treating dysmenorrhea.
Dysmenorrhea, or painful cramping, is the most common symptom associated with menses in females and its severity can hinder women's everyday lives. Here, we present an easy and inexpensive method that would be instrumental for testing new drugs decreasing uterine contractility. This method utilizes the unique ability of the entire mouse reproductive tract to exhibit spontaneous motility when maintained ex vivo in a Petri dish containing oxygenated Krebs buffer. This spontaneous motility resembles the wave-like myometrial activity of the human uterus, referred to as endometrial waves. To demonstrate the effectiveness of the method, we employed a well-known uterine relaxant drug, epinephrine. We demonstrate that the spontaneous motility of the entire mouse reproductive tract can be quickly and reversibly inhibited by 1 µM epinephrine in this Petri dish model. Documenting the changes of uterine motility can be easily done using an ordinary smart phone or a sophisticated digital camera. We developed a MATLAB-based algorithm allowing motion tracking to quantify spontaneous uterine motility changes by measuring the rate of uterine horn movements. A major advantage of this ex vivo approach is that the reproductive tract remains intact throughout the entire experiment, preserving all intrinsic intrauterine cellular interactions. The major limitation of this approach is that up to 10-20% of uteri may exhibit no spontaneous motility. Thus far, this is the first quantitative ex vivo method for assessing spontaneous uterine motility in a Petri dish model.
As a major female organ, the uterus is crucial for reproduction and essential for the nourishment of the fetus1. The uterus consists of three layers: the perimetrium, myometrium and endometrium. The myometrium is the major contractile layer of the uterus and plays a key role in fetus delivery. The endometrium is the innermost layer lining the uterine cavity and is essential for embryo implantation. In non-pregnant females of reproductive age, the endometrial layer is shed monthly at the beginning of the menstrual cycle. The myometrium aids in this shedding process by maintaining the spontaneous myometrial contractions needed for clearing the necrotic endometrial tissue from the uterus1.
Unfortunately, increased myometrial contractility can result in negative side effects such as dysmenorrhea, or painful menstrual cramps. This is especially seen in young females and nulliparous women2. However, dysmenorrhea is different for every woman and depends on the strength of their myometrial contractions; stronger contractions are often associated with the sensation of severe cramping3. Myometrial contractility can be visualized using uterine ultrasound and is often recognized as endometrial waves. Enhanced release of prostaglandins during menstruation4 in a uterus undergoing endometrial sloughing is believed to contribute to increased myometrial hypercontractility, resulting in ischemia and hypoxia of the uterine muscle and thus increased pain3.
Severe dysmenorrhea can hinder the day-to-day activity of some women and 3 to 33% of women have very severe pain, which could cause a woman to be bedridden for 1 to 3 days each menstrual cycle5. Dysmenorrhea is the leading cause of gynecological morbidity in women of reproductive age regardless of age, nationality, and economic status5. The estimated prevalence of dysmenorrhea is both high and variable, ranging from 45% to 93% in women of reproductive age5. Dysmenorrhea-associated pain has an effect on the daily life of women and may result in poor academic performance in adolescents, lower quality of sleep, restriction of daily activities, and mood changes5.
Many women who experience severe dysmenorrhea resort to over-the-counter medications to relieve their pain. Such over-the-counter medications contain cyclooxygenase (COX) inhibitors which prevent the formation of prostaglandins6. However, COX inhibitors are associated with adverse cardiovascular events, and about 18% of women with dysmenorrhea are unresponsive to these inhibitors7. Therefore, there is a need for new medications to reduce menstrual cramps. Since over contractility of the uterus contributes to the pathogenesis of dysmenorrhea, one possible strategy may be the usage of uterine relaxants.
It is beneficial to quantify the effects of potential relaxant drugs in a model of naturally occurring spontaneous myometrial wave-like contractions. However, thus far, no efficient ex vivo method for testing muscle-relaxing drugs in the intact uterus has been described. Currently, isometric tension measurements are used to evaluate relaxant drug effects. During such measurements, a uterine muscle strip is maintained at a constant length under preload in a tissue bath while the force of uterine muscle contractions is recorded before and after oxytocin stimulation in the presence or absence of a relaxant drug. Although this approach is very useful, it requires expensive equipment. Furthermore, isometric contractions do not resemble the spontaneous myometrial wave-like contractions that naturally occur in the intact uterus. Uniquely, the uterine myometrial waves in rodents can be visualized as uterine horn motility when the entire reproductive tract (ovaries, oviducts, uterus, and vagina) is maintained in a buffer solution. Here, we present an ex vivo method for monitoring the spontaneous motility of the intact mouse uterus placed in a Petri dish containing oxygenated Krebs buffer. We also describe a motility quantification algorithm utilizing the MATLAB motion tracker. This novel approach provides an easy and less expensive alternative to test the relaxant potential of naturally occurring remedies and synthetic compounds.
