title: Cerebrospinal fluid matrix metalloproteinase-9 increases during treatment of recurrent malignant gliomas.
abstract: BACKGROUND
  Matrix metalloproteinases (MMPs) are enzymes that promote tumor invasion and angiogenesis by enzymatically remodeling the extracellular matrix. MMP-2 and MMP-9 are the most abundant forms of MMPs in malignant gliomas, while a 130 kDa MMP is thought to be MMP-9 complexed to other proteinases. This study determined whether doxycycline can block MMP activity in vitro. We also measured MMP-2 and MMP-9 levels in cerebrospinal fluid (CSF) from patients with recurrent malignant gliomas.
  
  
  METHODS
  To determine whether doxycycline can block MMP activity, we measured the extent of doxycyline-mediated MMP-2 and MMP-9 inhibition in vitro using epidermal growth factor receptor (EGFR) transfected U251 glioma cell lines. MMP activity was measured using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) zymography. In addition, patients underwent lumbar puncture for CSF sampling at baseline, after 6 weeks (1 cycle), and after 12 weeks (2 cycles), while being treated with a novel chemotherapy regimen of irinotecan, thalidomide, and doxycycline designed to block growth/proliferation, angiogenesis, and invasion. Irinotecan was given at 125 mg/m2/week for 4 weeks in 6-week cycles, together with continuous doxycycline at 100 mg twice daily on Day 1 and 50 mg twice daily thereafter. Daily thalidomide dose in our cohort was 400 mg. Tumor progression was monitored by magnetic resonance imaging (MRI).
  
  
  RESULTS
  Doxycyline in vitro completely abolished MMP-9 activity at 500 mug/ml while there was only 30 to 50% inhibition of MMP-2 activity. Four patients respectively completed 4, 3, 1, and 2 cycles of irinotecan, thalidomide, and doxycycline. Patient enrollment was terminated after one patient developed radiologically defined pulmonary embolism, and another had probable pulmonary embolism. Although CSF MMP-2 and 130 kDa MMP levels were stable, MMP-9 level progressively increased during treatment despite stable MRI.
  
  
  CONCLUSIONS
  Doxycycline can block MMP-2 and MMP-9 activities from glioma cells in vitro. Increased CSF MMP-9 activity could be a biomarker of disease activity in patients with malignant gliomas, before any changes are detectable on MRI.
authors.affiliation: Beth Israel Deaconess Medical Center, Brain Tumor Center & Neuro-Oncology Unit, Boston, MA 02215, USA. ewong@bidmc.harvard.edu.
authors.forename: Eric T
authors.initials: ET
authors.lastname: Wong
authors.forename: David
authors.initials: D
authors.lastname: Alsop
authors.forename: Diana
authors.initials: D
authors.lastname: Lee
authors.forename: Angela
authors.initials: A
authors.lastname: Tam
authors.forename: Loretta
authors.initials: L
authors.lastname: Barron
authors.forename: Julianne
authors.initials: J
authors.lastname: Bloom
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Julian K
authors.initials: JK
authors.lastname: Wu