Longitudinal evaluation of a fibrosis index combining MMP-1 and PIIINP compared with MMP-9, TIMP-1 and hyaluronic acid in patients with chronic hepatitis C treated by interferon-alpha and ribavirin

We have recently described a fibrosis index combining serum procollagen type III N-terminal peptide (PIIINP) and matrix metalloproteinase 1 (MMP-1) concentrations for evaluating the amount of liver fibrosis in chronic hepatitis C patients. The aims of the present study were to validate this score in another cohort of patients and to assess its variations along those of TIMP-1, hyaluronic acid (HA) and MMP-9 during antiviral treatment. Seventy-nine patients treated by interferon-alpha and ribavirin for 24 or 48 weeks were included. A liver biopsy was performed within the 6 months before the start of treatment. Serum markers were measured in serum collected the day of the liver biopsy, at start of treatment, and every 3 months during treatment and a 6-month follow-up period. The PIIINP/MMP-1 index was significantly correlated to the METAVIR fibrosis (r = 0.68, P < 0.001). Its overall diagnostic value defined by the area under the receiver operating characteristics curves was 0.77 for discriminating F1 vs F2F3F4, and 0.81 for discriminating F1F2 vs F3F4, and was better than that observed for HA and TIMP-1. At the end of follow-up, the PIIINP/MMP-1 index significantly decreased in responders and remained stable in nonresponder patients. This decrease occurred early and continued regularly during the treatment period. This variation was because of both a decrease of PIIINP and an increase of MMP-1 concentrations. HA and TIMP-1 serum concentrations were also significantly lower at the end of follow-up in responder patients, but early changes were minimal and not influenced by the response to treatment. Our study shows that a noninvasive index combining PIIINP and MMP-1 is a useful tool to follow-up fibrosis change during and after antiviral therapy chronic hepatitis C patients.     

Plasma Levels of Matrix Metalloproteinase-2 (MMP-2) and Tissue Inhibitors of Metalloproteinases-1 and -2 (TIMP-1 and TIMP-2) as Noninvasive Markers of Liver Disease in Chronic Hepatitis C Comparison Using ROC Analysis

As chronic liver disease progresses, animbalance occurs between synthesis and breakdown ofextracellular matrix (ECM). Matrix metalloproteinases(MMPs) are involved in degrading ECM while tissueinhibitors of metalloproteinases (TIMPs) prevent theirfibrolytic action. We determined if plasma levels ofMMP-2, TIMP-1 and TIMP-2 are related to liver histologyin patients with chronic hepatitis C. Plasma MMP-2, TIMP-1 and TIMP-2 levels were measured in 43patients with chronic hepatitis C. Plasma levels ofMMP-2, TIMP-1 and TIMP-2 and serum ALT were correlatedwith liver biopsy score and specificity and sensitivity of the assays in detecting advanced liverdisease were calculated from ROC analysis. Plasma TIMP-1was significantly correlated with histological activityindex (r = 0.45), portal inflammation (r = 0.48), periportal necrosis (r = 0.34) and focalnecrosis (r = 0.38). Plasma TIMP-2 was significantlycorrelated with fibrosis (r = 0.43) and confluentnecrosis (r = 0.41). Using ROC analysis both TIMP-1 andTIMP-2 had significant diagnostic ability in detectingadvanced liver disease (Area under the curve 0.73 forboth, p 0.015 and 0.036 respectively). A normal plasmaTIMP-1 excluded advanced liver disease. Neither plasma MMP-2 or serum ALT were related tofibrosis or to histological activity index. Withincreased severity of liver disease in chronic hepatitisC there is increased plasma levels of TIMPs-1 and-2.Plasma TIMP-1 and TIMP-2 are sensitive and to a lesserextent specific in detecting advanced liver disease inchronic hepatitis C and could be used in preference toserum ALT.     

Serum TIMP-1, TIMP-2, and MMP-1 in patients with systemic sclerosis, primary Raynaud's phenomenon, and in normal controls

