Early Plasma Matrix Metalloproteinase Profiles. A Novel Pathway in Pediatric Acute Respiratory Distress Syndrome

• Published in: American journal of respiratory and critical care medicine Vol. 199; no. 2; pp. 181 - 189
• Main Authors: Zinter, Matt S., Delucchi, Kevin L., Kong, Michele Y., Orwoll, Benjamin E., Spicer, Aaron S., Lim, Michelle J., Alkhouli, Mustafa F., Ratiu, Anna E., McKenzie, Anne V., McQuillen, Patrick S., Dvorak, Christopher C., Calfee, Carolyn S., Matthay, Michael A., Sapru, Anil
• Format: Journal Article
• Language: English
• Published: United States American Thoracic Society 15.01.2019
• Subjects: Biomarkers - blood; Child; Children & youth; Clinical outcomes; Confidence intervals; Disease; Extracellular matrix; Growth factors; Humans; Inflammation; Matrix Metalloproteinases - blood; Morbidity; Mortality; Original; Pediatrics; Proteins; Pulmonary fibrosis; Respiratory distress syndrome; Respiratory Distress Syndrome - blood; Respiratory Distress Syndrome - diagnosis; Stem cells; Transplants & implants; Tumor necrosis factor-TNF; San Francisco California; California; pediatric intensive care unit; pediatric acute lung injury; tissue inhibitor of metalloproteinases; matrix metalloproteinases; pediatric acute respiratory distress syndrome
• ISSN: 1073-449X; 1535-4970; 1535-4970
• DOI: 10.1164/rccm.201804-0678OC

MMPs (Matrix metalloproteinases) and their endogenous tissue inhibitors may contribute to lung injury through extracellular matrix degradation and modulation of inflammation and fibrosis. To test for an association between MMP pathway proteins and inflammation, endothelial dysfunction, and clinical outcomes. We measured MMPs in plasma collected on acute respiratory distress syndrome (ARDS) Day 1 from 235 children at five hospitals between 2008 and 2017. We used latent class analysis to identify patients with distinct MMP profiles and then associated those profiles with markers of inflammation (IL-1RA, -6, -8, -10, and -18; macrophage inflammatory protein-1α and -1β; tumor necrosis factor-α and -R2), endothelial injury (angiopoietin-2, von Willebrand factor, soluble thrombomodulin), impaired oxygenation (Pa /Fi [P/F] ratio, oxygenation index), morbidity, and mortality. In geographically distinct derivation and validation cohorts, approximately one-third of patients demonstrated an MMP profile characterized by elevated MMP-1, -2, -3, -7, and -8 and tissue inhibitor of metalloproteinase-1 and -2; and depressed active and total MMP-9. This MMP profile was associated with multiple markers of inflammation, endothelial injury, and impaired oxygenation on Day 1 of ARDS, and conferred fourfold increased odds of mortality or severe morbidity independent of the P/F ratio and other confounders (95% confidence interval, 2.1-7.6; P < 0.001). Logistic regression using both the P/F ratio and MMP profiles was superior to the P/F ratio alone in prognosticating mortality or severe morbidity (area under the receiver operating characteristic curve, 0.75; 95% confidence interval, 0.68-0.82 vs. area under the receiver operating characteristic curve, 0.66; 95% confidence interval, 0.58-0.73; P = 0.009). Pediatric patients with ARDS have specific plasma MMP profiles associated with inflammation, endothelial injury, morbidity, and mortality. MMPs may play a role in the pathobiology of children with ARDS.