All procedures with animals have been approved by the Institutional Animal Care and Use Committee at the Indiana University School of Medicine (Indianapolis, IN). 2-5 month-old F2-129S-C57BL/6 sexually-mature female mice were used in the study.
CAUTION: Ensure safety by wearing a lab coat, mask, and gloves when working with animals and biohazardous materials.
1. Solution Preparation
2. Animal Preparation
3. Determination of Estrous Cycle Stage
4. Mouse Reproductive Tract Ddissection
5. Tissue Imaging
6. Data Analysis
Figure 1 shows representative images taken during the entire reproductive tract isolation procedure that is described in this protocol. To avoid contaminating the buffer with fur, which would decrease video quality, we moistened the mouse body with 70% ethanol. The major benchmark for the dissection section of the protocol is to find the urinary bladder. The uterus and vagina will be located inferior to the urinary bladder.
To test the protocol, we treated the entire reproductive tract with epinephrine. Epinephrine is well-known to cause uterine smooth muscle relaxation. This hormone is endogenously produced in the adrenal medulla and serves as a stress hormone in mammals. We used 1 µM epinephrine in our experiments. This is a saturating concentration known to cause maximal response12. A series of four experiments were performed. In all trials, 1 µM epinephrine reversibly inhibited spontaneously uterine motility (Figure 2).
To quantify the spontaneous motility of the reproductive tract, we designed an algorithm allowing us to assess the average rate of change in the Euclidean distance between two selected points on the mouse reproductive tract. The point positions are tracked using the motion tracking module of MATLAB software. The corresponding script for MATLAB, which we used to calculate the Euclidean distances, is provided in the Supplemental material online. The position of points is critical for a successful motion tracking procedure. Careful consideration should be taken concerning the quality of the videos because the light reflections from the Petri dish’s wall may distract the motion tracker, and it may stop tracking the horn movement while re-assigning the point to one of the light reflections. We opted to place one of the points in the middle of a horn to ensure that it was far enough from the Petri dish wall reflections. The second point was usually selected on the vagina since it did not exhibit spontaneous motility. Figure 3 provides a sample of data analysis, and Supplemental figure 1 shows the representative images acquired during motion tracking.
Figure 1: Steps of entire reproductive tract isolation. (A) An incision in the skin was made and the abdominopelvic region was exposed above the peritoneum (1). (B) The serous membrane was slowly opened to expose the gastrointestinal tract (2). (C) The gastrointestinal tract has been moved to expose the uterine horns (3). The urinary bladder (4) can be visualized near the conjunction of the horns. (D) The uterine horns have been freed and cuts have been made on the lateral sides of the pubic symphysis (5) to expose the vagina (6). (E) Removal of the isolated reproductive tract and placement into DPBS solution. Any excess fur or connective tissue was removed. (F) A deep indentation can be seen on the vagina (right) after removal of the rectum (left, 7). (G) The surrounding connective tissue is removed. A digital camera and Application Suite software (version 3.7.0) was used to acquire real-time images during dissection (camera setting: hue 20/saturation 80). Please click here to view a larger version of this figure.
Figure 2: A representative experiment with the entire isolated reproductive tract is shown. The images were taken 15 s apart before (A), during (B), and after (C) the application of 1 µM epinephrine. The reproductive tract preparation exhibited high motility in panels A and C in the absence of epinephrine, but it is quiescent in panel B with the presence of 1 µM epinephrine. The unedited video footage is provided as Supplemental videos 1-3. Please click here to view a larger version of this figure.
Figure 3: Data analysis in the ex vivo experiment described in Figure 2. (A) A time course of the Euclidean distance change rate is shown. The reference points between which the distance was determined during spontaneous uterine motility are shown as green dots in the inset. The points were selected at the proximal part of the vagina and the middle segment of a uterine horn as depicted. The blue filled circles show the spontaneous motility rate values before adding epinephrine, the red circles show the spontaneous motility rates in the presence of 1 µM epinephrine, and the green filled circles show the spontaneous motility rates after a washout. (B) A comparison of average Euclidean distance change rates (pixels/s) before addition of epinephrine (blue bar), in the presence of 1 µM epinephrine (red bar), and after a washout (green bar). The MATLAB software was used to quantify the uterine motility. Δt interval was set at 5 s. "ΔDistance" is calculated as the difference between the initial frame distance and the frame distance 5 s later. The statistical analysis was performed using Kruskal-Wallis One Way Analysis of Variance on Ranks followed by all pairwise multiple comparison procedures according to the Dunn's Method using SigmaPlot 13. The asterisk indicates the data set that was significantly different from the other experimental data sets (P = <0.001). Please click here to view a larger version of this figure.