BACKGROUND: Excess tissue matrix accumulates in systemic sclerosis (SSc), accounting for both visceral and dermal fibrosis. It is suggested that decreased serum levels of matrix metalloproteinases (MMPs) or increased levels of tissue inhibitors of matrix metalloproteinases (TIMPs) may account for this matrix accumulation. OBJECTIVE: To measure serum levels of tissue inhibitors of metalloproteinases, TIMP-1, TIMP-2, and collagenase-1 (MMP-1), in patients with diffuse cutaneous systemic sclerosis (dcSSc), limited cutaneous systemic sclerosis (lcSSc), primary Raynaud's phenomenon (RP), and in normal controls. METHODS: Serum samples from patients with dcSSc (n=83), lcSSc (n=87), RP (n=80), and normal controls (n=98) were analysed using enzyme linked immunosorbent assays (ELISAs) for total TIMP-1, TIMP-2, and MMP-1. Results from each assay were analysed by the Kruskal-Wallis test. Dunn's multiple comparison post-test was then applied between groups. RESULTS: TIMP-1 levels were significantly raised in dcSSc and lcSSc groups compared with the RP group and normal controls (p<0.01 to p<0.001). In the dcSSc group, TIMP-1 levels were significantly higher in early disease (<2 years) than in late stage disease (>4 years) (p<0.05). This was not found for the lcSSc group. Serum TIMP-2 and MMP-1 levels in dcSSc and lcSSc did not differ significantly from those in normal controls. Increased levels of TIMPs were not convincingly associated with organ disease. No assay result correlated with autoantibody status (anti-topoisomerase 1 (anti-Scl-70), anticentromere antibody, or anti-RNA polymerase). No significant differences in serum TIMP-1, TIMP-2, or MMP-1 levels were shown in the RP group compared with normal controls. CONCLUSIONS: Raised TIMP-1 levels in the SSc groups support the hypothesis that matrix accumulation occurs in SSc at least in part owing to decreased degradation. Moreover, the variation in TIMP-1 levels between the early and late disease stages of dcSSc seems to reflect the early progressive course of dermal fibrosis seen clinically. The expected reduction in serum MMP-1 levels in the SSc groups was not found. This suggests that tissue matrix accumulation is due to increased inhibitors rather than to decreased MMPs.     

Effect of antiviral therapy on markers of fibrogenesis in patients with chronic hepatitis C

BACKGROUND: The possible markers of liver fibrosis (plasma YKL-40, PIIINP, MMP-2 and TIMP-1) were measured at the start (t0) and end of treatment (t12) with alpha-interferon and ribavirin and repeated at 6-months follow-up (t18) in 51 patients with chronic hepatitis C. METHODS: We evaluated 1) whether treatment response is reflected by a decrease in these markers during antiviral therapy; 2) whether these markers reflect the activity of the disease; and 3) whether these markers could be used as predictors of the treatment response. RESULTS: Baseline plasma YKL-40, MMP-2, PIIINP and TIMP-1 were significantly increased in patients compared to normal controls. In responders (n = 30), plasma YKL-40 (P < 0.05), MMP-2 (P < 0.05) and TIMP-1 (P < 0.001) decreased significantly at t18, and no changes were observed at t12. Plasma PIIINP was unchanged in responders. In non-responders (n = 19), plasma MMP-2 (P < 0.01) and TIMP-1 (P < 0.01) decreased significantly at t18, whereas plasma YKL-40 and PIIINP were unchanged. The markers were significantly correlated at baseline (P < 0.001). Plasma PIIINP at baseline could predict treatment response (P = 0.01). CONCLUSIONS: Response to antiviral treatment is associated with a decrease in the fibrogenetic markers, but the markers do not reflect the biochemical disease activity during treatment. Baseline plasma PIIINP was the only marker predicting treatment response.     

慢性乙型肝炎肝组织中MMP-2、TIMP-1与肝纤维化关系的研究

为了研究慢性乙型肝炎患者肝纤维化与肝组织中基质金属蛋白酶-2(MMP-2)及其天然抑制物金属蛋白酶组织抑制剂-1(TIMP-1)的关系,对60例慢性乙型肝炎患者进行肝组织病理活检,其中S_110例,S_224例,S_312例,S_414例。采用苦叶酸天狼猩红染色检测胶原面积百分比,单克隆抗体(McAb)免疫组织化学染色检测MMP-2、TIMP-1阳性细胞的方法进行病理分析。结果显示：慢性乙型肝炎肝组织中胶原面积百分比与肝组织纤维化分期正相关(r=0．885,P=0．000);慢性乙型肝炎肝组织中MMP-2与肝纤维化的分期无关(r=0．034,P= 0．896);慢性乙型肝炎肝组织中TIMP-1和肝纤维化的分期正相关(r=0．760,P=0．000);慢性乙型肝炎肝组织中MMP-2/TIMP-1和肝纤维化分期负相关(r=-0．674,P=0．000)。总之,TIMP-1参与了慢性乙型肝炎肝纤维化纤维化的过程,而MMP-2/TIMP-1是诊断肝纤维化的比较合适的指标。     

Elevated plasma levels of TIMP-1 correlate with plasma suPAR/uPA in patients with chronic myeloproliferative disorders

