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Published in: BMC Pulmonary Medicine 1/2010

Open Access 01-12-2010 | Research article

Elevation of sputum matrix metalloproteinase-9 persists up to 6 months after smoking cessation: a research study

Authors: Noora Louhelainen, Harri Stark, Witold Mazur, Paula Rytilä, Ratko Djukanovic, Vuokko L Kinnula

Published in: BMC Pulmonary Medicine | Issue 1/2010

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Abstract

Background

Smoking cessation is the best possible way to prevent the progression of smoking related airway diseases. However, the effect and time scale of smoking cessation on airway inflammation/remodelling are largely unknown. This prospective study evaluated the effects of smoking cessation on induced sputum (IS) neutrophils, matrix metalloproteinases (MMP-7, -8, -9) and tissue inhibitor of metalloproteinase-1 (TIMP-1).

Methods

A total of 61 subjects participated in the study; 17 stopped smoking for 3 months and 9 for 6 months. The proportion of IS neutrophils and the levels of MMPs and TIMP-1 by ELISA were determined at baseline and at 3 and 6 months after cessation.

Results

In the smokers, baseline IS neutrophils, MMPs and TIMP-1 were significantly higher compared to non-smokers. Levels of MMP-7, -8 and TIMP-1 decreased nearly to those of non-smokers but the levels of MMP-9 increased significantly from the baseline of the same subjects at 3 months after cessation (p = 0.009) with no significant decline at 6 months after cessation.

