![]() A pilot case–control study reported that the CMP is more extensive and permeable in women at high risk of preterm birth than in those at low risk of preterm birth ( Critchfield et al., 2013). To date, only three GFMs, MUC2, MUC5AC, and MUC5B, have been detected in the human CMP ( Habte et al., 2008). In the human cervical canal, GFMs are secreted by mucus cells located in the endocervical epithelium and form the mucus plug during pregnancy. The in vivo mucus properties of the CMP are poorly understood because of the difficulties in studying it in humans for ethical and safety reasons. These are all highly conserved in mice and named Muc2, Muc5b, Muc5ac, Muc6, and Muc19 ( Desseyn and Laine, 2003 Lacroix et al., 2020). Five GFMs have been identified in humans and named MUC2, MUC5AC, MUC5B, MUC6, and MUC19. The secreted long polymers of GFMs form a highly hydrophilic network, which adopts a gel formation when in contact with water. GFMs are large and heavily O-glycosylated proteins that are secreted by specialized cells at the epithelial surface. Mucus is a hydrogel made mainly of water and gel-forming mucins (GFMs), which represent its main organic component and are responsible for its viscoelastic properties ( Demouveaux et al., 2018 Lacroix et al., 2020). A spontaneously expelled CMP in a healthy woman is made of solid-like materials. It is believed that the CMP acts as a physical barrier that prevents pathogens of the vaginal flora from ascending into the uterine cavity, thereby helping to ensure the sterility of the uterus during pregnancy ( Bastholm et al., 2014). It represents a major obstetric and global health problem that affects more than one in 10 births worldwide ( Liu et al., 2015).ĭuring human pregnancy, a large amount of mucus is produced in the cervical canal to form the cervical mucus plug (CMP). Intrauterine infection during pregnancy is recognized as a leading cause (40%) of preterm delivery ( Stinson and Payne, 2019). Preterm birth is associated with significant neonatal morbidity and mortality, and with a higher risk of adverse consequences in childhood and adulthood ( Platt, 2014 Ream and Lehwald, 2018 Sperling and Nelson, 2016).
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