Chronic myeloproliferative disorders (MPD) are characterized by progressive remodelling of bone marrow stroma as evidenced by increased deposition of extracellular matrix proteins, neoangiogenesis and displacement of normal haematopoietic cells by fibrotic tissue. The family of metalloproteinases (MMPs) and tissue inhibitors of metalloproteinase (TIMPs) serve to facilitate and inhibit matrix degradation processes, respectively. In an attempt to investigate potential markers for bone marrow remodelling processes, we investigated plasma levels of total-, free- and complexed TIMP-1, TIMP-2, MMP-2 and MMP-9 in a patient cohort comprising 17 with myelofibrosis (MF), 17 with polycythaemia vera (PV), 15 with essential thrombocythaemia (ET), 1 with a transitional MPD and 30 controls. Compared with controls, total- (P < 0.0001) (median: 132.6 microg/L vs. 80.8 microg/L), free- (P < 0.0001) (median: 126.4 microg/L vs. 65.8 microg/L) and complexed TIMP-1 (P = 0.0009) (median: 17.7 microg/L vs. 10.7 microg/L) concentration was significantly higher in the patients. TIMP-1 was significantly correlated with plasma soluble urokinase plasminogen activator receptor (P = 0.003) and urokinase plasminogen activator (P < 0.0001), respectively, suggesting a common cellular origin. No statistical significant difference between TIMP-2 and MMP-2 levels was observed between patients and controls. Furthermore, a significant correlation between free TIMP-1 and TIMP-2 levels was detected (r = 0.56; P < 0.0001). Median MMP-9 concentration was significantly higher among PV patients compared with controls (P = 0.0015), and 41% of patients with PV (7/17) had MMP-9 values that were above the mean + 2SD of plasma MMP-9 levels found in controls. The ratio of total TIMP-1/MMP-9 was significantly higher in patients with MF compared with controls (P = 0.0004). These findings suggest that a disturbed TIMP-1/MMP ratio may reflect an imbalance of the extracellular homeostasis towards an increased matrix deposition promoting fibrosis.     

Matrix metalloproteinase-1 and its inhibitor, TIMP-1, in systolic heart failure: relation to functional data and prognosis

BACKGROUND: Structural remodelling of left ventricle is a common feature in the progression of congestive heart failure (CHF). Matrix metalloproteinases (MMPs) have been directly implicated as they degrade extracellular proteins. To test the hypothesis that MMP-and its inhibitor, tissue type inhibitor of matrix metalloproteinases (TIMP-1), could be related to functional status and prognosis in CHF, we examined the relationship of MMP-1 and TIMP-1 to peak oxygen consumption (VO2) and peak minute ventilation/carbon dioxide production relationship (VE/VCO2), and assessed their prognostic value. METHODS: We studied 50 patients with CHF, who were compared with 53 controls echocardiogram and ergoespirometry were performed, and serum levels of MMP-1 and TIMP-1 were assayed by ELISA. Patients were followed up for 17.5+/-8.9 months, and total mortality, readmissions for heart failure and cardiac transplantation were recorded. RESULTS: Patients with CHF had lower levels of MMP-1 (P=0.027), and higher levels of TIMP-1 and TIMP-1/MMP-1 ratio (both P<0.01) than controls. TIMP-1 levels and the TIMP-1/MMP-1 ratio correlated negatively with peak VO2 (Spearman, r:-0.51; P=0.001 and r: -0.42; P=0.030, respectively). During the follow-up period, 23 patients (47.9%) suffered endpoints--these patients had higher baseline peak VE/VCO2 (P=0.001), TIMP-1 (P=0.004), and TIMP-1/MMP-1 ratio values (P=0.002), whereas MMP-1 levels were lower (P=0.027). On multivariate analysis, VE/VCO2, MMP-1 levels and age were the only variables independently related to prognosis (all P<0.05). CONCLUSION: Poor functional capacity in CHF can be related to abnormal extracellular matrix turnover. Patients who suffered endpoints had more abnormal indices of matrix turnover, where MMP-1 levels showed independent prognostic value.     

转化生长因子β1和基质金属蛋白酶抑制因子-1在肝纤维化诊断中的作用及关系

目的通过检测慢性乙型肝炎患者血清TGFβ1和TIMP-1在肝纤维化不同阶段的表达情况,探讨TGFβ1和TIMP-1在肝纤维化诊断中的作用及相互关系。方法采用酶联免疫吸附法（ELISA）检测40例慢性乙型肝炎患者和12名健康体检者血清TGFβ1、TIMP-1水平,RIA检测血清HA,LN、Ⅲ型前胶原氨基端肽（P．ⅢNP）水平,40例患者全部进行肝活组织检查,分析TGFβ1、TIMP-1与肝组织纤维化程度分期和炎症活动度分级的关系以及五项指标之间的相关性。结果血清TGFβ1、TIMP1在肝纤维化早期即明显升高,敏感性优于HA、LN、PⅢNP;且随肝纤维化程度的加重TGFβ1、TIMP-1逐渐升高（P＜0．05）;TGFβ1变化趋势与TIMP-1、HA、LN、PⅢNP均呈正相关（P＜0．01）,与TIMP-1相关性最强。结论TGFβ1、TIMP-1密切参与肝纤维化的形成过程,TIMP-1可能受TGFβ1调节,二者可作为早期肝纤维化的诊断指标。     

