Abstract
This final part of our review series addresses matrix metalloproteinases (MMPs) and biomarkers of platelet activation and concludes with a general discussion of biomarkers in acute coronary syndromes (ACS). ### Metalloproteinases MMPs are zinc-dependent endoproteases with collagenase and/or gelatinase activity (Table). Degradation of collagen fibrils compromises plaque stability and the integrity of the endothelial basement membrane, predisposing advanced atheromas to rupture.1 View this table: Inflammatory Biomarkers in ACS #### MMP-1, -2, and -9 MMP-1, a collagenase expressed in the interstitium, is quickly upregulated in animal models of coronary ischemia/reperfusion. MMP-2 is a gelatinase capable of degrading type IV collagen, the major collagen of the subendothelial basement membrane. MMP-9 is a gelatinase widely implicated in ventricular remodeling and the development of heart failure.2 MMPs are highly expressed in atherosclerotic plaques, with selective enrichment at the shoulder regions.3 Patients with ACS have increased plasma levels of MMP-1, -2, and -9.4 The time course of elevation is highly variable: some groups have found that MMP-1, -2, and -9 levels are not elevated at presentation but that they increase during the subsequent 7 to 14 days.5 Other groups have reported no significant elevation in MMP-2 but a rapid rise and fall of MMP-9 within the first week after ACS. Few data exist on the association, if any, between MMP levels during ACS and cardiovascular outcomes. In a study of 24 patients with ACS, elevations in MMP-1 at 7 and 14 days after ACS were negatively correlated with left ventricular ejection fraction.6 The slow elevation of MMP levels after ACS and the lack of clinical outcome data do not currently make MMPs useful biomarkers for therapeutic decision making or risk stratification in ACS. They do, however, remain an active area of investigation as a therapeutic target. #### Pregnancy-Associated Plasma Protein A Pregnancy-associated plasma protein A …
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