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Circulation Research. 2001;89:201-210
doi: 10.1161/hh1501.094396
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(Circulation Research. 2001;89:201.)
© 2001 American Heart Association, Inc.


Review

Matrix Metalloproteinase Inhibition After Myocardial Infarction

A New Approach to Prevent Heart Failure?

Esther E.J.M. Creemers, Jack P.M. Cleutjens, Jos F.M. Smits, Mat J.A.P. Daemen

From the Departments of Pathology (E.E.J.M.C., J.P.M.C., M.J.A.P.D.) and Pharmacology (J.F.M.S.), Cardiovascular Research Institute Maastricht, University of Maastricht, The Netherlands.

Correspondence to M.J.A.P. Daemen, MD, PhD, Department of Pathology, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. E-mail mda{at}lpat.azm.nl

Abstract— Increased activity of matrix metalloproteinases (MMPs) has been implicated in numerous disease processes, including tumor growth and metastasis, arthritis, and periodontal disease. It is now becoming increasingly clear that extracellular matrix degradation by MMPs is also involved in the pathogenesis of cardiovascular disease, including atherosclerosis, restenosis, dilated cardiomyopathy, and myocardial infarction. Administration of synthetic MMP inhibitors in experimental animal models of these cardiovascular diseases significantly inhibits the progression of, respectively, atherosclerotic lesion formation, neointima formation, left ventricular remodeling, pump dysfunction, and infarct healing. This review focuses on the role of MMPs in cardiovascular disease, in particular myocardial infarction and the subsequent progression to heart failure. MMPs, which are present in the myocardium and capable of degrading all the matrix components of the heart, are the driving force behind myocardial matrix remodeling. The recent finding that acute pharmacological inhibition of MMPs or deficiency in MMP-9 attenuates left ventricular dilatation in the infarcted mouse heart led to the proposal that MMP inhibitors could be used as a potential therapy for patients at risk for the development of heart failure after myocardial infarction. Although these promising results encourage the design of clinical trials with MMP inhibitors, there are still several unresolved issues. This review describes the biology of MMPs and discusses new insights into the role of MMPs in several cardiovascular diseases. Attention will be paid to the central role of the plasminogen system as an important activator of MMPs in the remodeling process after myocardial infarction. Finally, we speculate on the use of MMP inhibitors as potential therapy for heart failure.


