Hyperbaric oxygen effect on MMP-9 after a vascular insult.

Matrix metalloproteinease-9 (MMP-9) is involved in a host of processes. Many of its processes are physiologically beneficial as well as detrimental. The over-expression of this enzyme has been implicated as a contributory factor to some of the sequalae associated with cerebral ischemia, cell death, non-healing wounds, traumatic brain injury, aneurysms, and plaque instability in atherosclerosis. Several studies have examined the effect of hyperbaric oxygen (HBO) on MMP-9 expression. Because this proteinase is involved in both chronic and acute pathology, we wanted to investigate an acute expression model and see if, and how quickly, its expression would respond to HBO therapy. Our patient was scheduled to have elective surgery with an overnight stay followed by a series of HBO exposures. The patient served as her own control. An MMP-9 and urine pH was obtained prior to surgery to establish a baseline. On days 1, 3, and 4 post-op, samples were obtained before and after hyperbaric exposure. The patient was exposed to 100% O2 at 2.5 ATA for 60 min during each treatment for 5 days. The patient's MMP-9 values were dramatically elevated after surgery as compared to the baseline readings. The percentage increase from baseline was 400%. Our patient showed a significant reduction in MMP-9 expression after each hyperbaric exposure with the greatest decrease seen on post-op day 1 and subsequent exposures showing slightly less expression. Reduction in MMP-9 expression ranged from 46% on day 1 to 30% on post-op day 4. This case study suggests that if done relatively soon after a vascular or tissue insult, HBO can reduce MMP-9 expression. Chronic vascular pathologies, such as atherosclerotic plaque and aneurysms where over-expression of MMP-9 may result in acute coronary syndrome (ACS) or cerebral vascular accidents (CVAs), may be mitigated by a series of HBO treatments that reduce MMP-9 expression. Causality and/or contributory effects of MMP-9 expression in both pathologic and physiologic processes needs to be further elucidated. The understanding of how HBO therapy modulates these may provide an additional insight into mechanisms and future potential therapies for pathologic conditions such as those described above.