(Circulation. 2000;102:1944.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
A Matrix Metalloproteinase Induction/Activation System Exists in the Human Left Ventricular Myocardium and Is Upregulated in Heart Failure
From the Medical University of South Carolina, Charleston.
Correspondence to Francis G. Spinale, MD, PhD, Cardiothoracic Surgery, Room 625, Strom Thurmond Research Bldg, 770 MUSC Complex, Medical University of South Carolina, 114 Doughty St, Charleston, SC 29425.
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Abstract |
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Background—Matrix metalloproteinases (MMPs) contribute to matrix remodeling in disease states such as tumor metastases. Extracellular matrix metalloproteinase inducer (EMMPRIN) has been reported to increase MMP expression, and membrane-type MMP or MT1-MMP has been implicated to activate MMPs. The present study examined whether and to what degree EMMPRIN and MT1-MMP were expressed in human left ventricular (LV) myocardium as well as the association with MMP activity and expression in dilated cardiomyopathy (DCM).
Methods and Results—LV myocardial zymographic MMP activity increased by >2-fold with both nonischemic DCM (n=21) and ischemic DCM (n=16) compared with normal (n=13). LV myocardial abundance of MMP-9 was increased with both forms of DCM. MMP-2 and MMP-3 were increased with nonischemic DCM. MMP-1 levels were decreased with both forms of DCM. EMMPRIN increased by >250% and MT1-MMP increased by >1000% with both forms of DCM.
Conclusions—Increased LV myocardial MMP activity and selective upregulation of MMPs with nonischemic and ischemic forms of DCM occurred. Moreover, a local MMP induction/activation system was identified in isolated normal human LV myocytes that was upregulated with DCM. The control of MMP activation and expression in the failing human LV myocardium represents a new and potentially significant therapeutic target for this disease process.
Key Words: myocardium • remodeling • metalloproteinases • cardiomyopathy
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Introduction |
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Left ventricular (LV) remodeling is an important contributory event in the progression to end-stage congestive heart failure (CHF). However, the underlying cellular and molecular basis for LV myocardial remodeling in patients with severe CHF remains poorly understood. As in most tissue remodeling processes, LV myocardial remodeling with CHF is accompanied by changes in the structure and composition of the collagen matrix.1 2 3 4 Matrix metalloproteinases (MMPs) are an endogenous family of zinc-dependent enzymes that have been identified to be responsible for matrix remodeling in several disease states.
Dilated cardiomyopathy (DCM) is a common cause of CHF in which a primary determinant of the disease process is LV remodeling. Although the underlying causes are diverse, DCM can be partitioned into nonischemic or ischemic origin. The first objective of this study was to quantify MMP activity and expression in normal myocardium as well as in that of nonischemic and ischemic DCM. The second objective was to identify a potential basis for alterations in MMP activity and abundance that occur in patients with end-stage DCM with a nonischemic or an ischemic cause.
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Methods |
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Patients
Human LV myocardium was obtained from explanted hearts of patients (age 35 to 64 years) undergoing total orthotopic heart transplantation secondary to nonischemic (idiopathic; n=21) or ischemic (n=16) DCM. Sections of the LV free wall were snap-frozen in liquid nitrogen and stored at -70°C until use. Nonischemic DCM was identified by preoperative presentation and ischemic DCM confirmed by coronary catheterization studies. Patients with confirmed myocarditis were excluded from this study. In the patients with DCM, medications included digoxin (95%), diuretics (98%), ACE inhibitors (78%), ß-adrenergic antagonists (9%), and calcium channel blockers (4%). The treatment penetration was equivalent in both forms of DCM (
2=2.97, P=0.226). Normal LV
myocardial samples (n=13; age 16 to 22 years) were obtained from donor
hearts not matched for transplantation or used for valve harvest
(Cryolife, Inc). For the isolated myocyte studies, myocardial biopsies
were obtained from 6 patients with normal LV ejection fraction (>60%)
undergoing elective coronary artery bypass surgery as described
previously.5 Patient consent was obtained for all
myocardial samples used in the study, and protocols were approved by
the Medical University of South Carolina Institutional Review Board for
Human Research.