Key Words: myocardial infarction • therapy • matrix metalloproteinase inhibition




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Physiol Rev, April 1, 2004; 84(2): 649 - 698.
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Proc. Natl. Acad. Sci. USAHome page
B. Murtuza, K. Suzuki, G. Bou-Gharios, J. R. Beauchamp, R. T. Smolenski, T. A. Partridge, and M. H. Yacoub
Transplantation of skeletal myoblasts secreting an IL-1 inhibitor modulates adverse remodeling in infarcted murine myocardium
PNAS, March 23, 2004; 101(12): 4216 - 4221.
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J Am Coll CardiolHome page
Y. Nakano, S. Niida, K. Dote, S. Takenaka, H. Hirao, F. Miura, M. Ishida, T. Shingu, T. Sueda, M. Yoshizumi, et al.
Matrix metalloproteinase-9 contributes to human atrial remodeling during atrial fibrillation
J. Am. Coll. Cardiol., March 3, 2004; 43(5): 818 - 825.
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Am. J. Pathol.Home page
K. Takeshita, M. Hayashi, S. Iino, T. Kondo, Y. Inden, M. Iwase, T. Kojima, M. Hirai, M. Ito, D. J. Loskutoff, et al.
Increased Expression of Plasminogen Activator Inhibitor-1 in Cardiomyocytes Contributes to Cardiac Fibrosis after Myocardial Infarction
Am. J. Pathol., February 1, 2004; 164(2): 449 - 456.
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J. Clin. Endocrinol. Metab.Home page
A. M. Pereira, S. W. van Thiel, J. R. Lindner, F. Roelfsema, E. E. van der Wall, H. Morreau, J. W. A. Smit, J. A. Romijn, and J. J. Bax
Increased Prevalence of Regurgitant Valvular Heart Disease in Acromegaly
J. Clin. Endocrinol. Metab., January 1, 2004; 89(1): 71 - 75.
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J. Biol. Chem.Home page
Z. Xie, M. Singh, D. A. Siwik, W. L. Joyner, and K. Singh
Osteopontin Inhibits Interleukin-1{beta}-stimulated Increases in Matrix Metalloproteinase Activity in Adult Rat Cardiac Fibroblasts: ROLE OF PROTEIN KINASE C-{zeta}
J. Biol. Chem., December 5, 2003; 278(49): 48546 - 48552.
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Eur Heart JHome page
K. Kameda, T. Matsunaga, N. Abe, H. Hanada, H. Ishizaka, H. Ono, M. Saitoh, K. Fukui, I. Fukuda, T. Osanai, et al.
Correlation of oxidative stress with activity of matrix metalloproteinase in patients with coronary artery disease: Possible role for left ventricular remodelling
Eur. Heart J., December 2, 2003; 24(24): 2180 - 2185.
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CirculationHome page
W. M. Yarbrough, R. Mukherjee, G. P. Escobar, J. T. Mingoia, J. A. Sample, J. W. Hendrick, K. B. Dowdy, J. E. McLean, A. S. Lowry, T. P. O'Neill, et al.
Selective Targeting and Timing of Matrix Metalloproteinase Inhibition in Post-Myocardial Infarction Remodeling
Circulation, October 7, 2003; 108(14): 1753 - 1759.
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B. OSTERUD and E. BJORKLID
Role of Monocytes in Atherogenesis
Physiol Rev, October 1, 2003; 83(4): 1069 - 1112.
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Cardiovasc ResHome page
C. B Jones, D. C Sane, and D. M Herrington
Matrix metalloproteinases: A review of their structure and role in acute coronary syndrome
Cardiovasc Res, October 1, 2003; 59(4): 812 - 823.
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CirculationHome page
F. J. Villarreal, M. Griffin, J. Omens, W. Dillmann, J. Nguyen, and J. Covell
Early Short-Term Treatment With Doxycycline Modulates Postinfarction Left Ventricular Remodeling
Circulation, September 23, 2003; 108(12): 1487 - 1492.
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Am. J. Physiol. Heart Circ. Physiol.Home page
S. Hayashidani, H. Tsutsui, M. Ikeuchi, T. Shiomi, H. Matsusaka, T. Kubota, K. Imanaka-Yoshida, T. Itoh, and A. Takeshita
Targeted deletion of MMP-2 attenuates early LV rupture and late remodeling after experimental myocardial infarction
Am J Physiol Heart Circ Physiol, August 7, 2003; 285(3): H1229 - H1235.
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J Am Coll CardiolHome page
C. Boixel, V. Fontaine, C. Rucker-Martin, P. Milliez, L. Louedec, J.-B. Michel, M.-P. Jacob, and S. N. Hatem
Fibrosis of the left atria during progression of heart failure is associated with increased matrix metalloproteinases in the rat
J. Am. Coll. Cardiol., July 16, 2003; 42(2): 336 - 344.
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Cardiovasc ResHome page
H. Chen, D. Li, G. J Roberts, T. Saldeen, and J. L Mehta
Eicosapentanoic acid inhibits hypoxia-reoxygenation-induced injury by attenuating upregulation of MMP-1 in adult rat myocytes
Cardiovasc Res, July 1, 2003; 59(1): 7 - 13.
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P. Reidar Woldbaek, T. Tonnessen, U. Lie Henriksen, G. Florholmen, P. Kristian Lunde, T. Lyberg, and G. Christensen
Increased cardiac IL-18 mRNA, pro-IL-18 and plasma IL-18 after myocardial infarction in the mouse; a potential role in cardiac dysfunction
Cardiovasc Res, July 1, 2003; 59(1): 122 - 131.
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CirculationHome page
