Matrix metalloproteinases, and notably the gelatinases MMP-2 and MMP-9, have important roles in tumour invasion, metastasis and angiogenesis. Our study investigates the distribution of MMP-2 and MMP-9 in colorectal cancer, the correlation with plasma levels, changes following surgical resection and whether plasma levels reflect clinical staging and disease course. MMP-2 and MMP-9 expression in 48 colorectal tumours and 13 adenomatous polyps was analysed by RT-PCR, immunohistochemistry, and quantified by ELISA of tumour lysates. Concentrations of MMP-2 and MMP-9 in plasma samples from these patients and 36 other patients who underwent curative resections were measured by ELISA prior to and 6 -12 months after surgery. MMP-2 expression was significantly increased in colorectal cancer tissues compared to matched normal colon as measured by ELISA. Active MMP-2 was localised by immunohistochemistry to regions where tumour cells invaded the muscularis with little staining in more superficial areas. Plasma MMP-2 levels were also significantly elevated in patients with colorectal cancer, with significant reductions following curative resections at all stages. Similarly, MMP-9 expression was significantly increased in colorectal cancer tissues, predominantly in the tumour stroma. Plasma levels of MMP-9 were significantly elevated at all stages in colorectal cancer patients and a significant reduction was seen following curative resections. With both MMP-2 and MMP-9, the strongest correlation with clinical staging in colorectal cancer was represented by the total plasma concentration of the enzymes, both falling to within the normal range following curative surgery. Plasma levels of these enzymes may therefore have potential as a noninvasive indicator of invasion or metastasis in colorectal cancer or as a marker of disease status during follow-up. © 2003 Wiley-Liss, Inc. colorectal cancer; metastasis; proteolysis; staging; plasma Matrix metalloproteinases are a closely related multigene family of zinc-dependent proteolytic enzymes. They have a role in normal physiological tissue remodelling and are capable of degrading all components of the extracellular matrix. There is increasing evidence that metalloproteinases play many important roles in cancer, for example, releasing and activating growth factors and other proteases and assisting tumour cells to invade the extracellular matrix. In addition, MMPs potentiate neovascularisation of tumour tissue, 1-4 with both MMP-2 and MMP-9 expression being correlated with angiogenesis in colorectal cancer. 5 Several previous studies have examined MMPs and also tissue inhibitors of MMPs (TIMPs) in colorectal cancer and in some cases a relationship between expression and tumour characteristics or metastasis has been found. 2,6 -9 Other studies have measured serum or plasma levels of MMPs and stated that they are raised in various cancers; 10 -14 however few studies have been reported in colorectal cancer, and it is not clear whether circulating MMP levels reflect tumour expression....