Co-authors:
Muhammad Sheheryar Hussain
Contact: +923212776808
Email: baig2001@outlook.com
Affiliation: Dow University of Health Sciences.
Department: Medicine.
Address: Karachi, Pakistan.
Syeda Alishah Zehra
Contact: +923472745652
Email: aiyakami123@gmail.com
Affiliation: Dow University of Health Sciences, Karachi
Department: Medicine.
Address: Gulistan-e-Jauhar, Karachi.
Words count: 411
Conflict of Interest: None
Declaration: None
Acknowledgment: None
To the Editor,
We read with great interest your article named “Role of matrix
metalloproteinases in mitral valve regurgitation: Association between
the of MMP‐1, MMP‐9, TIMP‐1, and TIMP‐2 expression, degree of mitral
valve insufficiency, and pathologic etiology”.1 The
article is competent and well written. We concur with the findings that
a clear correlation between the Matrix Metalloproteinases expression and
the Mitral Insufficiency exists which also corresponds with the degree
of severity. However, after thoroughly reviewing your article, there are
a few ideas worth discussing that could enhance the quality of the
overall article.
Referring to the original article, the authors mainly emphasized Matrix
Metalloproteinases and their inhibitors. However, Brain Natriuretic
Peptide BNP, a hormone secreted from myocardial cells is a strong
independent predictor of cardiac events. In asymptomatic degenerative
mitral regurgitation, Left Ventricular longitudinal function and Left
Atrial volume are the main determinants of BNP release. Measurement of
BNP levels in plasma may aid in risk stratification and better
management of asymptomatic patients with degenerative
MR.2 Furthermore, studies have shown that embolic
myxomas also tend to show elevated MMP-2, MMP-9, and MT1-MMP levels and
activity compared to nonembolic tumors; this was associated with an
increase of extracellular matrix tumor degradation products containing
glycosaminoglycans chains. These findings strongly suggest that MMPs may
contribute to tumor ECM remodeling and increase the risk of embolism in
cardiac myxomas. Thus, demonstrating increased activity and involvement
of matrix metalloproteinases in cardiac myxoma
embolism.3 Additionally, MMP-2, MMP-9, and their
inhibitor TIMP-1 are the most promising candidates Among signaling
molecules that may have important prognostic value in Dilated
cardiomyopathy, a type of heart muscle disease that causes ventricles to
thin and stretch, growing larger. The MMP/TIMP ratio serves as a
beneficial marker of developing fibrosis in the extracellular matrix and
has prognostic value and importance in heart diseases. The activity of
Matrix Metalloproteinases in tissues depends upon the presence of their
tissue inhibitors. The expression of TIMP1 was decreased and the
expression of MMP-1 in the myocardium was enhanced in patients with
Dilated Cardiomyopathy in comparison with the normal.4
In conclusion, the study should also emphasize the measurements of
Natriuretic peptide molecules such as BNP to conclude the symptoms and
severity of mitral regurgitation. Screening for cancers should be
considered as certain cardiac tumors also tend to increase the
expression of MMPs. Inflammatory markers should also be checked as
Inflammatory and viral conditions such as Viral myocarditis could also
lead to increased expression of MMPs in cardiac tissues.
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