title: Expression levels of matrix metalloproteinase (MMP)-9 and its specific inhibitor TIMP-1, in septic and aseptic arthritis of the knee.
abstract: OBJECTIVE
  In cases of septic knee arthritis, there is excess of matrix metalloproteinases (MMPs) over tissue inhibitors of metalloproteinases (TIMPs), due to enhanced expression and activation that are induced by bacteria in comparison with rheumatic or degenerative arthritis. The aim of this study was to explore the expression levels of synovial gelatinase MMP-9 and its specific inhibitor TIMP-1 in septic and aseptic arthritis and their potential use as additional aids to clinical investigation.
  
  
  METHODS
  Gelatin zymography and western blot analysis were applied in effusions from knees of the patients with septic (SA-10 patients), rheumatic (RA-10 patients) and osteoarthritis (OA-10 patients).
  
  
  RESULTS
  Zymographic analysis revealed that all samples contained latent MMP-2 activity, albeit activated MMP-2 appeared in more of the septic than aseptic effusions. MMP-9 was not detected in osteoarthritic synovial fluid samples. Only trace amounts of MMP-9 activity were detected in 4 of 10 patients with RA, whereas higher MMP-9 levels were evident in all samples from SA (P = 0.0241). In immunoblotting assays, samples from SA showed significantly higher levels of MMP-9 compared with samples from RA (P = 0.0052), confirming zymographic results. Although no significant difference in TIMP-1 levels was observed, the estimated MMP-9/TIMP-1 ratio of septic effusions was significantly higher compared with aseptic ones (P = 0.0029).
  
  
  CONCLUSIONS
  The data presented suggest enhanced expression and activation of MMP-9 in septic native knee arthritis compared with aseptic. The presence of high levels of MMP-9 with concomitantly increased MMP-9/TIMP-1 ratio and activated gelatinases in effusions, independent of neutrophilic counts, may be indicative for infection.
authors.affiliation: Department of Medicine, University of Ioannina, Ioannina, Greece. fotova@yahoo.gr
authors.forename: Vasileios Christos
authors.initials: VC
authors.lastname: Fotopoulos
authors.forename: Athina
authors.initials: A
authors.lastname: Tzinia
authors.forename: Matthew
authors.initials: M
authors.lastname: Tzurbakis
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Kalfakakou
authors.forename: Stamatina
authors.initials: S
authors.lastname: Levidiotou-Stefanou
authors.forename: Anastasios
authors.initials: A
authors.lastname: Georgoulis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000378:metabolism*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D015153:Blotting, Western; D003937:Diagnosis, Differential; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D006801:Humans; D007717:Knee; D016014:Linear Models; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000378:metabolism; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism*; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000175:diagnosis / Q000378:metabolism*; D013582:Synovial Fluid / Q000378:metabolism*; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000378:metabolism*; D055815:Young Adult
chemical_list: D015415:Biomarkers; C560822:TIMP1 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D020778:Matrix Metalloproteinase 2; D020780:Matrix Metalloproteinase 9