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Circulation Research. 1999;85:364-376

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(Circulation Research. 1999;85:364-376.)
© 1999 American Heart Association, Inc.


Integrative Physiology

Matrix Metalloproteinase Inhibition During the Development of Congestive Heart Failure

Effects on Left Ventricular Dimensions and Function

Francis G. Spinale, Mytsi L. Coker, Stephen R. Krombach, Rupak Mukherjee, Hussein Hallak, Ward V. Houck, Mark J. Clair, Scott B. Kribbs, Linda L. Johnson, J. Thomas Peterson, Michael R. Zile

From the Division of Cardiothoracic Surgery (F.G.S., M.L.C., S.R.K., R.P., W.V.H., M.J.C., S.B.K., M.R.Z.), Medical University of South Carolina, Charleston, and Cardiovascular Pharmacology (H.H., L.L.J., J.T.P.), Parke-Davis, Ann Arbor, Mich.

Correspondence to Francis G. Spinale, MD, PhD, Cardiothoracic Surgery, Room 625, Strom Thurmond Research Building, 770 MUSC Complex, Medical University of South Carolina, 114 Doughty St, Charleston, SC 29425.

Abstract—The development of congestive heart failure (CHF) is associated with left ventricle (LV) dilation and myocardial remodeling. The matrix metalloproteinases (MMPs) play a significant role in extracellular remodeling, and recent studies have demonstrated increased MMP expression and activity with CHF. Whether increased MMP activity directly contributes to the LV remodeling with CHF remains unknown. Accordingly, this study examined the effects of chronic MMP inhibition (MMPi) on LV size and function during the progression of CHF. Pigs were assigned to the following groups: (1) CHF, rapid pacing for 3 weeks at 240 bpm (n=12); (2) CHF/MMPi, rapid pacing and concomitant MMPi (PD166793, 20 mg/kg per day [n=10]), and (3) control (n=11). With pacing CHF, LV fractional shortening was reduced (19±1 versus 45±1%), and end-diastolic dimension increased (5.67±0.11 versus 3.55±0.05 cm), compared with baseline values (P<0.05). In the CHF/MMPi group, LV endocardial shortening increased (25±2%) and the end-diastolic dimension was reduced (4.92±0.17 cm) compared with CHF-only values (P<0.05). LV midwall shortening was reduced to a comparable degree in the CHF-only and CHF/MMPi groups. LV peak wall stress increased 3-fold with pacing CHF compared with controls and was significantly reduced in the CHF/MMPi group. LV myocardial stiffness was unchanged with CHF but was increased in the CHF/MMPi group. LV myocyte length was increased with pacing CHF compared with controls (180±3 versus 125±4 µm, P<0.05) and was reduced in the CHF/MMPi group (169±4 µm, P<0.05). Basal-state myocyte shortening velocity was reduced with pacing CHF compared with controls (33±2 versus 66±1 µm/s, P<0.05) and was unchanged in the CHF/MMPi group (31±2 µm/s). Using an ex vivo assay system, myocardial MMP activity was increased with pacing CHF and was reduced with chronic MMPi. In summary, concomitant MMPi with developing CHF limited LV dilation and reduced wall stress. These results suggest that increased myocardial MMP activity contributes to LV myocardial remodeling in developing CHF.


Key Words: congestive heart failure • metalloproteinases • myocyte function




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W. S. Bradham Jr, H. Gunasinghe, J. R. Holder, M. Multani, D. Killip, M. Anderson, D. Meyer, W. H. Spencer III, G. Torre-Amione, and F. G. Spinale
Release of matrix metalloproteinases following alcohol septal ablation in hypertrophic obstructive cardiomyopathy
J. Am. Coll. Cardiol., December 18, 2002; 40(12): 2165 - 2173.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
I. Manabe, T. Shindo, and R. Nagai
Gene Expression in Fibroblasts and Fibrosis: Involvement in Cardiac Hypertrophy
Circ. Res., December 13, 2002; 91(12): 1103 - 1113.
[Abstract] [Full Text] [PDF]