Myocardial Zymography and MMP/TIMP Measurements
LV myocardial samples were homogenized and
concentrated to prevent MMP proteolytic activation and degradation as
described previously.2 3 6 Basal LV gelatinase activity
was examined by substrate specific zymography1 2 3 6
because detergent exposure, for example, SDS, facilitates MMP enzymatic
activation by unfolding.1 2 3 6 Total recruitable LV
gelatinase activity was assessed similarly after preactivation of LV
myocardial extracts with trypsin.1 2 3 6 It has been
demonstrated previously that the stepwise activation of MMPs can be
elicited by serine proteases such as trypsin or
plasmin.1 2 3 4 6 7 In the present study, trypsin (2.5
µM; 5 minutes) was used to cleave nascent MMPs so as to fully
activate enzyme moieties and/or facilitate the removal of
endogenous inhibitors. To express the
zymographic results in terms of MMP proteolytic activity, zymographic
analysis with purified MMP-2/MMP-9 (Chemicon) was performed
(Figure 1
). With the use of a 2-site
ELISA sandwich format and internal standards, quantitative
analysis for LV myocardial MMP-1, MMP-2, MMP-3, MMP-9, and
TIMP-1 as well as the MMP-1/TIMP-1 complex were
performed.8
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Myocardial Immunoblotting
Past studies identified a cell-surface protein in specific tumor
cell lines that caused the induction of MMP expression termed
extracellular matrix metalloproteinase inducer
(EMMPRIN).9 10 11 12 Membrane-type MMP (MT1-MMP) is a recently
discovered MMP that has the capacity to activate other MMPs,
including collagenase-3 (MMP-13).7 13
Accordingly, relative EMMPRIN, MT1-MMP, and MMP-13 levels were measured
in normal and DCM myocardial samples by
immunoblotting.2 3 6 A positive control
was included in all immunoblots (MMP-13: CC068, MT1-MMP:
CC1042, Chemicon; EMMPRIN: Human Breast Cancer Preparation).
Myocyte Isolation and Immunohistochemistry
The LV myocardial biopsy was placed in a collagenase
solution within a microtitration system developed by this
laboratory.5 8 14 A yield of >60% of viable myocytes was
obtained from each isolation. LV myocytes were washed, incubated with
primary antisera for MT1-MMP (1:300) or EMMPRIN (1:20) overnight at
4°C, washed, and incubated with conjugated goat-FITC antisera (1:60;
1 hour, 25°C). LV myocytes were double-stained with 
-actinin
antisera conjugated to rhodamine red-X and nuclei identified by
propidium iodide with confocal microscopy as described
previously.14 Colocalization of the
cytoskeletal-sarcomeric–associated protein -actinin, MT1-MMP, and
EMMPRIN were performed by means of confocal microscopy (Olympus
FluoView BX50WI).
Data Analysis
For comparisons of MMP zymography and ELISA values between
normal, ischemic DCM, and nonischemic DCM, an ANOVA was
first performed. If ANOVA revealed significant differences, pairwise
tests of individual group means were compared by means of Bonferroni
probabilities. For relative comparisons between groups for
immunoblotting results, the Kruskal-Wallis ANOVA was
used. Pharmacological treatment was considered a categoric
variable, and MMP activity was examined by ANOVA. Results are
presented as mean± SEM. Values of P<0.05 were
considered statistically significant.
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Results |
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All quantitative data with respect to MMP activity, MMP/TIMP abundance, and EMMPRIN abundance are shown in the Table
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MMP Zymographic Activity in Normal and DCM Human
Myocardium
LV myocardial MMP zymographic activity was detected in all
human LV myocardial samples at 50 to 90 kDa, consistent with
the molecular weights of several MMP species including MMP-2 and MMP-9
(Figure 2).4 7 Moreover, MMP
zymographic activity was increased in both forms of DCM. LV myocardial
MMP zymographic activity after trypsin activation increased by >3-fold
from basal values (Figure 2). Total recruitable MMP zymographic
activity was higher in both nonischemic and ischemic
DCM. There was no relation between increased MMP activity in DCM
patients when stratified with respect to pharmacological treatment
(P>0.9634).