E. M. Wilson, S. L. Moainie, J. M. Baskin, A. S. Lowry, A. M. Deschamps, R. Mukherjee, T. S. Guy, M. G. St John-Sutton, J. H. Gorman III, L. H. Edmunds Jr, et al.
Region- and Type-Specific Induction of Matrix Metalloproteinases in Post-Myocardial Infarction Remodeling
Circulation, June 10, 2003; 107(22): 2857 - 2863.
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R. Visse and H. Nagase
Matrix Metalloproteinases and Tissue Inhibitors of Metalloproteinases: Structure, Function, and Biochemistry
Circ. Res., May 2, 2003; 92(8): 827 - 839.
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Am. J. Physiol. Heart Circ. Physiol.Home page
H. Chen, D. Li, T. Saldeen, and J. L. Mehta
TGF-beta 1 attenuates myocardial ischemia-reperfusion injury via inhibition of upregulation of MMP-1
Am J Physiol Heart Circ Physiol, May 1, 2003; 284(5): H1612 - H1617.
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CirculationHome page
S. Blankenberg, H. J. Rupprecht, O. Poirier, C. Bickel, M. Smieja, G. Hafner, J. Meyer, F. Cambien, L. Tiret, and for the AtheroGene Investigators
Plasma Concentrations and Genetic Variation of Matrix Metalloproteinase 9 and Prognosis of Patients With Cardiovascular Disease
Circulation, April 1, 2003; 107(12): 1579 - 1585.
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S. Wei, Y. Chen, L. Chung, H. Nagase, and K. Brew
Protein Engineering of the Tissue Inhibitor of Metalloproteinase 1 (TIMP-1) Inhibitory Domain. IN SEARCH OF SELECTIVE MATRIX METALLOPROTEINASE INHIBITORS
J. Biol. Chem., March 7, 2003; 278(11): 9831 - 9834.
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HypertensionHome page
P. Philip-Couderc, F. Smih, M. Pelat, C. Vidal, P. Verwaerde, A. Pathak, S. Buys, M. Galinier, J.-M. Senard, and P. Rouet
Cardiac Transcriptome Analysis in Obesity-Related Hypertension
Hypertension, March 1, 2003; 41(3): 414 - 421.
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M. K. King, M. L. Coker, A. Goldberg, J. H. McElmurray III, H. R. Gunasinghe, R. Mukherjee, M. R. Zile, T. P. O'Neill, and F. G. Spinale
Selective Matrix Metalloproteinase Inhibition With Developing Heart Failure: Effects on Left Ventricular Function and Structure
Circ. Res., February 7, 2003; 92(2): 177 - 185.
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C. F. Baicu, J. D. Stroud, V. A. Livesay, E. Hapke, J. Holder, F. G. Spinale, and M. R. Zile
Changes in extracellular collagen matrix alter myocardial systolic performance
Am J Physiol Heart Circ Physiol, January 1, 2003; 284(1): H122 - H132.
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E. E. J. M. Creemers, J. N. Davis, A. M. Parkhurst, P. Leenders, K. B. Dowdy, E. Hapke, A. M. Hauet, P. G. Escobar, J. P. M. Cleutjens, J. F. M. Smits, et al.
Deficiency of TIMP-1 exacerbates LV remodeling after myocardial infarction in mice
Am J Physiol Heart Circ Physiol, January 1, 2003; 284(1): H364 - H371.
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J Am Coll CardiolHome page
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.
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F. G. Spinale
Bioactive Peptide Signaling Within the Myocardial Interstitium and the Matrix Metalloproteinases
Circ. Res., December 13, 2002; 91(12): 1082 - 1084.
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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.
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J. Peng, D. Gurantz, V. Tran, R. T. Cowling, and B. H. Greenberg
Tumor Necrosis Factor-{alpha}-Induced AT1 Receptor Upregulation Enhances Angiotensin II-Mediated Cardiac Fibroblast Responses That Favor Fibrosis
Circ. Res., December 13, 2002; 91(12): 1119 - 1126.
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T. Tsuruda, G. Boerrigter, B. K. Huntley, J. A. Noser, A. Cataliotti, L. C. Costello-Boerrigter, H. H. Chen, and J. C. Burnett Jr
Brain Natriuretic Peptide Is Produced in Cardiac Fibroblasts and Induces Matrix Metalloproteinases
Circ. Res., December 13, 2002; 91(12): 1127 - 1134.
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Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
Y. Shizukuda and P. M. Buttrick
Oxygen free radicals and heart failure: new insight into an old question
Am J Physiol Lung Cell Mol Physiol, August 1, 2002; 283(2): L237 - L238.
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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.
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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.
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F. G. Spinale
Matrix Metalloproteinases: Regulation and Dysregulation in the Failing Heart
Circ. Res., March 22, 2002; 90(5): 520 - 530.
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P. Pacher, L. Liaudet, P. Bai, L. Virag, J. G. Mabley, G. Hasko, and C. Szabo
Activation of Poly(ADP-Ribose) Polymerase Contributes to Development of Doxorubicin-Induced Heart Failure
J. Pharmacol. Exp. Ther., March 1, 2002; 300(3): 862 - 867.
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