Expression of TIMP-1 and TIMP-2 in rats with hepatic fibrosis

AIM: To investigate the location and expression of TIMP-1 and TIMP-2 in the liver of normal and experimental hepatic fibrosis in rats. METHODS: The rat models of experimental immunity hepatic fibrosis (n=20) were prepared by the means of immunologic attacking with human serum albumin (HSA),and normal rats (n=10) served as control group. Both immunohistochemistry and in situ hybridization methods were respectively used to detect the TIMP-1 and TIMP-2 mRNA and related antigens in liver. The liver tissue was detected to find out the gene expression of TIMP-1 and TIMP-2 with RT-PCR. RESULTS: The TIMP-1 and TIMP-2 related antigens in livers of experimental group were expressed in myofibroblasts and fibroblasts (TIMP-1: 482&#177;65 vs 60&#177;20; TIMP-2:336&#177;48 vs 50&#177;19, P&lt;0.001). This was the most obvious in portal area and fibrous septum. The positive signals were located in cytoplasm, not in nucleus. Such distribution and location were confirmed bysitu hybridization (TIMP-1/β-actin: 1.86&#177;0.47 vs 0.36&#177;0.08; TIMP-2/β-actin: 1.06&#177;0.22 vs 0.36&#177;0.08,P&lt;0.001). The expression of TIMP-1 and TIMP-2 was seen in the liver of normal rats, but the expression level was very low. However, the expression of TIMP-1 and TIMP-2 in the liver of experimental group was obviously high. CONCLUSION: In the process of hepatic fibrosis, fibroblasts and myofibroblasts are the major cells that express TIMPs.The more serious the hepatic fibrosis is in the injured liver,the higher the level of TIMP-1 and TIMP-2 gene expression.     

Serum matrix metalloproteinase-1 in patients with chronic viral hepatitis

BACKGROUND AND AIMS: Previously we found that serum matrix metalloproteinase (MMP)-1 activity decreased with progression of chronic liver disease. Our objectives in the present study were to observe the change in the serum MMP-1 protein concentration using recently developed specific enzyme immunoassays for MMP-1 and MMP-1 complexed with tissue inhibitor of metalloproteinases (TIMP)-1 and to elucidate the clinical usefulness of the serum MMP-1 test in chronic viral hepatitis. We measured the serum concentrations of MMP-1 and MMP-1/TIMP-1 complex using these immunoassays in 64 patients with histologically characterized chronic viral hepatitis. RESULTS: Serum MMP-1 concentration was inversely related to the histological severity of chronic hepatitis (P< 0.0001). It was closely associated with the histological degree of periportal necrosis (P< 0.0001), intralobular necrosis (P< 0.005), portal inflammation (P<0.0001) and liver fibrosis (P< 0.05). The serum concentration of MMP-1/TIMP-1 complex was also related to the histological severity of chronic hepatitis (P< 0.0001). It was associated with the degree of portal inflammation (P< 0.05), but not with the degree of periportal necrosis, intralobular necrosis or liver fibrosis. As serum MMP-1 level was closely associated with the histological degree of necroinflammation, we examined the ability of the serum MMP-1 test to differentiate active and inactive forms of hepatitis with a receiver operating curve. The results were compared with those of serum procollagen type III N-peptide (PIIINP) test. We found that the serum MMP-1 test was superior to the serum PIIINP test in assessing liver necroinflammation. CONCLUSIONS: In addition to the previously reported changes in enzyme activity, MMP-1 proteins in serum decreased during histological progression of chronic hepatitis. The serum MMP-1 test may be useful clinically to differentiate active and inactive types of hepatitis in patients with chronic viral hepatitis.     