Conclusions

Sputum MMP-9 remained elevated after 6 months of smoking cessation, which may contribute to ongoing lung damage typical of COPD.
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Literature
1.
go back to reference Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary. Am J Respir Crit Care Med. 2007, 176: 532-555. 10.1164/rccm.200703-456SO.CrossRefPubMed Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, Zielinski J: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD Executive Summary. Am J Respir Crit Care Med. 2007, 176: 532-555. 10.1164/rccm.200703-456SO.CrossRefPubMed
2.
go back to reference Hogg JC, Chu F, Utokaprach S, Woods R, Elliot WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Pare PD: The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004, 350 (26): 2645-53. 10.1056/NEJMoa032158.CrossRefPubMed Hogg JC, Chu F, Utokaprach S, Woods R, Elliot WM, Buzatu L, Cherniack RM, Rogers RM, Sciurba FC, Coxson HO, Pare PD: The nature of small-airway obstruction in chronic obstructive pulmonary disease. N Engl J Med. 2004, 350 (26): 2645-53. 10.1056/NEJMoa032158.CrossRefPubMed
3.
go back to reference Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, Conway WA, Enright PL, Kanner RE, O'Hara P, et al: Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994, 272 (19): 1497-505. 10.1001/jama.272.19.1497.CrossRefPubMed Anthonisen NR, Connett JE, Kiley JP, Altose MD, Bailey WC, Buist AS, Conway WA, Enright PL, Kanner RE, O'Hara P, et al: Effects of smoking intervention and the use of an inhaled anticholinergic bronchodilator on the rate of decline of FEV1. The Lung Health Study. JAMA. 1994, 272 (19): 1497-505. 10.1001/jama.272.19.1497.CrossRefPubMed
4.
go back to reference Chalmers GW, Macleod KJ, Thomson L, Little SA, McSharry C, Thomson NC: Smoking and airway inflammation in patients with mild asthma. Chest. 2001, 120: 1917-1922. 10.1378/chest.120.6.1917.CrossRefPubMed Chalmers GW, Macleod KJ, Thomson L, Little SA, McSharry C, Thomson NC: Smoking and airway inflammation in patients with mild asthma. Chest. 2001, 120: 1917-1922. 10.1378/chest.120.6.1917.CrossRefPubMed
5.
go back to reference Gibson PG, Simpson JL: The overlap syndrome of asthma and COPD: what are its features and how important is it?. Thorax. 2009, 64 (8): 728-35. 10.1136/thx.2008.108027.CrossRefPubMed Gibson PG, Simpson JL: The overlap syndrome of asthma and COPD: what are its features and how important is it?. Thorax. 2009, 64 (8): 728-35. 10.1136/thx.2008.108027.CrossRefPubMed
6.
go back to reference Rutgers SR, Postma SD, ten Hacken NHT, Kauffman HF, Mark van der TW, Koëter GH, Timens W: Ongoing airway inflammation in patients with COPD who do not currently smoke. Thorax. 2000, 55: 12-18. 10.1136/thorax.55.1.12.CrossRefPubMedPubMedCentral Rutgers SR, Postma SD, ten Hacken NHT, Kauffman HF, Mark van der TW, Koëter GH, Timens W: Ongoing airway inflammation in patients with COPD who do not currently smoke. Thorax. 2000, 55: 12-18. 10.1136/thorax.55.1.12.CrossRefPubMedPubMedCentral
7.
go back to reference Laperre TS, Postma DS, Gosman MME, Snoeck-Stroband JB, ten Hacken NHT, Hiemstra PS, Timens W, Sterk PJ, Mauad T: Relation between duration of smoking cessation and bronchial inflammation in COPD. Thorax. 2006, 61: 115-121. 10.1136/thx.2005.040519.CrossRef Laperre TS, Postma DS, Gosman MME, Snoeck-Stroband JB, ten Hacken NHT, Hiemstra PS, Timens W, Sterk PJ, Mauad T: Relation between duration of smoking cessation and bronchial inflammation in COPD. Thorax. 2006, 61: 115-121. 10.1136/thx.2005.040519.CrossRef
8.
go back to reference Louhelainen N, Rytilä P, Haahtela T, Kinnula VL, Djukanovic R: Persistence of oxidant and protease burden in the airways after smoking cessation. BMC Pulm Med. 2009, 27 (9): 25-10.1186/1471-2466-9-25.CrossRef Louhelainen N, Rytilä P, Haahtela T, Kinnula VL, Djukanovic R: Persistence of oxidant and protease burden in the airways after smoking cessation. BMC Pulm Med. 2009, 27 (9): 25-10.1186/1471-2466-9-25.CrossRef
9.
go back to reference Bergeron C, Tulic MK, Hamid Q: Tools used measure airway remodellation in research. Eur Respir J. 2007, 29: 596-604. 10.1183/09031936.00019906.CrossRefPubMed Bergeron C, Tulic MK, Hamid Q: Tools used measure airway remodellation in research. Eur Respir J. 2007, 29: 596-604. 10.1183/09031936.00019906.CrossRefPubMed