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HeartHome page
D Reinhardt, H H Sigusch, J Hensse, S C Tyagi, R Korfer, and H R Figulla
Cardiac remodelling in end stage heart failure: upregulation of matrix metalloproteinase (MMP) irrespective of the underlying disease, and evidence for a direct inhibitory effect of ACE inhibitors on MMP
Heart, December 1, 2002; 88(5): 525 - 530.
[Abstract] [Full Text] [PDF]


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Eur Heart J SupplHome page
M. Pauschinger, K. Chandrasekharan, J. Li, W. Poller, M. Noutsias, C. Tschope, and H.-P. Schultheiss
Inflammation and extracellular matrix protein metabolism: two sides of myocardial remodelling
Eur. Heart J. Suppl., December 1, 2002; 4(suppl_I): I49 - I53.
[Abstract] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
D. Li, V. Williams, L. Liu, H. Chen, T. Sawamura, T. Antakli, and J. L. Mehta
LOX-1 inhibition in myocardial ischemia-reperfusion injury: modulation of MMP-1 and inflammation
Am J Physiol Heart Circ Physiol, November 1, 2002; 283(5): H1795 - H1801.
[Abstract] [Full Text] [PDF]


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Eur J Heart FailHome page
B. Schwartzkopff, M. Fassbach, B. Pelzer, M. Brehm, and B. E. Strauer
Elevated serum markers of collagen degradation in patients with mild to moderate dilated cardiomyopathy
Eur J Heart Fail, August 1, 2002; 4(4): 439 - 444.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
J. G.F Bronzwaer, C. Zeitz, C. A Visser, and W. J Paulus
Endomyocardial nitric oxide synthase and the hemodynamic phenotypes of human dilated cardiomyopathy and of athlete's heart
Cardiovasc Res, August 1, 2002; 55(2): 270 - 278.
[Abstract] [Full Text] [PDF]


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CirculationHome page
R. Nakamura, K. Egashira, Y. Machida, S. Hayashidani, M. Takeya, H. Utsumi, H. Tsutsui, and A. Takeshita
Probucol Attenuates Left Ventricular Dysfunction and Remodeling in Tachycardia-Induced Heart Failure: Roles of Oxidative Stress and Inflammation
Circulation, July 16, 2002; 106(3): 362 - 367.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
J. D. Stroud, C. F. Baicu, M. A. Barnes, F. G. Spinale, and M. R. Zile
Viscoelastic properties of pressure overload hypertrophied myocardium: effect of serine protease treatment
Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2324 - H2335.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
M. M. Thompson and I. B. Squire
Matrix metalloproteinase-9 expression after myocardial infarction: physiological or pathological?
Cardiovasc Res, June 1, 2002; 54(3): 495 - 498.
[Full Text] [PDF]


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J Am Coll CardiolHome page
Y. Iwanaga, T. Aoyama, Y. Kihara, Y. Onozawa, T. Yoneda, and S. Sasayama
Excessive activation of matrix metalloproteinases coincides with left ventricular remodeling during transition from hypertrophy to heart failure in hypertensive rats
J. Am. Coll. Cardiol., April 17, 2002; 39(8): 1384 - 1391.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
W. S. Bradham, G. Moe, K. A. Wendt, A. A. Scott, A. Konig, M. Romanova, G. Naik, and F. G. Spinale
TNF-alpha and myocardial matrix metalloproteinases in heart failure: relationship to LV remodeling
Am J Physiol Heart Circ Physiol, April 1, 2002; 282(4): H1288 - H1295.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. R. Zile and D. L. Brutsaert
New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part II: Causal Mechanisms and Treatment
Circulation, March 26, 2002; 105(12): 1503 - 1508.
[Full Text] [PDF]