肝纤维化过程中胶原、基质金属蛋白酶及其抑制因子表达的动态变化及相互关系

目的研究在整个肝纤维化形成过程中肝组织Ⅰ、Ⅲ型胶原,间质性胶原酶(MMP 1 3)及其抑制因子(TIMP-1)表达水平的动态变化规律及相互间的关系.方法将大鼠随机分成正常对照组与模型组.模型组以二甲基亚硝胺腹腔内注射,第1周注射3次,随后每周2次,共注射6周,停用后再观察2周;正常对照组以等渗盐水代替腹腔内注射.分别于第1、4、10、17、28、42、56天分批处死大鼠.留取的肝脏组织做HE与Masson染色,按0～4期标准判定肝纤维化程度,测定羟脯氨酸含量,应用半定量RTPCR检测Ⅰ、Ⅲ型胶原、MMp-13和TIMP-1 mRNA.结果在肝纤维化形成过程中,胶原持续增高,其中Ⅰ型胶原mRNA在肝组织受损后10 d开始较正常对照明显增高(正常组0.468±0.015,模型组0.603±0.031,t=2.8 5,P＜0.05),并保持不断增高的表达水平直至实验结束;Ⅲ型胶原mRNA从28d左右开始显著增高(正常组0.774±0.043,模型组0.922±0.079,t=4.16,P＜0.01),直至实验结束;TIMP-1 mRNA从第4天即开始明显增高(正常组0.618±0.030,模型组0.728±0.013,t=2.60,P＜0.05),并保持不断增高的趋势直至实验结束;MMP-13 mRNA从10 d后到28 d有显著增高(17d左右达到高峰,正常组0.987±0.048,模型组1.141±0.033,t=4.08,P＜0.01),此后便逐渐下降至实验结束.结论在肝纤维化形成过程中MMP-13的表达虽有增高,但由于TIMP-1的表达在肝受损后早期即开始持续不断增高,从而MMP-13降解胶原的能力受到抑制,致使过度产生与沉积的胶原得不到有效降解,促进了肝纤维化的发展.     

Peripheral blood level alterations of TIMP-1, MMP-2 and MMP-9 in patients with type 1 diabetes.

AIM: To determine the plasma levels of enzymes and inhibitors involved in extracellular matrix turnover in patients with Type 1 diabetes with normal renal function. METHODS: Plasma levels of matrix metalloproteinases 2 and 9 (MMP-2, MMP-9) and tissue inhibitor of metalloproteinase 1 (TIMP-1) were measured in 43 Type 1 diabetic subjects and age- and sex-matched controls. RESULTS: No significant difference in plasma MMP-2 between diabetic patients and controls was observed. MMP-9 was detected in the plasma of 15 diabetic patients (35%), but undetectable in all control subjects (P < 0.015). Plasma TIMP-1 concentrations were significantly elevated (P < 0.001) in diabetic patients compared to controls. There was no correlation observed between MMP-2, MMP-9 and TIMP-1 and similarly between MMP-2, MMP-9 and TIMP-1 and age, duration of diabetes, blood pressure and glycated haemoglobin (HbA1c). CONCLUSIONS: This study has demonstrated alterations in several plasma extracellular matrix modulators in the absence of significant vascular disease.     

Management of fibrosing pancreatitis in children presenting with obstructive jaundice

Background—Altered matrix degradation contributesto fibrosis in some liver diseases but the role of matrix degradationin fibrogenesis associated with genetic haemochromatosis has not previously been addressed.
Aims—To measure serum concentrations of tissueinhibitor of metalloproteinase 1 (TIMP-1) and matrix metalloproteinases(MMP), MMP-1, MMP-2, and MMP-3 in patients with haemochromatosis and control subjects.
Patients—Forty patients with haemochromatosis and19 healthy control subjects. Ten of the 40 patients were studied before and after venesection therapy.
Methods—Serum levels of TIMP-1, MMP-1, MMP-2, andMMP-3 were measured by enzyme immunoassay and correlated to hepaticiron concentration and degree of histological fibrosis.
Results—Serum TIMP-1 was increased in patientswith haemochromatosis compared with controls (163 (30) versus 123 (28)ng/ml, p<0.0002). Mean serum TIMP-1 concentration of patients withhaemochromatosis without fibrosis was significantly higher than incontrols (153(16) versus 123 (28) ng/ml, p=0.03). Serum TIMP-1concentration correlated with both hepatic iron concentration andhepatic iron index (r=0.42, p<0.01; r=0.42,p<0.01). Serum MMP-2 concentrations correlated with increasing degreeof fibrosis in patients with haemochromatosis (r=0.38,p=0.01). The mean MMP-1:TIMP-1, MMP-2:TIMP-1 and age/sex matchedMMP-3:TIMP-1 ratios were significantly lower in patients withhaemochromatosis than controls (0.11 (0.06) versus 0.2 (0.14), p=0.02;3.32 (0.9) versus 3.91 (0.81), p=0.05; and 0.26 (0.12) versus 0.47 (0.27), p=0.007, respectively). Following venesection, MMP-2 and MMP-3concentrations increased by 11% (p=0.03) and 19% (p=0.03), respectively.
Conclusions—This study provides the firstevidence of an alteration in matrix degradation in haemochromatosisthat may be a contributing factor to hepatic fibrogenesis in this disease.