Supplemental movie 1: Time-lapse video clip showing spontaneous uterine motility before adding 1 µM epinephrine. Please click here to view this video. (Right-click to download.)
Supplemental movie 2: Time-lapse video clip showing spontaneous uterine motility when the Krebs buffer was supplemented with 1 µM epinephrine. Please click here to view this video. (Right-click to download.)
Supplemental movie 3: Time-lapse video clip showing spontaneous uterine motility after washout. Please click here to view this video. (Right-click to download.)
Supplemental Figure 1: Representative images taken every 15 s during motion tracking. Please click here to view a larger version of this figure.
Supplemental Material: The MATLAB-based tracking algorithm script. Please click here to download this file.
Here, we described a method for assessing spontaneous contractility of the entire rodent reproductive tract, which includes the ovaries, oviducts, uterine horns, and the vagina. We used a similar method to demonstrate the relaxant effect of phenylephrine on spontaneous uterine motility13, however, in the past we were unable to provide quantitative analysis of the data. In this work, we developed an algorithm for quantitative motility data analysis using the MATLAB motion tracking module. This is a useful technique for testing new drugs that regulate uterine contractility regardless of whether the drugs relax or constrict uterine smooth muscles. A major advantage of this model is that the reproductive tract is intact, preserving all intrinsic intrauterine cellular interactions. Notably, this protocol does not require any special equipment. The uterus isolation can be done with a simple magnifying glass and there is no requirement for any sophisticated video recording equipment. If a high-resolution digital camera is not available for imaging, a personal mobile phone camera may be used as an alternative.
The most critical step of the protocol for assessing reproductive tract motility is to obtain viable uterine tissue. The myometrium, within the uterine horns, is the motile element of the reproductive tract. Therefore, during isolation it is important to avoid overstretching or compressing the horns. It is also important to ensure that the uterine tissue is well-oxygenated throughout the experiment to maintain uterine motility. The best way to prevent any damage to the uterine horns is to make contact with only the adjacent connective tissue while cleaning the uterus or moving the reproductive tract. Since the vagina does not contract spontaneously during the experiment, it is acceptable to compress it with the forceps when moving the reproductive tract from one dish to another. The entire reproductive tract experiments may be performed in conjunction with isometric tension recordings that assess preload- and/or oxytocin-induced uterine contractility. However, a wire myograph is an expensive piece of equipment that is not always available in a common laboratory environment.
The described method has several limitations. Since the myometrium is very sensitive to compressions or pulls, this complicates the dissection process of the reproductive tract. If the horns are damaged during dissection, no spontaneous contractility will be observed. This is a major limitation of the protocol because it is uncertain whether the contractile smooth muscle cells were unknowingly damaged despite the use of proper care and caution or whether they lacked motility due to a natural cause. Indeed, we observed no motility in 10-20% of the reproductive tract preparations in this study. It is important to ensure that the vaginal segment of the reproductive tract remains intact because removal of the vagina markedly decreases spontaneous motility of the uterine horns. In contrast, the absence of ovaries and/or oviducts does not impair the entire reproductive tract motility. In addition, one should note that some compounds are sensitive to oxidation. For example, epinephrine can be easily oxidized. Testing the effects of such compounds would require shorter incubation time preventing excessive oxidation. However, shorter incubation times may hinder the ability of a drug to efficiently penetrate the thickness of the uterine wall. A further limitation of the method includes assessing the 3-dimensional movements of the horns. The horns have an innate nature of curling into a 3-dimensional plane, complicating analysis. To overcome this problem, one may decrease the Krebs buffer volume in the Petri dish to 2 mL.
We found that the optimum age range for female mice is 2-5 months. We indicated that anesthesia with isoflurane may result in reduced motility and additional washes may be necessary to prevent this isoflurane-induced complication. Alternatively, one can use carbon dioxide to euthanize mice. If difficulties arise during dissection, focus on landmarks, such as the urinary bladder, may help. To quantify the obtained motility data, we used MATLAB software. The major problem with motion tracking in MATLAB was that the tracker was unable to properly locate the horns when they moved near the wall of the Petri dish. Adobe Premier Element was used to clip the video footage and to reduce the size of video files. Although it is an outstanding software package, it may not always be available in a typical laboratory setting. An alternative option may be to use the free motion tracking module of ImageJ software or even simple manual assessment of images taken with identical intervals and comparing the position of the uterine horns on a segmentation grid. Figure 2 shows an example of simple assessment of the spontaneous uterine motility and includes a comparison of reproductive tract movements within a 15 s interval.