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MMP Abundance in Normal and DCM Human Myocardium
MMP-9 was increased in both ischemic and
nonischemic DCM. MMP-2 was increased 2-fold in
nonischemic DCM but was unchanged in ischemic DCM.
MMP-1 was reduced in both nonischemic and ischemic DCM.
A robust immunoreactive signal was observed for collagenase
3 (MMP-13) in normal human myocardium (Figure 3) and was increased with both forms of
DCM. Stromelysin (MMP-3) was increased in nonischemic DCM but
was unchanged with ischemic DCM.
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MMP Inhibition in Normal and DCM Human Myocardium
A mechanism for controlling MMP activity in normal tissue is
through a family of closely related inhibitors known as
tissue inhibitors of MMPs, or TIMPs.4 7 One of
the more ubiquitous TIMPs, TIMP-1, has been demonstrated in LV
myocardium previously.6 With both
nonischemic and ischemic DCM, TIMP-1 abundance was
similar to normal values. However, actual MMP-1/TIMP-1 complex
abundance was reduced with nonischemic DCM and was further
reduced with ischemic DCM.
Local MMP Induction and Activation in Normal and DCM
Myocardium
EMMPRIN levels, as measured by immunoblotting,
were increased in both nonischemic and ischemic DCM
(Figure 3
). Relative EMMPRIN levels were increased in
ischemic DCM when compared with nonischemic DCM.
MT1-MMP, as measured by immunoblotting (Figure 3), was localized at 
50 kDa. MT1-MMP was substantially
increased in ischemic and nonischemic DCM.
In the first series of studies, purified LV myocyte sarcolemmal
preparations were prepared and immunoblotting was
performed (Figure 4). A robust signal was
obtained in LV sarcolemmal preparations for both MT1-MMP and EMMPRIN in
both forms of DCM. MT1-MMP and EMMPRIN were localized by
immunofluorescence to human LV myocytes by confocal
microscopy (Figure 5). Colocalization of
both MT1-MMP and EMMPRIN to the LV myocyte sarcolemma was observed. A
punctate and well-defined colocalization with -actinin was also
observed with MT1-MMP.
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Discussion |
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Although the activation of MMPs has been identified to occur in a number of disease states, whether and to what degree of activation of this local proteolytic system occurs in failing human myocardium as the result of DCM remain unknown. There were 3 significant findings of the present study regarding myocardial MMP activity and expression in severe end-stage human DCM. First, MMP zymographic activity was increased in DCM and was accompanied by increased levels of certain MMP species, including the emergence of unique MMPs without a compensatory increase in the levels of the endogenous inhibitors of MMPs (TIMPs). Second, a local induction/activation system was localized to the LV myocyte sarcolemma that consisted of EMMPRIN and MT-MMP. Third, this local inducer/activation system was significantly upregulated in DCM. These findings provide new mechanistic insight into the cellular and molecular basis for the increased LV myocardial MMP activity that occurs in end-stage human heart failure.
MMP and TIMP Species Expression
With both ischemic and nonischemic DCM, a common
pattern of myocardial content for the interstitial
collagenases MMP-1 and MMP-13 was observed. Specifically,
MMP-1 was reduced with DCM and was accompanied by increased levels of
collagenase 3, or MMP-13. MMP-13 has been identified to be
expressed in human breast carcinoma and in osteoarthritic
chondrocytes.4 7 The present study is the first report
to demonstrate the emergence of this MMP species in failing human
myocardium. The important substrates for MMP-1 and MMP-13
within the myocardium include the fibrillar collagens such
as collagen type I and III.4 Thus, the reduction in MMP-1
accompanied by increased MMP-13 may result in a persistence of
interstitial collagenolytic activity within the
myocardium. More importantly, MMP-13 is activated
by MT1-MMP, whereas MMP-1 is not.7 13 MT1-MMP has been
shown to cleave fibrillar collagen.13 Thus, the emergence
of MMP-13 as the predominant interstitial
collagenase coupled with a robust increase in MT1-MMP
levels within the DCM myocardium may contribute to
increased susceptibility of the myocardial fibrillar collagen network
to degradation.