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Circ. Res.Home page
F. G. Spinale
Matrix Metalloproteinases: Regulation and Dysregulation in the Failing Heart
Circ. Res., March 22, 2002; 90(5): 520 - 530.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. R. Zile and D. L. Brutsaert
New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function
Circulation, March 19, 2002; 105(11): 1387 - 1393.
[Full Text] [PDF]


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J. Thorac. Cardiovasc. Surg.Home page
P. W.M. Fedak, R. D. Weisel, T. M. Yau, D. A.G. Mickle, and R.-K. Li
Cell transplantation, ventricular remodeling, and the extracellular matrix
J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 584 - 585.
[Full Text]


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Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Y. Li, T. Kadokami, P. Wang, C. F. McTiernan, and A. M. Feldman
MMP inhibition modulates TNF-alpha transgenic mouse phenotype early in the development of heart failure
Am J Physiol Heart Circ Physiol, March 1, 2002; 282(3): H983 - H989.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
W. S. Bradham, B. Bozkurt, H. Gunasinghe, D. Mann, and F. G. Spinale
Tumor necrosis factor-alpha and myocardial remodeling in progression of heart failure: a current perspective
Cardiovasc Res, March 1, 2002; 53(4): 822 - 830.
[Abstract] [Full Text] [PDF]


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CirculationHome page
T. Walther, A. Schubert, V. Falk, C. Binner, A. Kanev, S. Bleiziffer, C. Walther, N. Doll, R. Autschbach, and F. W. Mohr
Regression of Left Ventricular Hypertrophy After Surgical Therapy for Aortic Stenosis Is Associated With Changes in Extracellular Matrix Gene Expression
Circulation, September 18, 2001; 104 (2009): I-54 - I-58.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
T. Etoh, C. Joffs, A. M. Deschamps, J. Davis, K. Dowdy, J. Hendrick, S. Baicu, R. Mukherjee, M. Manhaini, and F. G. Spinale
Myocardial and interstitial matrix metalloproteinase activity after acute myocardial infarction in pigs
Am J Physiol Heart Circ Physiol, September 1, 2001; 281(3): H987 - H994.
[Abstract] [Full Text] [PDF]


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CirculationHome page
N. Sivasubramanian, M. L. Coker, K. M. Kurrelmeyer, W. R. MacLellan, F. J. DeMayo, F. G. Spinale, and D. L. Mann
Left Ventricular Remodeling in Transgenic Mice With Cardiac Restricted Overexpression of Tumor Necrosis Factor
Circulation, August 14, 2001; 104(7): 826 - 831.
[Abstract] [Full Text] [PDF]


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Circ. Res.Home page
E. E.J.M. Creemers, J. P.M. Cleutjens, J. F.M. Smits, and M. J.A.P. Daemen
Matrix Metalloproteinase Inhibition After Myocardial Infarction: A New Approach to Prevent Heart Failure?
Circ. Res., August 3, 2001; 89(3): 201 - 210.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
M. L. Coker, J. R. Jolly, C. Joffs, T. Etoh, J. R. Holder, B. R. Bond, and F. G. Spinale
Matrix metalloproteinase expression and activity in isolated myocytes after neurohormonal stimulation
Am J Physiol Heart Circ Physiol, August 1, 2001; 281(2): H543 - H551.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
S. M. Dolgilevich, F. M. Siri, S. A. Atlas, and C. Eng
Changes in collagenase and collagen gene expression after induction of aortocaval fistula in rats
Am J Physiol Heart Circ Physiol, July 1, 2001; 281(1): H207 - H214.
[Abstract] [Full Text] [PDF]