Keywords:hepatic stellate cell; hepatic fibrosis; matrixmetalloproteinase; tissue inhibitor of metalloproteinase-1; genetichaemochromatosis

     

Diagnostic value of platelet derived growth factor-BB, transforming growth factor-β1,matrix metalloproteinase-1, and tissue inhibitor of matrix metaUoproteinase-1 in serum and peripheral blood mononuclear cells for hepatic fibrosis

AIM: Noninvasive diagnosis of hepatic fibrosis has become the focus because of the limited biopsy, especially in the surveillance of treatment and in screening hepatic fibrosis. Recently, regulatory elements involved in liver fibrosis, such as platelet derived growth factor-BB (PDGF-BB), transforming growth factor-β1(TGF-β1), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), have been studied extensively. To determine whether these factors or enzymes could be used as the indices for the diagnosis of hepatic fibrosis, we investigated them by means of receiver operating characteristic (ROC) curve. METHODS: Serum samples from sixty patients with chronic viral hepatitis B and twenty healthy blood donors were assayed to determine the level of PDGF-BB, TGF-β1, MMP-1, and TIMP-1 with ELISA, and HA, PCIII, C-IV, and LNlevel with RIA. The message RNA (mRNA) expression of TIMP-1 and MMP-1 in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR and Northern blot hybridization. Liver biopsy was performed in all patients. The biopsy samples were histopatholocjically examined. The trial was double-blind controlled. RESULTS: The serum level of PDGF-BB, TIMP-1, the ratio of TIMP-1 and MMP-1 (TIMP-1/MMP-1), mRNA expression of TIMP-1 (TIMP-lmRNA), and the ratio of TIMP-lmRNA and MMP-lmRNA (TIMP-lmRNA/MMP-lmRNA) in patients was significantly higher than those in the healthy blood donors (t=2.514-11.435, P=0.000-0.016). The serum level of PDGF-BB, TIMP-1, TIMP-1/MMP-1, and TIMP-lmRNA was positively correlated with fibrosis stage and inflammation grade (r=0.239-0.565, P=0.000-0.033), while the serum level of MMP-1 was negatively correlated with fibrosis stage and inflammation grade, and TIMP-lmRNA/MMP-lmRNA was positively correlated with inflammation grade. Through the analysis by ROC curve, serum PDGF-BB was the most valuable marker, and its sensitivity was the highest among the nine indices. The markers with the highest specificity were TIMP-lmRNA and TIMP-lmRNA/MMP-lmRNA in PBMCs. The area under the curve (AUC) of PDGF-BB, TIMP-lmRNA, TIMP-lmRNA/MMP-lmRNA, TIMP-1/MMP-1, HA, PCIII, TIMP-1, C-IV, and LN was 0.985, 0.876, 0.792, 0.748, 0.728, 0.727, 0.726, 0.583, and 0.463, respectively. The sensitivity and the specificity in the parallel test was 99.0% and 95.0 % when serum PDGF-BB, TIMP-lmRNA and TIMP-lmRNA/MMP-lmRNA was detected simultaneously. CONCLUSION: Serum level of PDGF-BB, TIIVIP-lmRNA, TIMP-lmRNA/MMP-lmRNA in PBMCs, and serum level of TIMP-1 and TIMP-1/MMP-1 can be used as the indices for the diagnosis of hepatic fibrosis, but the former three are more useful. The combination of serum PDGF-BB, TIMP-lmRNA and TIMP-lmRNA/MMP-lmRNA in PBMCs is even more efficient in screening liver fibrosis.     

MMP-9 and TIMP-1 levels in the sputum of patients with chronic obstructive pulmonary disease and asthma

Chronic obstructive pulmonary disease (COPD) and asthma are associated with morphological changes in airway and lung and metalloproteinases are tought to play a role in this destruction. The aim of this study is to compare the levels of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of matrix metalloproteinases (TIMP)-1 in the airways of COPD and asthma patients in stable period. We measured MMP-9 and TIMP-1 levels in the induced sputum of 20 asthma, 22 COPD patients in stable period and 15 healthy controls. MMP-9 and TIMP-1 levels were measured by using ELISA kits. MMP-9 and TIMP-1 levels were higher in patient groups than the controls. In COPD patients MMP-9 and TIMP-1 were significantly higher than the controls (respectively; p= 0.0001, p= 0.0001). Similarly, in asthma patients MMP-9 and TIMP-1 levels were higher than the controls (respectively; p= 0.005, p= 0.002). However, while there were no significant difference in MMP-9 levels between the patient groups (p= 0.29), TIMP-1 levels were significantly higher in COPD patients (96.2 +/- 58.2 versus 52.8 +/- 52 microg/mg protein, respectively, p= 0.0001). Atopic asthma patients TIMP-1 levels were slightly higher than non-atopic asthma patients (p> 0.05). There was no significant correlation between FEV(1) and MMP-9 or TIMP-1 levels in all groups. Although known pathogenetic differences in COPD and asthma, the increases in protease-antiprotease levels in both two patient groups may be associated with bronchial and parenchimal morphological changes. New treatment strategies which are focused on modulating of increased protease-antiprotease levels may be give a hope to patients with COPD and asthma.     

