Abstract-Matrix metalloproteinases (MMPs) can degrade strength-giving collagens and other structural proteins of the arterial extracellular matrix. Overproduction of MMPs by monocyte/macrophages could therefore promote atherosclerotic plaque rupture and myocardial infarction. Freshly-recruited monocyte macrophages appear to use a prostaglandin (PG)-dependent pathway to coordinately upregulate a broad and potentially highly-destructive spectrum of MMPs. is an important contributory cause of atherosclerotic plaque rupture, which underlies most cases of myocardial infarction. 1 Net loss of collagen, which normally provides the main tensile strength of the artery wall, closely colocalizes with areas of activated foam-cell macrophages especially at so-called "shoulder regions." 2 Advanced plaques show large lipid cores in which macrophages are often present and the ECM has been extensively degraded. Advanced lesions also have a hypo-cellular fibrous cap probably attributable to death of macrophages and vascular smooth muscle cells (VSMCs). Recent evidence has revealed considerable diversity in the monocyte and macrophage populations in plaques. Two monocytes subsets have been defined, and plaques shown to attract predominantly the more inflammatory phenotype. 3 A variety of macrophage phenotypes have also been defined, 4 and at least 2 of these (so-called M1 and M2) were recently shown to be present in atherosclerotic plaques. 5 Lipopolysaccharide (LPS) and inflammatory cytokines such as tumor necrosis factor (TNF)-␣, interleukin (IL)-1, and interferon (IFN)-␥ are all believed to induce the M1 macrophage phenotype. 4 The alternative, so-called M2, macrophage phenotype is generated in response to cytokines that include IL-4. 4 The roles of these different macrophage phenotypes in plaque progression and instability are just beginning to be investigated.Macrophages secrete several classes of neutral extracellular proteases, including serine proteases, cathepsins, and metalloproteinases (MMPs). 6 Although these proteases act in concert, for limitations of space, this review focuses on the MMPs. MMPs are a family of some 23 genetically related proteins that share a common Zn 2ϩ -based catalytic mechanism. 7 MMP activity is increased by transcription of MMP proform genes and activation of proenzymes by proteolytic cascades, often (but not always) mediated by induction of other MMPs. 7 Inactivation is largely by binding to endogenous tissue inhibitors of MMPs (TIMPs). 7 Collectively MMPs have the ability to completely degrade collagen and most other ECM components 7 ; they also modify other soluble and cell surface proteins, including cytokines and chemokines, leading to regulation of plaque cell behavior including migration proliferation and death. 8 The reasons for considering MMPs culprits in plaque rupture are discussed in several recent reviews. 6,9,10 Briefly summarized, studies consistently demonstrate colocalization of MMPs with areas of degraded ECM in human plaques. Several, although not all, MMP knockout a...