No simple method assessing uterine motility in a Petri dish setting has been reported thus far. Ultrasound and intrauterine pressure sensors can be used to monitor human uterus contractility14. However, it is difficult to study underlying mechanisms in the intact human uterus. Therefore, the use of animal models for investigating spontaneous uterine contractility is important. The female reproductive tract exhibits spontaneous myometrial contractions that are critical for a woman's well-being, including her fertility and labor15. These contractions can be visualized as endometrial waves during an ultrasound examination. However, during menstruation, over contractility of the uterus can create discomfort and lead to dysmenorrhea, or menstrual cramps. To help relieve some symptoms of dysmenorrhea, new drugs targeted at relaxing uterine smooth muscles are needed. Our simple method provides a way for assessing the effects of various compounds on uterine contractility.
In this study, we used our easy Petri dish model to confirm the effectiveness of epinephrine, a uterine relaxant hormone12, to prevent spontaneous uterine motility of isolated mouse reproductive tracts. Our method may also be used for testing such compounds that may increase the contractility of the uterus. Importantly, this method might have the potential to be upgraded for throughput drug screening using a six-well plate format. Thus, the method we present here may have the capability to be optimized for industrial scale screening procedures. We did not attempt to perform similar experiments in larger rodents, but we expect that similar spontaneous motility will be present in isolated rat uteri. The larger reproductive tract of rats may exhibit more pronounced uterine motility. We found that pregnant mouse uteri may also be assessed using this ex vivo uterine motility Petri dish model. As expected, the spontaneous motility of the pregnant uterus was reduced because it is in a quiescent state. However, increased weight added by the fetal tissue may also contribute to motility obstruction. It may still be beneficial to further explore the suitability of this entire reproductive tract model to assess the effect of tocolytic (relaxant) or uterotonic (stimulant) compounds in the context of pregnancy and labor. Thus, here we presented an easy ex vivo model for assessing the spontaneous motility of the intact reproductive tract. This approach may be adopted for drug screening and be utilized for novel drug discovery.
The authors have nothing to disclose.
This work was supported by internal IU funds. AGO conceived the study. XC and AGO were involved in the design of the described experiments. FL and AGO analyzed and interpreted the data. KLL, JOB, FL performed all of the ex vivo experiments. FL wrote the MATLAB script. KLL, JOB, and AGO wrote the manuscript. All authors read and approved the final version of the manuscript.
Epinephrine hydrochloride | Sigma-Aldrich | E4642 | |
Dulbecco's PBS | Fisher Sceintific | 17-512Q | |
Ethanol 200 PROOF | Decon Laboratories | 2701 | |
NaCl | Sigma-Aldrich | S7653 | |
Glucose | Sigma-Aldrich | G7528 | |
KCl | Sigma-Aldrich | P9333 | |
CaCl2 · 2H2O | Sigma-Aldrich | C5080 | |
NaH2PO4 | Sigma-Aldrich | S0751 | |
MgCl2 · 6H2O | Sigma-Aldrich | M9272 | |
NaHCO3 | Sigma-Aldrich | S6297 | |
Isoflurane, USP | Patterson Veterinary | 07-893-2374 | |
Dissecting Extra-Fine-Pointed Precision Splinter Forceps | Fisher Sceintific | 13-812-42 | |
Curved Hardened Fine Iris Scissors | Fine Science Tools | 14091-09 | |
Dissection High-performance Modular Stereomicroscope | Leica | MZ6 | |
Digital 5 Megapixel Color Microscope Camera with active cooling system | Leica | DFC425 C | |
Stereomaster Microscope Fiber-Optic Light Sources | Fisher Sceintific | 12-562-21 | |
Weigh Boat | Fisher Sceintific | WB30304 | |
Convertors Astound Standard Surgical Gown | Cardinal Health | 9515 | Small, Medium or Large |
Gloves | McKesson Corporation | 20-1080 | Small, Medium, or Large; powder-free sterile latex or nitrile surgical gloves |
Petri Dish | Corning Falcon | 351029 | 100 mm |
Petri Dish | Corning Falcon | 353001 | 35 mm |
95% O2– 5% CO2 gas mixture | Praxair | MM OXCD5-K | |
Ear-loop Masks | Valumax International | 5430E-PP | |
DSLR 24.2 MP Camera | Canon | EOS Rebel T6i | |
MATLAB | MathWorks | N/A | version 2019 or later |