Diagnostic value of platelet derived growth factor-BB, transforming growth factor-β1,matrix metalloproteinase-1, and tissue inhibitor of matrix metalloproteinase-1 in serum and peripheral blood mononuclear cells for hepatic fibrosis

AIM: Noninvasive diagnosis of hepatic fibrosis has become the focus because of the limited biopsy, especially in the surveillance of treatment and in screening hepatic fibrosis.Recently, regulatory elements involved in liver fibrosis, such as platelet derived growth factor-BB (PDGF-BB), transforming growth factor-β1 (TGF-β1), matrix metalloproteinase-1 (MMP-1), and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1), have been studied extensively. To determine whether these factors or enzymes could be used as the indices for the diagnosis of hepatic fibrosis, we investigated them by means of receiver operating characteristic (ROC) curve.METHODS: Serum samples from sixty patients with chronic viral hepatitis B and twenty healthy blood donors were assayed to determine the level of PDGF-BB, TGF-β1, MMP-1, and TIMP-1 with ELISA, and HA, PCIII, C-IV, and LN level with RIA. The message RNA (mRNA) expression of TIMP-1 and MMP-1 in peripheral blood mononuclear cells (PBMCs) was detected by RT-PCR and Northern blot hybridization. Liver biopsy was performed in all patients.The biopsy samples were histopathologically examined. The trial was double-blind controlled.RESULTS: The serum level of PDGF-BB, TIMP-1, the ratio of TIMP-1 and MMP-1 (TIMP-1/MMP-1), mRNA expression of TIMP-1 (TIMP-1mRNA), and the ratio of TIMP-1mRNA and MMP-1mRNA (TIMP-1mRNA/MMP-1mRNA) in patients was significantly higher than those in the healthy blood donors (t=2.514-11.435, P=0.000-0.016). The serum level of PDGF-BB, TIMP-1, TIMP-1/MMP-1, and TIMP-1mRNA was positively correlated with fibrosis stage and inflammation grade (r=0.239-0.565, P=0.000-0.033), while the serum level of MMP-1 was negatively correlated with fibrosis stage and inflammation grade, and TIMP-1mRNA/MMP-1mRNA was positively correlated with inflammation grade. Through the analysis by ROC curve, serum PDGF-BB was the most valuable marker, and its sensitivity was the highest among the nine indices. The markers with the highest specificity were TIMP-1mRNA and TIMP-1mRNA/MMP-1mRNA in PBMCs. The area under the curve (AUC) of PDGF-BB, TIMP-1mRNA, TIMP-1mRNA/MMP-1mRNA, TIMP-1/MMP-1, HA,PCIII, TIMP-1, C-IV, and LN was 0.985, 0.876, 0.792, 0.748,0.728, 0.727, 0.726, 0.583, and 0.463, respectively. The sensitivity and the specificity in the parallel test was 99.0 %and 95.0 % when serum PDGF-BB, TIMP-1mRNA and TIMP1mRNA/MMP-1mRNA was detected simultaneously.CONCLUSION: Serum level of PDGF-BB, TIMP-1mRNA,TIMP-1mRNA/MMP-1mRNA in PBMCs, and serum level of TIMP-1 and TIMP-1/MMP-1 can be used as the indices for the diagnosis of hepatic fibrosis, but the former three are more useful. The combination of serum PDGF-BB, TIMP-1mRNA and TIMP-1mRNA/MMP-1mRNA in PBMCs is even more efficient in screening liver fibrosis.     

Diagnostic potential of serum matrix metalloproteinase-2 and tissue inhibitor of metalloproteinase-1 as non-invasive markers of hepatic fibrosis in patients with HCV related chronic liver disease