MMP-2 and MMP-9 are commonly called the gelatinases because of a
high affinity for this substrate. However, these MMPs posses the
capacity to degrade a number of interstitial proteins
including basement membrane components such as laminin and
fibronectin.4 Past studies have demonstrated that MMP-9 is
synthesized by myocytes, fibroblasts, and smooth muscle
cells.4 7 Moreover, neutrophils have also been reported to
be a potential source of MMP-9.4 7 Increased myocardial
levels of MMP-9 occurred in both nonischemic and
ischemic DCM, but MMP-2 was increased only in
nonischemic DCM. The MMPs contain certain regulatory DNA
sequences within the promoter region that bind transcription factors
that are influenced by a number of intracellular signaling
pathways.4 7 The development of DCM is accompanied by
increased neurohormonal system activity such as increased levels of
norepinephrine and tumor necrosis factor-. These
bioactive molecules can induce formation of transcription factors,
which will bind to the MMP promoter region.4 7 MMP-9 and
MMP-2 contain dissimilar promoter sequences and regulatory
elements.4 7 Thus, the different levels of MMP-2 with
nonischemic and ischemic forms of DCM probably are due
to the differences in the underlying cause of the disease process,
which in turn may result in the stimulation of different intracellular
signaling pathways and selective activation of MMP-2. Although further
studies regarding the regulatory mechanisms of MMP expression in the
myocardium are warranted, results from the present
study demonstrated that MMPs are differentially regulated in end-stage
DCM.
MMP-1 induction may depend on cooperative binding of the PEA-3 element and the formation of the transcription factor AP-1, whereas stromelysin, or MMP-3 transcription, can occur independent of the AP-1 response.4 7 Thus, increased extracellular stimuli such as neurohormones and cytokines, which occur with DCM, may induce differential levels of MMP-1 and MMP-3 expression. In the present study, MMP-1 levels were reduced in both forms of DCM, whereas MMP-3 levels were increased in nonischemic DCM. MMP activation can be achieved through a final common enzymatic pathway requiring MMP-3.4 7 Moreover, MMP-3 can participate in the activation cascade required to achieve activation of MMP species relevant to the LV remodeling process.4 7 Thus, the increased MMP-3 expression that occurred in nonischemic DCM may be an important contributory mechanism for the LV remodeling in this form of heart failure.
TIMPs bind to the active site of the MMPs by blocking access to extracellular matrix substrates. The MMP/TIMP complex is formed in a stoichiometric 1:1 molar ratio and forms an important endogenous system for regulating MMP activity in vivo.4 7 15 Although up to 4 TIMPS have been identified to date, the most well characterized of these endogenous inhibitors of MMPs are TIMP-1 and TIMP-2.4 6 7 15 TIMP-1 forms a complex with several MMPs, which include MMP-1 and MMP-9.4 7 15 In the present study, there was no change in absolute TIMP-1 levels with DCM, but a reduction in MMP-1/TIMP-1 complex formation occurred. One contributory factor for the reduction in the levels of this specific MMP/TIMP complex was the absolute reduction in MMP-1 levels with DCM. TIMP-1 binds to other MMPs such as proMMP-9, which slows the activation process of this MMP species.4 7 In both forms of DCM, MMP-9 levels were increased without a concomitant increase in TIMP-1 levels. Thus, the ratio of MMP-9 to TIMP-1 was reduced, which in turn may have contributed to the increased MMP zymographic activity and the reduction in MMP-1/TIMP-1 complex formation observed with DCM. Although the role of other myocardial TIMPs remains to be defined, the focus of this study as well as past reports1 2 3 6 was MMP induction and activation.
