Imbalance of metallaproteinase/tissue inhibitors of metalloproteinase system in renal transplant recipients with chronic allograft injury.

Introduction. Nowadays, renal allografts continue to be lost at the rate of 2% to 4% per year beyond the first year after transplantation due to chronic allograft injury. Excessive accumulation of extracellular matrix results from overproduction and/or defective degradation by proteolytic enzymes, among which metalloproteinases (MMPs) play a major role. The aim of this study was to assess the role of MMPs in renal transplant recipients (RTR) in the context of allograft injury or proteinuria. Materials and methods. Plasma and urine MMP-2 and MMP-9 and tissue inhibitors of metalloproteinases (TIMPs) were assessed by enzyme-linked immunoassay in 150 RTR including 66% males with an overall mean age of 49.2 +/- 11.5 years. The subjects were examined at a mean of 73.4 +/- 41.2 months (range = 12-240) after kidney transplantation. Thirty-seven healthy volunteers including 54% male with an overall mean age of 48.4 +/- 14.1 years served as a control group. Results. Renal transplant recipients displayed significantly decreased plasma MMP-2 activity compared with healthy controls (P < .000) probably due to increased inhibitory plasma (p) TIMP-2 activity (P = .0029), and lower plasma MMP-2:TIMP-2 index (P < .0001). Plasma MMP-9 and pTIMP-1 activities were twofold increased in RTR compared with controls (P = .0015 and P < .000) but with a nearly stable plasma MMP-9:TIMP-1 index (P = NS). There was no difference between RTR and controls according to urine (u) MMP-2 activity, but uMMP-9 was increased in RTR compared with healthy controls (P = .0032). Urine MMP-9 potential was probably diminished by increased uTIMPs (uTIMP-2, P = .017; uTIMP-1, P = .000), which contributed to graft impairment or proteinuria. Conclusion. Our study revealed profibrotic MMP/TIMP constellations in RTR that show an imbalance in plasma MMP-2 and MMP-9 with increased plasma and urinary TIMPs. The net proteolytic potential of increased plasma and urinary MMP-9 may be diminished significantly by enhanced plasma and urine TIMP activities.