Decreased vascular matrix metalloproteinase abundance in diabetic patients with symptomatic macroangiopathy

The incidence of diabetic amputations is 2- to 3-fold higher in African-American patients compared to Caucasians. Vascular remodeling characterized by extracellular matrix (ECM) deposition occurs in diabetes and contributes to vascular complications. The matrix metalloproteinases (MMP) play important roles in the regulation of collagen turnover and vascular remodeling. However, the temporal expression profile of MMPs in diabetic vascular tissue during the disease process remained unknown. The objective of this study was to compare the vascular MMP system in African-American diabetic patients without symptoms to patients undergoing lower limb amputation due to severe vascular complications. Internal mammary artery (IMA, N = 8) and anterior/posterior tibial artery (AT/PT, N = 8) specimens were obtained from patients undergoing coronary artery bypass grafting and lower limb amputation, respectively. ECM inducer protein (EMMPRIN) and MMP activator membrane-type MMP (MT1-MMP), as well as MMP-1, -2, and -9, were quantified by immunoblotting and densitometry (pixels). MMP-1 and -9 levels were decreased from 398 +/- 61 and 175 +/- 54 pixels, respectively, in IMA tissue to 287 +/- 31 and 51 +/- 36 pixels in the AT/PT tissue (P < .05). Both EMMPRIN and MT1-MMP expression was increased by 3-fold in AT/PT preparations (P < .05). These results provided evidence that the molecular components required for the induction and activation of the MMP system exist in arterial vasculature and, MMP expression is downregulated in diabetic patients with severe complications despite elevated MMP inducer and activator proteins. Decreased MMP activity may contribute to pathological remodeling leading to increased incidence of amputations in African-American patients.