10.
11.
go back to reference Barnes PJ: Mediators of chronic obstructive pulmonary disease. Pharmacol Rev. 2004, 56: 515-548. 10.1124/pr.56.4.2.CrossRefPubMed Barnes PJ: Mediators of chronic obstructive pulmonary disease. Pharmacol Rev. 2004, 56: 515-548. 10.1124/pr.56.4.2.CrossRefPubMed
12.
go back to reference Burke B: The role of matrix metalloproteinase 7 in innate immunity. Immunobiology. 2004, 209 (1-2): 51-56. 10.1016/j.imbio.2004.04.005.CrossRefPubMed Burke B: The role of matrix metalloproteinase 7 in innate immunity. Immunobiology. 2004, 209 (1-2): 51-56. 10.1016/j.imbio.2004.04.005.CrossRefPubMed
13.
go back to reference Lohi J, Wilson CL, Roby JD, Parks WC: Epilysin, a novel human matrix metalloproteinase (MMP-28) expressed in testis and keratinocytes and in response to injury. J Biol Chem. 2001, 276: 10134-10144. 10.1074/jbc.M001599200.CrossRefPubMed Lohi J, Wilson CL, Roby JD, Parks WC: Epilysin, a novel human matrix metalloproteinase (MMP-28) expressed in testis and keratinocytes and in response to injury. J Biol Chem. 2001, 276: 10134-10144. 10.1074/jbc.M001599200.CrossRefPubMed
14.
go back to reference Kinnula VL: Focus on antioxidant enzymes and antioxidant strategies in smoking related airway diseases. Thorax. 2005, 60: 693-700. 10.1136/thx.2004.037473.CrossRefPubMedPubMedCentral Kinnula VL: Focus on antioxidant enzymes and antioxidant strategies in smoking related airway diseases. Thorax. 2005, 60: 693-700. 10.1136/thx.2004.037473.CrossRefPubMedPubMedCentral
15.
go back to reference Culpitt SV, Rogers DF, Traves SL, Barnes PJ, Donnelly LE: Sputum matrix metalloproteases: comparison between chronic obstructive pulmonary disease and asthma. Respir Med. 2005, 99: 703-710. 10.1016/j.rmed.2004.10.022.CrossRefPubMed Culpitt SV, Rogers DF, Traves SL, Barnes PJ, Donnelly LE: Sputum matrix metalloproteases: comparison between chronic obstructive pulmonary disease and asthma. Respir Med. 2005, 99: 703-710. 10.1016/j.rmed.2004.10.022.CrossRefPubMed
16.
go back to reference Ilumets H, Rytilä P, Demedts I, Brusselle GG, Sovijärvi A, Myllärniemi M, Sorsa T, Kinnula VL: Matrix metalloproteinases -8, -9 and -12 in smokers and patients with Stage 0 COPD. Int J COPD. 2007, 2 (3): 369-379. Ilumets H, Rytilä P, Demedts I, Brusselle GG, Sovijärvi A, Myllärniemi M, Sorsa T, Kinnula VL: Matrix metalloproteinases -8, -9 and -12 in smokers and patients with Stage 0 COPD. Int J COPD. 2007, 2 (3): 369-379.
17.
go back to reference Demedts IK, Brusselle GG, Bracke KR, Vermaelen KY, Pauwels RA: Matrix metalloproteinases in asthma and COPD. Curr Opin Pharmacol. 2005, 5 (3): 257-63. 10.1016/j.coph.2004.12.005.CrossRefPubMed Demedts IK, Brusselle GG, Bracke KR, Vermaelen KY, Pauwels RA: Matrix metalloproteinases in asthma and COPD. Curr Opin Pharmacol. 2005, 5 (3): 257-63. 10.1016/j.coph.2004.12.005.CrossRefPubMed
18.
go back to reference Djukanovic R, Sterk PJ, Fahy JV, Hargreave HH: Standardised methodology of sputum induction and processing. Eur Respir J. 2002, 37 (Suppl): 1s-2s. 10.1183/09031936.02.00000102.CrossRef Djukanovic R, Sterk PJ, Fahy JV, Hargreave HH: Standardised methodology of sputum induction and processing. Eur Respir J. 2002, 37 (Suppl): 1s-2s. 10.1183/09031936.02.00000102.CrossRef
19.
go back to reference Louhelainen N, Myllärniemi M, Rahman I, Kinnula VL: Airway biomarkers of the oxidant burden in asthma and chronic obstructive pulmonary disease: current and future perspectives. Int J Chron Obstruct Pulmon Dis. 2008, 3 (4): 585-603.PubMedPubMedCentral Louhelainen N, Myllärniemi M, Rahman I, Kinnula VL: Airway biomarkers of the oxidant burden in asthma and chronic obstructive pulmonary disease: current and future perspectives. Int J Chron Obstruct Pulmon Dis. 2008, 3 (4): 585-603.PubMedPubMedCentral
20.
go back to reference [GINA] Global Initiative for Asthma: Global strategies for asthma management and prevention. NIH Publication, No 02-3659. 2002, National Institutes of Health, National Heart, Lung and Blood Institute. [online], [http://www.ginasthma.com] [GINA] Global Initiative for Asthma: Global strategies for asthma management and prevention. NIH Publication, No 02-3659. 2002, National Institutes of Health, National Heart, Lung and Blood Institute. [online], [http://​www.​ginasthma.​com]
