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Matrix metalloproteinase-9 as a marker for acute ischemic stroke: a systematic review
Maria Ramos-Fernandez1, M Fernanda Bellolio2, Latha G Stead3
1Department of Emergency Medicine, University of Puerto Rico, Carolina, Puerto Rico.
Abstract:
Matrix metalloproteinase-9 (MMP-9) is a possible marker for acute ischemic stroke (AIS). In animal models of cerebral ischemia, MMP expression was significantly increased and was related to blood-brain barrier disruption, vasogenic edema formation, and hemorrhagic transformation. The definition of the exact role of MMPs after ischemic stroke will have important diagnostic implications for stroke and for the development of therapeutic strategies aimed at modulating MMPs. The objectives of the present study were to determine (1) whether MMP-9 is a possible marker for AIS; (2) whether MMP-9 levels correlate with infarct volume, stroke severity, or functional outcome; and (3) whether MMP-9 levels correlate with the development of hemorrhagic transformation after tissue plasminogen activator (t-PA) administration. The literature was searched using MEDLINE and EMBASE with no year restriction. All relevant reports were included. A total of 22 studies (3,289 patients) satisfied the inclusion criteria. Our review revealed that higher MMP-9 values were significantly correlated with larger infarct volume, severity of stroke, and worse functional outcome. There were significant differences in MMP-9 levels between patients with AIS and healthy control subjects. Moreover, MMP-9 was a predictor of the development of intracerebral hemorrhage in patients treated with thrombolytic therapy. MMP-9 level was significantly increased after stroke onset, with the level correlating with infarct volume, stroke severity, and functional outcome. MMP-9 is a possible marker for ongoing brain ischemia, as well as a predictor of hemorrhage in patients treated with t-PA.
Insights
Matrix metalloproteinase-9 (MMP-9) is a potential biomarker for acute ischemic stroke (AIS). Elevated MMP-9 levels correlate with stroke severity, larger infarcts, poorer outcomes, and predict hemorrhage risk in patients receiving thrombolytic therapy.
Area of Science:
- Neurology
- Biochemistry
- Medical Diagnostics
Background:
- Matrix metalloproteinases (MMPs), particularly MMP-9, are implicated in cerebral ischemia.
- MMP expression is linked to blood-brain barrier disruption, edema, and hemorrhagic transformation in animal models.
- Understanding MMP roles is crucial for stroke diagnostics and therapeutics.
Purpose of the Study:
- To evaluate Matrix metalloproteinase-9 (MMP-9) as a potential biomarker for acute ischemic stroke (AIS).
- To determine the correlation between MMP-9 levels and infarct volume, stroke severity, and functional outcomes.
- To assess MMP-9's predictive value for hemorrhagic transformation following tissue plasminogen activator (t-PA) treatment.
Main Methods:
- Systematic literature review of MEDLINE and EMBASE databases.
- Inclusion of all relevant reports without year restriction.
- Analysis of data from 22 studies encompassing 3,289 patients.
Main Results:
- Significantly higher MMP-9 levels were observed in AIS patients compared to healthy controls.
- Elevated MMP-9 values correlated with larger infarct volumes, increased stroke severity, and worse functional outcomes.
- MMP-9 levels predicted the development of intracerebral hemorrhage in patients treated with t-PA.
Conclusions:
- Matrix metalloproteinase-9 (MMP-9) serves as a potential biomarker for ongoing brain ischemia.
- MMP-9 levels are significantly increased post-stroke and correlate with key clinical indicators.
- MMP-9 is a valuable predictor of hemorrhagic complications in t-PA treated AIS patients.
