Distribution and Dynamic Changes in Matrix Metalloproteinase (MMP)-2, MMP-9, and Collagen in an In Stent Restenosis Process

Objective: The aim of this study was to observe the spatial distribution and dynamic changes of matrix metalloproteinase (MMP)-2, MMP-9, and collagen in in stent restenosis (ISR) and to explore their influence on ISR. Methods: Sixty Z type stents were implanted into the common iliac arteries of minipigs, which were divided into 10 groups (six in each group) according to euthanasia time (6 hours, and 1, 3, 7, 14, 28, 56, 84, 168, and 336 days). After the samples were harvested, haematoxylin and eosin staining, immunohistochemical staining, Western blotting, and Picrosirius red staining were performed for all groups. Results: ISR occurred in all six minipigs in the 56 day group (percentage diameter stenosis range 71.6%-79.2%, mean +/- standard deviation 75.6% +/- 2.5%). The percentage diameter stenosis decreased to 38.3% +/- 2.7% at 336 days (p < .001). Immunohistochemical staining showed that MMP-2 and MMP-9 were strongly stained near the internal elastic lamina or in the damaged parts of the intima, around the struts and neointimal lumen surface in the ISR process. The expression of MMP-2 and MMP-9 at 56 days was significantly lower compared with their peaks (seven days and one day [p < .001; p = .002], respectively). At 56 days, the collagen content reached its maximum (mean integrated optical density range 0.73-0.92, mean +/- standard deviation 0.82 +/- 0.09). From the 14 day group to the 336 day group, mature collagen in neointima was correlated negatively with MMP-2 (gamma(36) = -0.816; p < .001) and MMP-9 expression (gamma(36) = -0.853; p < .001). During the neointimal regression period, new collagen in neointima was positively correlated with MMP-2 (gamma(24) = 0.683; p < .001) and MMP-9 (gamma(24) = 0.873; p < .001). Conclusion: This study has demonstrated the spatial distribution of and dynamic changes in MMP-2, MMP-9, and collagen in ISR by simulating the process of neointima from generation to regression after stent implantation. When ISR occurred, MMP-2 and MMP-9 expression decreased and collagen content reached its maximum, which might contribute to ISR.

Automated summary

This study simulated the process of neointima generation and regression after stent implantation, demonstrating the spatial distribution and dynamic changes of MMP-2, MMP-9, and collagen in ISR. The expression of MMP-2 and MMP-9 decreased and collagen content reached its maximum when ISR occurred, suggesting their potential contribution to ISR.