Increased Matrix Metalloproteinase-9 Predicts Poor Wound Healing in Diabetic Foot Ulcers
- Yu Liu, MD1,
- Danqing Min, PhD2,
- Thyra Bolton3,
- Vanessa Nubé3,
- Stephen M. Twigg, PhD, MD1,2,3,
- Dennis K. Yue, PhD, MD1,2,3 and
- Susan V. McLennan, PhD (smclennan{at}med.usyd.edu.au)1,2
- 1Discipline of Medicine, University of Sydney, Sydney, Australia
- 2Department of Endocrinology, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
- 3Diabetes Centre, Royal Prince Alfred Hospital (RPAH), Sydney, Australia
Abstract
Objective: We studied the relationship of diabetic ulcer wound fluid matrix metalloproteinase (MMPs), their tissue inhibitors (TIMPs) and Transforming Growth Factor -β1 (TGF-β1) with wound healing rate (WHR).
Methods/Research Design: The ulcers were cleansed to remove exudates and wound fluids were collected for analysis of MMP-2 and -9, TIMP-1 and TGF-β1.
Results: At presentation, MMP-9 and MMP-9/TIMP-1 ratio correlated inversely with WHR at 28 days (p<0.001). The MMP-9 and MMP-9/TIMP-1 ratio were lower in the 23 patients who achieved complete healing at 12 weeks versus the 39 that did not. The pro-MMP-9 concentration was predictive of healing within 12 weeks, addition of cutoffs for TIMP-1(>480pg/ml) and TGF-β (>115pg/ml) further improved its predictive power (AUC=0.94).
Conclusions: These findings suggest that a milieu with high MMP-9 may be indicative of inflammation and poor wound healing. Measurements of MMP-9, TIMP-1 and TGF-β in wound fluid may help to identify ulcers at risk of poor healing
Footnotes
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- Received April 21, 2008.
- Accepted September 18, 2008.
- Copyright © American Diabetes Association