21.
go back to reference Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001, 163: 1256-1276.CrossRefPubMed Pauwels RA, Buist AS, Calverley PM, Jenkins CR, Hurd SS: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. Am J Respir Crit Care Med. 2001, 163: 1256-1276.CrossRefPubMed
23.
go back to reference ATS/ERS: Standardization of spirometry. Eur Respir J. 2005, 26: 319-338. 10.1183/09031936.05.00034805.CrossRef ATS/ERS: Standardization of spirometry. Eur Respir J. 2005, 26: 319-338. 10.1183/09031936.05.00034805.CrossRef
24.
go back to reference Viljanen AA, Halttunen PK, Kreus KE, Viljanen BC: Spirometric studies in non-smoking healthy adults. Scand J Clin Lab Invest. 1982, 159: 5-20. 10.3109/00365518209168377.CrossRef Viljanen AA, Halttunen PK, Kreus KE, Viljanen BC: Spirometric studies in non-smoking healthy adults. Scand J Clin Lab Invest. 1982, 159: 5-20. 10.3109/00365518209168377.CrossRef
25.
go back to reference Godtfredsen NS, Vestbo J, Osler M, Prescott E: Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax. 2002, 57: 967-972. 10.1136/thorax.57.11.967.CrossRefPubMedPubMedCentral Godtfredsen NS, Vestbo J, Osler M, Prescott E: Risk of hospital admission for COPD following smoking cessation and reduction: a Danish population study. Thorax. 2002, 57: 967-972. 10.1136/thorax.57.11.967.CrossRefPubMedPubMedCentral
26.
go back to reference Burchfiel CM, Marcus EB, Curb JD, Maclean CJ, Vollmer WM, Johnson LR, Fong KO, Rodriguez BL, Masaki KH, Buist AS: Effects of smoking and smoking cessation on longitudinal decline in pulmonary function. Am J Respir Crit Care Med. 1995, 151: 1778-1785.CrossRefPubMed Burchfiel CM, Marcus EB, Curb JD, Maclean CJ, Vollmer WM, Johnson LR, Fong KO, Rodriguez BL, Masaki KH, Buist AS: Effects of smoking and smoking cessation on longitudinal decline in pulmonary function. Am J Respir Crit Care Med. 1995, 151: 1778-1785.CrossRefPubMed
27.
go back to reference Townsend MC, DuChene AG, Morgan J, Browner WS: Pulmonary function in relation to cigarette smoking and smoking cessation. Prev Med. 1991, 20: 621-637. 10.1016/0091-7435(91)90059-D.CrossRefPubMed Townsend MC, DuChene AG, Morgan J, Browner WS: Pulmonary function in relation to cigarette smoking and smoking cessation. Prev Med. 1991, 20: 621-637. 10.1016/0091-7435(91)90059-D.CrossRefPubMed
28.
go back to reference Ilumets H, Rytila PH, Sovijärvi AR, Tervahartiala T, Myllärniemi M, Sorsa TA, Kinnula VL: Transient elevation of neutrophil proteinases in induced sputum during COPD exacerbation. Scan J Clin Lab Invest. 2008, 9: 1-6. Ilumets H, Rytila PH, Sovijärvi AR, Tervahartiala T, Myllärniemi M, Sorsa TA, Kinnula VL: Transient elevation of neutrophil proteinases in induced sputum during COPD exacerbation. Scan J Clin Lab Invest. 2008, 9: 1-6.
29.
go back to reference Lowrey GE, Henderson N, Blakey JD, Corne JM, Johnson SR: MMP-9 protein level does not reflect overall MMP activity in the airways of patients with COPD. Respir Med. 2008, 102 (6): 845-51. 10.1016/j.rmed.2008.01.006.CrossRefPubMed Lowrey GE, Henderson N, Blakey JD, Corne JM, Johnson SR: MMP-9 protein level does not reflect overall MMP activity in the airways of patients with COPD. Respir Med. 2008, 102 (6): 845-51. 10.1016/j.rmed.2008.01.006.CrossRefPubMed
30.
go back to reference Yoon HK, Cho HY, Kleeberger SR: Protective role of matrix metalloproteinase-9 in ozone induced airway inflammation. Environ Health Perspect. 2007, 115: 1557-1563. 10.1289/ehp.10289.CrossRefPubMedPubMedCentral Yoon HK, Cho HY, Kleeberger SR: Protective role of matrix metalloproteinase-9 in ozone induced airway inflammation. Environ Health Perspect. 2007, 115: 1557-1563. 10.1289/ehp.10289.CrossRefPubMedPubMedCentral
31.
go back to reference Willemse BWM, ten Hacken NHT, Rutgers B, Lesman-Leegte IGAT, Postma DS, Timens W: Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J. 2004, 26: 835-845. 10.1183/09031936.05.00108904.CrossRef Willemse BWM, ten Hacken NHT, Rutgers B, Lesman-Leegte IGAT, Postma DS, Timens W: Effect of 1-year smoking cessation on airway inflammation in COPD and asymptomatic smokers. Eur Respir J. 2004, 26: 835-845. 10.1183/09031936.05.00108904.CrossRef
