Potential implications of matrix metalloproteinase-9 in assessment and treatment of coronary artery disease

Abstract

Background: Matrix metalloproteinase (MMP)-9, a member of the MMP superfamily is consistently implicated in the pathophysiology of atherosclerosis and plaque rupture, the most common mechanism responsible for acute coronary syndrome (ACS).

Aim: To summarize the role of MMP-9 in atherosclerosis and its potential implications in assessment and treatment of coronary artery disease (CAD).

Methods: We reviewed the PubMed database for relevant data regarding the role of MMP-9 in the pathophysiology of atherosclerosis. In the light of these data, we postulate potential implications of MMP-9 in the management and treatment of CAD.

Results and conclusions: Existing data strongly support the role of MMP-9 in plaque destabilization and rupture. Based on the current knowledge, MMP-9 can potentially serve as a diagnostic biomarker in ACS and a prognostic biomarker in ACS and chronic CAD patients. MMP-9 is reduced by therapies that are associated with favourable outcome in atherosclerosis and thus may serve as a surrogate biomarker of treatment efficacy. However, large morbidity and mortality trials are still required to confirm that MMP-9 reduction is associated with improved outcome independent of the traditional risk factors (i.e. low-density lipoprotein cholesterol). Given its role in plaque rupture, inhibition of MMP-9 may promote plaque stabilization and consequently reduce cardiovascular events. Yet, the efficacy and safety of MMPs inhibitors should be first studied in preclinical models of atherosclerosis.

Keywords::

• Atherosclerosis
• acute coronary syndrome
• MMPs
• MMP-9
• MMP inhibitors

Acknowledgements

Declaration of interest: Tu T Nguyen, Robert Wolk, Robert J Aiello, Steven G Terra, and David A Fryburg are all employees and shareholders of Pfizer, Inc. This paper was prepared while Yuval Konstantino was supported by the Israel Heart Society-Pfizer postdoctoral fellowship in cardiovascular drug development.