Relationship between serum matrix Metalloproteinase-9 levels and severity of multibacillary leprosy in patients aged 30 years and under
DOI:
https://doi.org/10.22437/proca.v1i2.50520Keywords:
Leprosy, multibacillary; matrix metalloproteinase 9; bacterial load; cell-mediated immunity; biomarkers; age factorsAbstract
Background: Leprosy presents a spectrum of immunological responses linked to pathological and clinical manifestations. Matrix Metalloproteinase-9 (MMP-9), an enzyme involved in extracellular matrix degradation and inflammation, has been implicated in cellular immunity. However, the relationship between MMP-9 levels and bacterial load in multibacillary (MB) leprosy remains incompletely understood, particularly across different age groups. Objective: To analyze the relationship between serum MMP-9 levels and Bacterial Index (BI) severity in MB leprosy patients, stratified by age groups. Methods: A cross-sectional comparative study was conducted from October 2017 to September 2018 at Dr. Rivai Abdullah Leprosy Hospital and Sukajadi Community Health Center, South Sumatra, Indonesia. Thirty-two newly diagnosed or recurrent MB leprosy patients were enrolled via consecutive sampling. Serum MMP-9 levels were measured using ELISA, and disease severity was classified by BI (<3 vs ≥3) using Slit Skin Smear. Data were analyzed using unpaired t-tests and Kruskal-Wallis tests, with significance set at P<0.05. Results: Age group and marital status significantly influenced BI severity (P<0.05). Among patients aged <30 years, those with BI≥3 had significantly lower serum MMP-9 levels (2101.44±430.02 ng/L) compared to BI<3 (2621.57±469.37 ng/L; P=0.044). In patients aged ≥30 years, MMP-9 levels were lower in BI≥3 group (1770.19±477.21 ng/L vs 2068.67±550.58 ng/L), but this difference was not statistically significant (P>0.05). Conclusion: Lower serum MMP-9 levels in severe MB leprosy may reflect diminished cell-mediated immunity. The significant inverse relationship between MMP-9 and BI in younger patients suggests age-dependent immunological variations. These findings support MMP-9 as a potential biomarker for disease severity assessment in MB leprosy.
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[1] Wondmagegn D, Saskia H, Takarinda KC, Mberu EK, Abdela GS. Slit-skin smear for the classification of leprosy; are we wasting time and resource? J Infect Dev Ctries. 2022;16(8.1):3S-7S. doi:10.3855/jidc.15992
[2] Silva MJA, Silva CS, Brasil TP, Alves AK, et al. An update on leprosy immunopathogenesis: systemic review. Front Immunol. 2024;15:1416177. doi:10.3389/fimmu.2024.1416177
[3] World Health Organization. Global leprosy update, 2022: reducing the burden of leprosy through prevention initiatives. Geneva: WHO; 2023. Available from: https://www.who.int/publications/i/item/who-wer9836-401-430
[4] Tarique M, Naz H, Saini C, Naqvi RA, Khanna N, Rao DN. Increased IL-35 producing Tregs and CD19+IL-35+ cells are associated with disease progression in leprosy patients. Cytokine. 2017;91:82-88. doi:10.1016/j.cyto.2016.12.011
[5] Kumar S, Naqvi RA, Khanna N, Pathak P, Rao DN. Th3 immune responses in the progression of leprosy via molecular cross-talks of TGF-β, CTLA-4 and Cbl-b. Clin Immunol. 2011;141(2):133-142. doi:10.1016/j.clim.2011.07.003
[6] Chen KH, Lin CY, Su SB, Chen KT. Leprosy: a review of epidemiology, clinical diagnosis, and management. J Trop Med. 2022;2022:8652062. doi:10.1155/2022/8652062
[7] Mahajan VK. Slit-skin smear in leprosy: lest we forget it! Indian J Lepr. 2013;85:177-183.
[8] Visse R, Nagase H. Matrix metalloproteinases and tissue inhibitors of metalloproteinases: structure, function, and biochemistry. Circ Res. 2003;92(8):827-839. doi:10.1161/01.RES.0000070112.80711.3D
[9] Singh G, Jahan A, Gupta R, Soin N. Expression of matrix metalloproteinase-9 in skin lesions of leprosy patients: the difference between paucibacillary and multibacillary cases. Lepr Rev. 2020;91:413-420. doi:10.47276/lr.91.4.413
[10] Youssef SS, Attia EAS, Awad NM, Mohamed GF. Expression of matrix metalloproteinases (MMP-3 and MMP-9) in skin lesions of leprosy patients. J Egypt Women Dermatol Soc. 2009;6:80-87.
[11] Shubayev V, Angert M, Dolkas J. TNF-α induced MMP-9 promotes macrophage recruitment into injured peripheral nerve. Mol Cell Neurosci. 2006;31(3):407-415. doi:10.1016/j.mcn.2005.10.011
[12] Teles RMB, Teles RB, Amadeu T, Moura DF, et al. High matrix metalloproteinase production correlates with immune activation and leukocyte migration in leprosy reactional lesions. Infect Immun. 2010;78(3):1012-1021. doi:10.1128/IAI.00896-09
[13] Chizzolini C, Rezzonico R, De Luca C, Burger D, Dayer JM. Th2 cell membrane factors in association with IL-4 enhance matrix metalloproteinase-1 (MMP-1) while decreasing MMP-9 production by granulocyte-macrophage colony-stimulating factor-differentiated human monocytes. J Immunol. 2000;164(11):5952-5960. doi:10.4049/jimmunol.164.11.5952
[14] Corcoran ML, Stetler-Stevenson WG, Brown PD, Wahl LM. Interleukin 4 inhibition of prostaglandin E2 synthesis blocks interstitial collagenase and 92-kDa type IV collagenase/gelatinase production by human monocytes. J Biol Chem. 1992;267(1):515-519.
[15] Paczek L, Michalska W, Bartlomiejczyk I. Trypsin, elastase, plasmin and MMP-9 activity in the serum during the human ageing process. Age Ageing. 2008;37(3):318-323. doi:10.1093/ageing/afn039
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