title: Matrix Metalloproteinases (MMPs), Their Genetic Variants and miRNA in Mitral Valve Diseases: Potential Biomarker Tools and Targets for Personalized Treatments.
abstract: Mitral valve diseases (MVD)s, comprising congenital and acquired forms, are characterized by a diverse etiology, pathophysiology, prevalence, and incidence. In industrialized countries, the acquired forms represent 2.5% of all cardiovascular diseases, with a marked augmentation after the age of 65 years. In addition, all forms of MVDs (i.e., degenerative forms) have a difficult clinical management. The major challenge is 'the early diagnosis', and echocardiographic analysis has been shown inappropriate for diagnosing MVD in moderate forms. Thus, there is a strong need to identify more appropriate biomarker tools to diagnose MVDs at early clinical stage before complications occur and worsen the prognosis. Innovative biomarker tools may particularly be appropriate for the complex treatment of elderly patients, the clinical management of which is very difficult due to the high risk of surgical interventions and no clear benefits in terms of life expectancy or quality of life compared to younger patients. These biomarker tools may be identified as genetic factors and/or components of cellular and molecular pathways related to the mechanisms of MDV pathophysiology. In this review, emphasis is placed on the possibility of proposing matrix metalloproteinase (MMP) pathways, their genetic variants and microRNA as promising predictive, diagnostic and prognostic biomarkers and targets for personalized treatments. Evidence is also provided of the lack of any consistent evidence which actually hampers their clinical application. Thus, criticisms and concerns are underlined, as well as suggestions to close the existing gaps.
authors.affiliation: Department of Pathobiology and Medical Biotechnologies, University of Palermo, Sicily. Electronic correspondence: carmelarita.balistreri@unipa.it.
authors.forename: Carmela
authors.initials: C
authors.lastname: Rita Balistreri
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily.
authors.forename: Alberto
authors.initials: A
authors.lastname: Allegra
authors.affiliation: Department of Pathobiology and Medical Biotechnologies, University of Palermo, Sicily.
authors.forename: Florina
authors.initials: F
authors.lastname: Crapanzano
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily.
authors.forename: Calogera
authors.initials: C
authors.lastname: Pisano
authors.affiliation: Unit of Cardiac Surgery, Department of Surgery and Oncology, University of Palermo, Sicily.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ruvolo
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000235:genetics* / Q000378:metabolism* / Q000628:therapy; D006801:Humans; D020782:Matrix Metalloproteinases / Q000235:genetics* / Q000378:metabolism*; D035683:MicroRNAs / Q000235:genetics* / Q000378:metabolism*; D008943:Mitral Valve / Q000201:enzymology*; D020641:Polymorphism, Single Nucleotide; D011379:Prognosis; D015398:Signal Transduction
chemical_list: D015415:Biomarkers; D035683:MicroRNAs; D020782:Matrix Metalloproteinases