Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review

Abstract

Purpose Anastomotic leakage (AL) is the most severe complication following colorectal resection and is associated with increased mortality. The main group of enzymes responsible for collagen and protein degradation in the extracellular matrix is matrix metalloproteinases. The literature is conflicting regarding anastomotic leakage and the degradation of extracellular collagen by matrix metalloproteinase-9 (MMP-9). In this systematic review, the possible correlation between anastomotic leakage after colorectal surgery and MMP-9 activity is investigated. Methods Embase, MEDLINE, Cochrane, and Web of Science databases were searched up to 3 February 2020. All published articles that reported on the relationship between MMP-9 and anastomotic leakage were selected. Both human and animal studies were found eligible. The correlation between MMP-9 expression and anastomotic leakage after colorectal surgery. Results Seven human studies and five animal studies were included for analysis. The human studies were subdivided into those assessing MMP-9 in peritoneal drain fluid, intestinal biopsies, and blood samples. Five out of seven human studies reported elevated levels of MMP-9 in patients with anastomotic leakage on different postoperative moments. The animal studies demonstrated that MMP-9 activity was highest in the direct vicinity of an anastomosis. Moreover, MMP-9 activity was significantly reduced in areas further proximally and distally from the anastomosis and was nearly or completely absent in uninjured tissue. Conclusion Current literature shows some relation between MMP-9 activity and colorectal AL, but the evidence is inconsistent. Innovative techniques should further investigate the value of MMP-9 as a clinical biomarker for early detection, prevention, or treatment of AL.

Physical abuse of young children during the COVID-19 pandemic: Alarming increase in the relative frequency of hospitalizations during the lockdown period

“…It is therefore difficult to understand why this phenomenon would not also affect abused children, especially since their parents, who may be the perpetrators of violence, are often reluctant to take their children to the hospital. In addition, in France, during the most critical period of the epidemic, radiology units were reserved in priority for patients suffering from COVID-19 ( Meyer et al, 2021 ), resulting in a delay in diagnosis for other patients, including physically abused children. Some children arrived at the emergency room and were redirected as outpatients for additional examinations (typically in the case of fractures), thus delaying diagnosis and reducing the likelihood that the physical abuse would be discovered.…”

Intestinal Anastomotic Healing: What do We Know About Processes Behind Anastomotic Complications

“…The second way of negative bacterial influence on the connective tissues of the intestinal anastomosis is mediated by human collagenases, where the bacteria do not produce collagenase itself, but a human collagenase activator, which acts locally by breaking down collagen fibers in a similar way as bacterial collagenases. Bacterial activator of matrix metalloproteinase 9 can play such role ( 20 ). During the process of formation the collagen-rich extracellular matrix is degraded by these enzymes.…”

“…During the process of formation the collagen-rich extracellular matrix is degraded by these enzymes. This can lead to mechanical weakness of the anastomosis or even dehiscence ( 20 ).…”

Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients

“…In a recent systematic review, which included animal and human studies, the role of tissue, blood and peritoneal MMP levels in the development of AL was investigated. The results from 12 studies suggested that elevated MMP-9 levels were the most consistent finding in patients that developed an AL [229]. The authors claimed that although these studies suggested that tissue or peritoneal fluid levels of MMP and/or TIMP could act as biomarkers for AL, the number of studies and number of patients used were small.…”