MMPs are secreted in a proenzyme form and require proteolytic cleavage for activation, most notably by serine proteases.2 3 4 6 7 The present study demonstrated heightened MMP activity in DCM by zymography that increased after preactivation with the serine protease trypsin. Endogenous myocardial MMP activation by serine proteases could involve chymase, which has been demonstrated to be increased during both pressure- and volume-overload states.16 There are problematic issues that surround in vitro zymographic measurements that prevent direct extrapolation to in vivo LV myocardial MMP activity. First, this assay does not provide a measure of total MMP content and species identification. Second, the zymographic assays were performed under optimal enzymatic conditions and substrate availability and in the absence of the influence of TIMPs. These issues were addressed in part by the present study through the direct measurement of MMP and TIMP abundance and MMP/TIMP complex formation. Another limitation of the present study is that MMP zymographic activity was measured in end-stage DCM. Whether increased MMP activity exists in milder forms of heart failure remains to be established. Finally, Although the entire complement of LV myocardial cells including fibroblasts, smooth muscle cells, endothelial cells, and the LV myocyte itself have been demonstrated to produce MMPs,4 7 8 the focus of the present study was first, to examine global MMP expression and activity in whole myocardial tissue, and second, to determine the existence of a local cellular MMP induction and activation system in LV myocardium. Given that the present study has identified both EMMPRIN and MT1-MMP in LV myocytes, and this laboratory routinely performs isolated LV myocyte studies, future directions will entail a more careful examination of this local induction and activation system in an isolated LV myocyte system.
MMP Induction and Activation
Although serine proteases such as plasmin and trypsin
contribute to MMP activation through proteolytic cleavage of the
C-terminal propeptide domain, recent studies have demonstrated that the
membrane-bound MMPs, MT-MMPs, can induce local MMP
activation.7 13 MT1-MMP has been clearly shown to
participate in the MMP activation process in a number of cell systems
and in extracellular matrix degradation.13 15 For example,
pro–MMP-2 will bind to a specific extracellular domain of MT1-MMP,
resulting in full activation of MMP-2.13 15 Past studies
have demonstrated that in human fibroblast cultures, MMP-13 activation
occurs by MT1-MMP.7 13 Although the complete mechanism of
MT-MMP mediated MMP activation is still not completely understood,
MT-MMPs provide a more precise means for localizing MMP activation and
extracellular matrix degradation. Furthermore, MT1-MMP is not inhibited
by TIMP-1,13 which provides further support that increased
levels of MT1-MMP would result in increased local extracellular
proteolytic activity and degradation. In the present study, a
significant increase in the levels of myocardial MT1-MMP occurred with
DCM and could be localized to the LV myocyte sarcolemma. With the use
of confocal microscopy, sarcomeric -actinin and MT1-MMP coalesced at
the sarcolemma, consistent with the location of
costameres.17 This would suggest that MT1-MMP is in
proximity to extracellular binding domains, which would implicate
MT1-MMP in modulating local myocyte adhesion to the extracellular
matrix. It has been demonstrated that cytokines such as tumor
necrosis factor- upregulate MT1-MMP in several cell
systems.13 Moreover, it has been demonstrated that MT1-MMP
can yield the mature form of tumor necrosis factor-, which suggests
that an important autoinduction system may exist for MT1-MMP in
DCM.13 Because DCM is accompanied by increased
neurohormonal and cytokine synthesis, it is likely that these
extracellular signals contribute to the induction of myocardial
MT1-MMP.
A large portfolio of extracellular stimuli can alter the expression of MMPs in various cell systems.4 13 In severe end-stage congestive heart failure such as DCM, it is likely that a number of neurohormonal and cytokine signaling cascades contribute to alterations in myocardial MMP expression and activity. However, it remained unclear whether a local MMP induction system existed at the level of the LV myocyte and whether this system may be upregulated in DCM. EMMPRIN is a 58-kDa, membrane-bound protein that has been identified in both normal (keratinocytes) and diseased human tissue (breast and lung carcinoma).9 10 11 12 Exposure of human fibroblasts to recombinant EMMPRIN caused an induction of MMP-1, MMP-2, and MMP-3.9 12 Whether and to what degree other MMPs are induced by EMMPRIN remain to be defined.