As chronic liver disease progresses, an imbalance occurs between synthesis and breakdown of extracellular matrix (ECM). Matrix metalloproteinases (MMPs) are involved in degrading ECM while tissue inhibitors of metalloproteinases (TIMPs) prevent their fibrolytic action. In the present study, serum levels of matrix metalloproteinase-2 (MMP-2) and tissue inhibitor of metalloproteinase-1 (TIMP-1) were investigated as non-invasive parameters for the diagnosis of hepatic fibrosis in patients with HCV related chronic liver disease. Their diagnostic potential was evaluated in comparison to hepatic histology and standard liver function tests. A sandwich enzyme immunoassay technique was used to study circulating values of MMP-2 and TIMP-1 in forty-one patients with HCV antibodies in their sera (27 patients with biopsy ascertained chronic hepatitis C and 14 patients with histologically proven liver cirrhosis. Hepatic histology was evaluated using the hepatitis-activity-index according to Ishak et al. (1995), quantifying separately inflammatory activity and fibrosis. Ten healthy individuals were also included in the study as controls. Serum levels of MMP-2 were similar in controls and in chronic hepatitis C patients with (n = 15) and without (n = 12) fibrosis, but increased significantly in cirrhosis. TIMP-1 serum values showed a steady increase from normal controls to chronic hepatitis C without fibrosis, hepatitis C with fibrosis, and cirrhosis. The diagnostic potential of MMP-2 to detect fibrosis was low with a sensitivity of 7% and a diagnostic efficiency of 56%. The diagnostic potential of circulating MMP-2 to detect cirrhosis was higher with a sensitivity of 83% and a specificity of 96% resulting in a diagnostic efficiency of 92%. Serum TIMP-1 values detected fibrosis with a sensitivity of 67% and a specificity of 69% resulting in an efficiency rate of 70%. TIMP-1 values detected cirrhosis with 100% sensitivity but only 75% specificity. The diagnostic potential of circulating TIMP-1 was higher than that of serum ALT, AST or albumin values. In conclusion, serum values of MMP-2 and TIMP-1 are able to detect cirrhosis with a high sensitivity. Moreover, TIMP-1 values can detect fibrosis with comparable efficiency. Regular determinations of both TIMP-1 and MMP-2 in patients with chronic hepatitis C may be used as indicators of increasing fibrosis and the development of cirrhosis.     

氯沙坦协同辛伐他汀对心力衰竭大鼠心室基质金属蛋白酶2、9及其组织抑制因子1、2基因表达的影响

目的 探讨心力衰竭(心衰)时心脏基质金属蛋白酶2(MMP-2)、9(MMP-9)及其组织抑制因子1(TIMP-1)、2(TIMP-2)基因表达及其与心肌纤维化的关系.方法 用降主动脉缩窄术建立心衰模型.SD大鼠随机分成6组.分别在氯沙坦5 mg/kg、辛伐他汀2 mg/kg以及两药合用(联合投药组)投药后1、3,5周动态测定左室舒张末期内径、左室收缩末期内径及左室后壁厚度、左室短轴缩短率.ELISA法检测B型利钠肽浓度.Masson染色观察心肌胶原情况.RT-PCR法检测心室MMP-2、MMP-9和TIMP-1、TIMP-2基因表达.结果 投药后5周各组胶原容积分数比较差异有统计学意义(P<0.01),投药各组较降主动脉缩窄(模型)组下降(P<0.05),尤其联合投药组下降更明显(P<0.01).MMP-2 mRNA和MMP-9 mBNA在投药各组与模型组差异无统计学意义(P>0.05);但TIMP-1 mRNA和TIMP-2 mRNA在投药各组明显低于模型组(P<0.01),联合投药组降低更明显(P<0.05).结论 心衰模型大鼠MMP-2 mRNA、MMP-9 mRNA和TIMP-1 mRNA、TIMP-2 mRNA表达升高可能是压力负荷大鼠心肌胶原含量增加的分子机制之一,氯沙坦、辛伐他汀以及联合投药均能下调TIMP-1 mRNA、TIMP-2 mRNA水平,缓解心肌重构,尤其联合投药组效果更明显.     

Imbalanced matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 activities in patients with thromboangiitis obliterans

The pathogenic mechanisms of thromboangiitis obliterans (TAO) are not entirely known and the imbalance of matrix metalloproteinases (MMPs) plays a role in vascular diseases. We evaluated the MMP-2 and MMP-9 circulating levels and their endogenous tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) in TAO patients with clinical manifestations. The study included 20 TAO patients (n = 10 female, n = 10 male) aged 38-59 years under clinical follow-up. The patients were classified into two groups: (1) TAO former smokers (n = 11) and (2) TAO active smokers (n = 9); the control group included normal volunteer non-smokers (n = 10) and active smokers without peripheral artery disease (n = 10). Patient plasma samples were used to analyze MMP-2 and MMP-9 levels using zymography, and TIMP-1 and TIMP-2 concentrations were determined by enzyme-linked immunosorbent assays. The analysis of MMP-2/TIMP-2 and MMP-9/TIMP-1 ratios (which were used as indices of net MMP-2 and MMP-9 activity, respectively) showed significantly higher MMP-9/TIMP-1 ratios in TAO patients (p < 0.05). We found no significant differences in MMP-2/TIMP-2 ratios (p > 0.05). We found higher MMP-9 levels and decreased levels of TIMP-1 in the TAO groups (active smokers and former smokers), especially in active smokers compared with the other groups (all p < 0.05). MMP-2 and TIMP-2 were not significantly different in patients with TAO as compared to the control group (p > 0.05). In conclusion, our results showed increased MMP-9 and reduced TIMP-1 activity in TAO patients, especially in active smokers compared with non-TAO patients. These data suggest that smoke compounds could activate MMP-9 production or inhibit TIMP-1 activity.