Keywordsangiotensin converting enzyme inhibitors; matrix metalloproteinase-9; editorial Since the early 1990's, angiotensin converting enzyme (ACE) inhibitors have been used clinically to improve survival and reduce adverse left ventricular (LV) remodeling following myocardial infarction (MI). Seminal studies performed by the Pfeffer laboratory clearly demonstrated a survival benefit post-MI for both rats and humans treated with ACE inhibitors. [1,2] Several avenues of research have since sprouted to better understand the underlying mechanisms behind this benefit. Patten and colleagues demonstrated that both the ACE inhibitor enalapril and the angiotensin II type I receptor inhibitor losartan prevented LV hypertrophy and decreased collagen I gene expression compared to placebo-treated controls, suggesting that these events signaled through the angiotensin II type I receptor.[3] Yoshiyama and colleagues then showed that, in mice deficient for the angiotensin type I receptor, treatment with an ACE inhibitor prevented remodeling post-MI, indicating that ACE inhibitors also block angiotensin receptor-independent remodeling pathways. [4] In this issue, Dr. Yamamoto and colleagues examined the ability of the ACE inhibitor imidapril to directly bind to the matrix metalloproteinase MMP-9.[5] The importance of these findings is that ACE inhibition may also inhibit MMP-9, which provides a common link between strategies to prevent adverse remodeling post-MI (Figure 1). Adverse remodeling post-MI leading to congestive heart failure remains a leading cause of long-term morbidity and mortality. [6] ACE and MMP-9 are both zinc-dependent endopeptidases, both stimulate remodeling post-MI, and both process angiotensin I to form angiotensin II. [7] Matrix metalloproteinases are a family of 25 proteolytic enzymes defined by their ability to cleave individual extracellular matrix (ECM) components. MMP-9, also known as gelatinase B, processes multiple extracellular substrates, including denatured collagen I, fibronectin, and laminin.[8] Adding another layer of complexity, MMP-9 also cleaves non-ECM components, including cytokines and growth factors, to regulate multiple cell functions. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. to date, TIMP-1 binds MMP-9 with greatest affinity.
NIH Public Access[10] MMPs have assigned roles in many cardiovascular diseases, including atherosclerosis, myocardial infarction, and heart failure [11]. Ample evidence has demonstrated a direct cause and effect relationship between MMP-9 and LV remodeling: 1) MMP-9 levels increase early post-MI [12], 2) MMP inhib...