Patey Prize 06

Abstract

Background: Rupture of an abdominal aortic aneurysm (AAA) carries a mortality rate of up to 90%. Matrix metalloproteinases (MMPs) play a fundamental role in aneurysm formation. Previous studies have suggested a systemic increase in proteolysis in patients with AAAs and MMPs have been shown to be elevated in the serum of these patients. However, no study as yet has demonstrated differences in asymptomatic and ruptured aneurysms. The aim of the study was to determine the MMP profiles of serum from patients presenting for elective and emergency aneurysm repair. Methods: Samples of venous blood were obtained intraoperatively from 61 patients undergoing elective repair of nonruptured AAA (n = 50, median age 71 years), or emergency repair (n = 11, age 72) of ruptured AAA. Serum was quantified for the concentration of MMPs-1, -2, -3, -9, -13, TIMP-1 and -2 utilizing ELISA. Results: There were no significant differences in MMPs-2,-3,-13 and TIMP levels in the serum of patients with nonruptured and ruptured AAA. Serum MMP-1 levels were significantly increased in rupture (10.36 ng mL−1[IQR 5.94–15.94]versus 24.81 ng mL−1[18.14–41.39], P < 0.0001). MMP-9 levels were six times higher in serum from ruptured compared with nonruptured AAA patients (19.13 ng mL−1[9.27–34.24]versus 117.9 ng mL−1[30.43–161.8], P = 0.0015). Conclusions: These data demonstrate that the serum MMP profile of patients with ruptured aneurysms is significantly different to patients with nonruptured AAA. Extension of these data may allow prediction of rupture rates from serum MMP levels.