Degradation of Collagen by Metalloproteinase 2 in Patients with Abdominal Hernias

Abstract

Background: The groin hernia is a significant social and economic problem of our times. The pathogenesis of the disease is not clear. The metalloproteinases (MMP) are the group of proteolytic enzymes responsible for the degradation of extracellular matrix proteins and the basic membrane of blood vessels. The aims of our study were: (1) to estimate the MMP-2 levels in the blood and tissues of patients with a groin hernia; (2) to answer the question of whether changes in MMP-2 activity correlate with the occurrence of inguinal hernias. Method: The study was performed on a group of 90 male patients suffering from inguinal hernias, aged 28–70 years (mean: 49 years). The control group was made up of 10 healthy (free from hernia) males, aged 30–68 years (mean: 46 years). Results: We noticed increased levels of MMP-2 in patients with all types of hernia and across all age groups. The MMP-2 mean serum levels were statistically higher in patients with a groin hernia when compared to the control group. The highest blood levels of MMP-2 were observed in young men with a direct hernia. Conclusions: This study confirmed the important role of MMP-2 in the pathogenesis of inguinal hernia. The increased activity may lead to dysfunctions in collagen fiber, which is responsible for forming fascial structures, and as a result weaken their durability.

Connective tissue alteration in abdominal wall hernia

“…Significantly higher MMP-2 levels have been found in patients with a direct inguinal hernia than in those with an indirect inguinal hernia and controls. These results were derived from larger studies on both fascia transversalis and serum, suggesting that the MMP-2 level was also increased systemically in these patients 32,65,67 . These conclusions were based on protein level measurements and not MMP-2 proteolytic activity in the fascia transversalis.…”

“…Another study on skin fibroblasts from patients with a recurrent inguinal hernia showed a significant increase in type III procollagen mRNA, and a concomitant increase in MMP-1 and MMP-13 levels, compared with controls 55 . A significant increase in serum MMP-2 was also found in patients with a recurrent inguinal hernia compared with controls 67 . One caveat is that only a fraction of the total circulating MMP-2 was measured.…”

“…The interrelationship between these three factors is not fully established. However, it seems that there is reduced collagen synthesis by the fibroblasts 43,44 , decreased hydroxylation 32 , decreased cross-linking 46,47 and/or increased MMP activity 32,55,65,67,73 , causing accelerated collagen breakdown (Fig. 2).…”

“…Advanced age and compromised wound healing are associated with upregulation of MMP-2 and MMP-9 78 -81 . Furthermore, the MMP-2 level is especially raised in young patients with a direct inguinal hernia 65,67 .…”

“…These conclusions were based on protein level measurements and not MMP-2 proteolytic activity in the fascia transversalis. The highest MMP-2 level in both serum and fascia transversalis was observed in young patients (aged less than 50 years) with a direct inguinal hernia 65,67 . It is of note that levels of TIMP-2 were decreased significantly in the fascia transversalis of patients with a direct inguinal hernia compared with patients with an indirect inguinal hernia or controls 68 .…”