32.
go back to reference Vernooy JH, Lindeman JH, Jacobs JA, Hanemaaier R, Wouters EF: Increased activity of matrix metalloproteinase-8 and matrix metalloproteinase-9 in induced sputum from patients with COPD. Chest. 2004, 126: 1082-1010. 10.1378/chest.126.6.1802.CrossRef Vernooy JH, Lindeman JH, Jacobs JA, Hanemaaier R, Wouters EF: Increased activity of matrix metalloproteinase-8 and matrix metalloproteinase-9 in induced sputum from patients with COPD. Chest. 2004, 126: 1082-1010. 10.1378/chest.126.6.1802.CrossRef
33.
go back to reference Demedts IK, Morel-Montero A, Lebecque S, Pacheco Y, Cataldo D, Joos GF, Pauwels RA, Brusselle CG: Elevated MMP-12 protein levels in induced sputum from patients with COPD. Thorax. 2006, 61 (3): 196-201. 10.1136/thx.2005.042432.CrossRefPubMed Demedts IK, Morel-Montero A, Lebecque S, Pacheco Y, Cataldo D, Joos GF, Pauwels RA, Brusselle CG: Elevated MMP-12 protein levels in induced sputum from patients with COPD. Thorax. 2006, 61 (3): 196-201. 10.1136/thx.2005.042432.CrossRefPubMed
34.
go back to reference Babusyte A, Stravinskaite K, Jeroch J, Lötvall J, Sakalauskas R, Sitkauskiene B: Patterns of airway inflammation and MMP-12 expression in smokers and ex-smokers with COPD. Respir Res. 2007, 14 (8): 81-10.1186/1465-9921-8-81.CrossRef Babusyte A, Stravinskaite K, Jeroch J, Lötvall J, Sakalauskas R, Sitkauskiene B: Patterns of airway inflammation and MMP-12 expression in smokers and ex-smokers with COPD. Respir Res. 2007, 14 (8): 81-10.1186/1465-9921-8-81.CrossRef
35.
go back to reference Deshmukh HS, Shacer C, Case LM, Dietsch M, Wesselkamper SC, Hardie WD, Korfhagen TR, Corradi M, Nadel JA, Borchers MT, Leikauf GD: Acrolein-activated matrix metalloproteinase 9 contributes to persistent mucin production. Am J Respir Cell Mol Biol. 2008, 38 (4): 446-54. 10.1165/rcmb.2006-0339OC.CrossRefPubMed Deshmukh HS, Shacer C, Case LM, Dietsch M, Wesselkamper SC, Hardie WD, Korfhagen TR, Corradi M, Nadel JA, Borchers MT, Leikauf GD: Acrolein-activated matrix metalloproteinase 9 contributes to persistent mucin production. Am J Respir Cell Mol Biol. 2008, 38 (4): 446-54. 10.1165/rcmb.2006-0339OC.CrossRefPubMed
36.
go back to reference Burke B, Giannoudis A, Corke KP, Gill D, Wells M, Ziegler-Heitbrock L, Lewis CE: Hypoxia-induced gene expression in human macrophages: implications for ischemic tissues and hypoxia-regulated gene therapy. Am J Pathol. 2003, 163: 1233-1243.CrossRefPubMedPubMedCentral Burke B, Giannoudis A, Corke KP, Gill D, Wells M, Ziegler-Heitbrock L, Lewis CE: Hypoxia-induced gene expression in human macrophages: implications for ischemic tissues and hypoxia-regulated gene therapy. Am J Pathol. 2003, 163: 1233-1243.CrossRefPubMedPubMedCentral
37.
go back to reference Dunsmore SE, Saarialho-Kere UK, Roby JD, Wilson CL, Matrisian LM, Welgus HG, Parks WC: Matrilysin expression and function in airway epithelium. J Clin Invest. 1998, 102 (7): 1321-31. 10.1172/JCI1516.CrossRefPubMedPubMedCentral Dunsmore SE, Saarialho-Kere UK, Roby JD, Wilson CL, Matrisian LM, Welgus HG, Parks WC: Matrilysin expression and function in airway epithelium. J Clin Invest. 1998, 102 (7): 1321-31. 10.1172/JCI1516.CrossRefPubMedPubMedCentral
38.
go back to reference Kaper J, Wagena EJ, Willemsen MC, van Schayck CP: Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trial. Addiction. 2005, 100 (7): 1012-1020. 10.1111/j.1360-0443.2005.01097.x.CrossRefPubMed Kaper J, Wagena EJ, Willemsen MC, van Schayck CP: Reimbursement for smoking cessation treatment may double the abstinence rate: results of a randomized trial. Addiction. 2005, 100 (7): 1012-1020. 10.1111/j.1360-0443.2005.01097.x.CrossRefPubMed
Metadata
Title
Elevation of sputum matrix metalloproteinase-9 persists up to 6 months after smoking cessation: a research study
Authors
Noora Louhelainen
Harri Stark
Witold Mazur
Paula Rytilä
Ratko Djukanovic
Vuokko L Kinnula
Publication date
01-12-2010
Publisher
BioMed Central
Published in
BMC Pulmonary Medicine / Issue 1/2010
Electronic ISSN: 1471-2466
DOI
https://doi.org/10.1186/1471-2466-10-13

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