Basal expression of EMMPRIN has been reported in a number of tissue types, suggesting multiple roles for this transmembrane protein.9 10 11 12 The present study clearly defined increased abundance of EMMPRIN in failing human myocardium. This provides circumstantial evidence that EMMPRIN may facilitate MMP expression in DCM myocardium. Identification of extracellular binding domains that interrupt EMMPRIN function would be an important avenue of future study that may provide a definitive approach for detecting the role of EMMPRIN in myocardial remodeling. In the present study, EMMPRIN was identified in normal human LV myocardium. With confocal microscopy, a definitive staining pattern for EMMPRIN was localized to the LV myocyte sarcolemma. Using multicellular culture systems, it has been postulated that EMMPRIN induces MMP expression by a cell-cell interaction or a paracrine-mediated effect.11 12 Increased myocardial EMMPRIN levels were observed in both forms of DCM and could be localized to the LV myocyte sarcolemma. Thus, increased sarcolemmal levels of EMMPRIN in DCM may enhance MMP induction through this cell-cell interaction.
Through immunoprecipitation experiments, Berditchevski and
colleagues11 demonstrated that EMMPRIN forms a complex
with 3ß1 integrin.
Functions of integrins include cell-cell adhesion, extracellular
matrix-cell adhesion, and transduction of cellular signaling
cascades.17 The coexistence of EMMPRIN and
3ß1 integrin suggests
that EMMPRIN-mediated MMP induction may be influenced by both the
composition of and stress placed on the extracellular matrix. The
intracellular signaling pathways by which EMMPRIN facilitates MMP
expression remain to be fully elucidated but probably involve tyrosine
kinase pathways.12 The EMMPRIN protein sequence contains a
PKC phosphorylation site, which may also be an
important intracellular regulatory mechanism (Biology Workbench NCSA,
Prosite Database, Board of Trustees, University of Illinois, 1997).
Interestingly, in vitro studies have demonstrated that although EMMPRIN
induced MMP expression, it did not influence basal expression of
TIMP-1.10 In the present study, a similar pattern of
expression was observed with DCM in which increased EMMPRIN levels were
associated with increased levels of certain MMP species, but TIMP-1
levels remained unchanged. Thus, while remaining speculative, increased
EMMPRIN expression in developing DCM may contribute to increased MMP
levels in myocardial cells without a concomitant increase in TIMP
expression, which in turn would ultimately favor myocardial matrix
degradation and remodeling. However, future studies involving the use
of purified EMMPRIN and isolated LV myocytes are necessary to fully
elucidate EMMPRIN-mediated MMP regulation.
Although the causes of CHF are diverse, a common event in the
progression of this disease process is LV remodeling, resulting in
increased wall stress and subsequent pump dysfunction. An important
cause of CHF is DCM, in which significant LV remodeling and changes in
chamber geometry are an important prognostic indicator of disease
progression. In the present study, patients with DCM were treated
with conventional medical therapy (ie, ACE inhibition, digoxin,
diuretics, and ß-adrenergic antagonists). Such
therapeutic approaches for CHF have been focused on modifying LV load
or by interrupting the effects of specific neurohormonal stimuli.
Despite the high treatment penetrance, MMP activity and expression
remained increased in patients with DCM. This observation would suggest
that current conventional therapy for CHF fails to significantly
influence MMP expression and activation processes. Past
studies1 2 3 6 as well as present observations would
support the concept that direct modulation of the LV myocardial
remodeling process through the control of MMP expression and activity
would be an important therapeutic strategy in the setting of developing
CHF. The present study identified that a local MMP induction and
activation pathway exists in the normal human LV myocardium
that is upregulated with DCM. Moreover, localization of this system to
the LV myocyte suggests that a paracrine loop exists with respect to
MMP induction and activation (Figure 6).
The local myocardial MMP induction/activation system identified in the
present study may represent an important system responsible
for LV remodeling in the heart failure process.
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Acknowledgments |
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This study was supported by National Institutes of Health grants HL-45024 (F.G.S.), HL-97012 (F.G.S.), and PO1-HL-48788 (F.G.S.).
