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SUMMARYFocal adhesions anchor cells to extracellular matrix (ECM) and direct assembly of a pre-stressed actin cytoskeleton. They act as a cellular sensor and regulator, linking ECM to the nucleus. Here, we identify proteolytic turnover of the anti-adhesive proteoglycan versican as a requirement for maintenance of smooth muscle cell (SMC) focal adhesions. Using conditional deletion in mice, we show that ADAMTS9, a secreted metalloprotease, is required for myometrial activation during late gestation and for parturition. Through knockdown of ADAMTS9 in uterine SMC, and manipulation of pericellular versican via knockdown or proteolysis, we demonstrate that regulated pericellular matrix dynamics is essential for focal adhesion maintenance. By influencing focal adhesion formation, pericellular versican acts upstream of cytoskeletal assembly and SMC differentiation. Thus, pericellular versican proteolysis by ADAMTS9 balances pro- and anti-adhesive forces to maintain an SMC phenotype, providing a concrete example of the dynamic reciprocity of cells and their ECM.

This is the first prospective study to evaluate the impact of adenomyosis on pregnancy outcome following frozen embryo transfer, finding that asymptomatic adenomyosis is not associated with adverse pregnancy outcome in this setting. In addition, it provides information regarding the reproducibility of three-dimensional ultrasound diagnosis of adenomyosis. What are the clinical implications of this work? These findings suggest that routine screening for asymptomatic adenomyosis in an unselected infertile patient population undergoing frozen embryo transfer is not warranted.

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Contraceptive use was lower than the national average in this cohort of mainly Spanish-speaking Latinas, with most of the women using methods considered not as efficacious as hormonal ones. These data suggest that initial counseling for young Latinas, especially for those who may not be acclimated to U.S. culture as evidenced by their preference for counseling in Spanish, should focus on how to optimally prepare for planning and spacing of pregnancies rather than on how to prevent pregnancy. Counseling that emphasizes only birth control options and not pregnancy concerns should be employed after desired family size is reached.

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