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CirculationHome page
J. T. Peterson, H. Hallak, L. Johnson, H. Li, P. M. O'Brien, D. R. Sliskovic, T. M. A. Bocan, M. L. Coker, T. Etoh, and F. G. Spinale
Matrix Metalloproteinase Inhibition Attenuates Left Ventricular Remodeling and Dysfunction in a Rat Model of Progressive Heart Failure
Circulation, May 8, 2001; 103(18): 2303 - 2309.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
B. K. Podesser, D. A. Siwik, F. R. Eberli, F. Sam, S. Ngoy, J. Lambert, K. Ngo, C. S. Apstein, and W. S. Colucci
ETA-receptor blockade prevents matrix metalloproteinase activation late postmyocardial infarction in the rat
Am J Physiol Heart Circ Physiol, March 1, 2001; 280(3): H984 - H991.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Cell Physiol.Home page
D. A. Siwik, P. J. Pagano, and W. S. Colucci
Oxidative stress regulates collagen synthesis and matrix metalloproteinase activity in cardiac fibroblasts
Am J Physiol Cell Physiol, January 1, 2001; 280(1): C53 - C60.
[Abstract] [Full Text] [PDF]


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Proc. Natl. Acad. Sci. USAHome page
Y. Y. Li, Y. Q. Feng, T. Kadokami, C. F. McTiernan, R. Draviam, S. C. Watkins, and A. M. Feldman
Myocardial extracellular matrix remodeling in transgenic mice overexpressing tumor necrosis factor alpha can be modulated by anti-tumor necrosis factor alpha therapy
PNAS, November 7, 2000; 97(23): 12746 - 12751.
[Abstract] [Full Text] [PDF]


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CirculationHome page
P. Libby and R. T. Lee
Matrix Matters
Circulation, October 17, 2000; 102(16): 1874 - 1876.
[Full Text] [PDF]


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Circ. Res.Home page
D. A. Siwik, D. L.-F. Chang, and W. S. Colucci
Interleukin-1{beta} and Tumor Necrosis Factor-{alpha} Decrease Collagen Synthesis and Increase Matrix Metalloproteinase Activity in Cardiac Fibroblasts In Vitro
Circ. Res., June 23, 2000; 86(12): 1259 - 1265.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
Y. Y. Li, C. F. McTiernan, and A. M. Feldman
Interplay of matrix metalloproteinases, tissue inhibitors of metalloproteinases and their regulators in cardiac matrix remodeling
Cardiovasc Res, May 1, 2000; 46(2): 214 - 224.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
F. G Spinale, M. L Coker, B. R Bond, and J. L Zellner
Myocardial matrix degradation and metalloproteinase activation in the failing heart: a potential therapeutic target
Cardiovasc Res, May 1, 2000; 46(2): 225 - 238.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
H. Li, H. Simon, T. M.A. Bocan, and J.T. Peterson
MMP/TIMP expression in spontaneously hypertensive heart failure rats: the effect of ACE- and MMP-inhibition
Cardiovasc Res, May 1, 2000; 46(2): 298 - 306.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
J.T. Peterson, H. Li, L. Dillon, and J. W. Bryant
Evolution of matrix metalloprotease and tissue inhibitor expression during heart failure progression in the infarcted rat
Cardiovasc Res, May 1, 2000; 46(2): 307 - 315.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. L. Lindsey, J. Gannon, M. Aikawa, F. J. Schoen, E. Rabkin, L. Lopresti-Morrow, J. Crawford, S. Black, P. Libby, P. G. Mitchell, et al.
Selective Matrix Metalloproteinase Inhibition Reduces Left Ventricular Remodeling but Does Not Inhibit Angiogenesis After Myocardial Infarction
Circulation, February 12, 2002; 105(6): 753 - 758.
[Abstract] [Full Text] [PDF]


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CirculationHome page
A. L. Chancey, G. L. Brower, J. T. Peterson, and J. S. Janicki
Effects of Matrix Metalloproteinase Inhibition on Ventricular Remodeling Due to Volume Overload
Circulation, April 23, 2002; 105(16): 1983 - 1988.
[Abstract] [Full Text] [PDF]