Received March 2, 2000; revision received May 25, 2000; accepted May 25, 2000.
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H. Oral, N. Sivasubramanian, D. B. Dyke, R. H. Mehta, P. M. Grossman, K. Briesmiester, W. P. Fay, F. D. Pagani, S. F. Bolling, D. L. Mann, et al. Myocardial Proinflammatory Cytokine Expression and Left Ventricular Remodeling in Patients With Chronic Mitral Regurgitation Circulation, February 18, 2003; 107(6): 831 - 837. [Abstract] [Full Text] [PDF]
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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. [Abstract] [Full Text] [PDF]
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R. Mukherjee, T. A. Brinsa, K. B. Dowdy, A. A. Scott, J. M. Baskin, A. M. Deschamps, A. S. Lowry, G. P. Escobar, D. G. Lucas, W. M. Yarbrough, et al. Myocardial Infarct Expansion and Matrix Metalloproteinase Inhibition Circulation, February 4, 2003; 107(4): 618 - 625. [Abstract] [Full Text] [PDF]
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P. W. M. Fedak, S. M. Altamentova, R. D. Weisel, N. Nili, N. Ohno, S. Verma, T.-Y. J. Lee, C. Kiani, D. A. G. Mickle, B. H. Strauss, et al. Matrix remodeling in experimental and human heart failure: a possible regulatory role for TIMP-3 Am J Physiol Heart Circ Physiol, February 1, 2003; 284(2): H626 - H634. [Abstract] [Full Text] [PDF]
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W. Briest, A. Holzl, B. Rassler, A. Deten, H. A Baba, and H.-G. Zimmer Significance of matrix metalloproteinases in norepinephrine-induced remodelling of rat hearts Cardiovasc Res, February 1, 2003; 57(2): 379 - 387. [Abstract] [Full Text] [PDF]
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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. [Abstract] [Full Text] [PDF]
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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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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. [Abstract] [Full Text] [PDF]
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M. Watanabe, S. Hasegawa, N. Ohshima, H. Tanaka, T. Sakamoto, and M. Sunamori Differential regulation of MMP-2, TIMP-2 and IL-6 in valve replacement versus CABG patients Perfusion, December 1, 2002; 17(6): 435 - 439. [Abstract] [PDF]
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 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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J. Li, P. Lothar Schwimmbeck, C. Tschope, S. Leschka, L. Husmann, S. Rutschow, F. Reichenbach, M. Noutsias, U. Kobalz, W. Poller, et al. Collagen degradation in a murine myocarditis model: relevance of matrix metalloproteinase in association with inflammatory induction Cardiovasc Res, November 1, 2002; 56(2): 235 - 247. [Abstract] [Full Text] [PDF]
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 V. Portik-Dobos, M. P. Anstadt, J. Hutchinson, M. Bannan, and A. Ergul Evidence for a Matrix Metalloproteinase Induction/Activation System in Arterial Vasculature and Decreased Synthesis and Activity in Diabetes Diabetes, October 1, 2002; 51(10): 3063 - 3068. [Abstract] [Full Text] [PDF]
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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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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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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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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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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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 S.M. DALLABRIDA and M.A. RUPNICK Vascular Endothelium in Tissue Remodeling: Implications for Heart Failure Cold Spring Harb Symp Quant Biol, January 1, 2002; 67(0): 417 - 428. [Abstract] [PDF]
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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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D. L. Mann and H. Taegtmeyer Dynamic Regulation of the Extracellular Matrix After Mechanical Unloading of the Failing Human Heart: Recovering the Missing Link in Left Ventricular Remodeling Circulation, September 4, 2001; 104(10): 1089 - 1091. [Full Text] [PDF]
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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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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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 C. Joffs, H. R. Gunasinghe, M. M. Multani, B. H. Dorman, J. M. Kratz, A. J. Crumbley III, F. A. Crawford Jr, and F. G. Spinale Cardiopulmonary bypass induces the synthesis and release of matrix metalloproteinases Ann. Thorac. Surg., May 1, 2001; 71(5): 1518 - 1523. [Abstract] [Full Text] [PDF]
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