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Published on: September 22, 2020
Matrix metalloproteinases and risk stratification in patients undergoing surgical revascularisation for critical limb
Giovanni De Caridi1, Mafalda Massara1, Francesco Spinelli1
1Department of Dentistry and Medical and Surgical Experimental Sciences, University of Messina, Messina, Italy.
Insights
Matrix metalloproteinases (MMPs) are elevated in critical limb ischaemia (CLI) patients. Higher MMP levels, particularly MMP-1 and MMP-8, may predict poor outcomes like amputation or death in CLI patients undergoing bypass surgery.
Area of Science:
- Vascular Surgery
- Biochemistry
- Cardiovascular Medicine
Background:
- Critical limb ischaemia (CLI) is the severe stage of peripheral artery disease (PAD), often leading to amputation and increased mortality.
- Matrix metalloproteinases (MMPs) are implicated in the pathogenesis of atherosclerosis, PAD, and CLI.
Purpose of the Study:
- To investigate serum MMP level variations in CLI patients before and after lower extremity bypass (LEB) surgery.
- To assess the potential of MMP levels to predict clinical outcomes in CLI patients.
Main Methods:
- Enrolled 29 CLI patients undergoing LEB (synthetic or venous bypass) and 30 healthy controls.
- Measured serum MMP levels using enzyme-linked immunosorbent assay (ELISA).
- Compared MMP levels between CLI patients and controls, and correlated levels with patient outcomes.
Main Results:
- CLI patients exhibited significantly higher serum MMP levels compared to healthy controls (P < 0.01).
- Five CLI patients (17.2%) experienced poor outcomes (amputation or death).
- These patients with poor outcomes had markedly elevated levels of MMP-1 and MMP-8.
Conclusions:
- Elevated serum MMP levels are characteristic of CLI.
- MMP-1 and MMP-8 serum levels may serve as predictive biomarkers for adverse clinical outcomes in CLI patients.
- MMP levels warrant further investigation for their role in CLI prognosis and management.
Abstract:
Critical limb ischaemia (CLI) is the most advanced form of peripheral artery disease (PAD) and it is often associated with foot gangrene, which may lead to major amputation of lower limbs, and also with a higher risk of death due to fatal cardiovascular events. Matrix metalloproteinases (MMPs) seem to be involved in atherosclerosis, PAD and CLI. Aim of this study was to evaluate variations in MMP serum levels in patients affected by CLI, before and after lower limb surgical revascularisation through prosthetic or venous bypass. A total of 29 patients (7 females and 22 males, mean age 73·4 years, range 65-83 years) suffering from CLI and submitted to lower extremity bypass (LEB) in our Institution were recruited. Seven patients (group I) underwent LEB using synthetic polytetrafluoroethylene (PTFE) graft material and 22 patients (group II) underwent LEB using autogenous veins. Moreover, 30 healthy age-sex-matched subjects were also enrolled as controls (group III). We documented significantly higher serum MMPs levels (P < 0·01) in patients with CLI (groups I and II) with respect to control group (group III). Finally, five patients with CLI (17·2%) showed poor outcomes (major amputations or death), and enzyme-linked immunosorbent assay (ELISA) test showed very high levels of MMP-1 and MMP-8. MMP serum levels seem to be able to predict the clinical outcomes of patients with CLI.
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