Acute Aortic Disease.. - Index of

146 Botta et al.
DISCUSSION AND COMMENTARY
Questions for the Authors
Are MMP levels followed clinically, or does assessment of levels of these important
enzymes remain a research tool?
At the time being, these levels are followed as part of research efforts. We are not
aware of a laboratory that offers MMP assay as a clinical test. If a predictive utility
for disease progression should be developed, there would then be impetus for
conversion to a clinically available testing modality.
Doxycycline has been shown to inhibit MMPs. Why is doxycycline-based treatment
not applied more widely?
First, benefit from doxycycline has not been conclusively demonstrated, even for
abdominal aortic aneurysm. Second, the MMPs are a complex system of several
dozen discrete enzymes. We need to determine which ones need to be inhibited in
aneurysm disease, as well as which MMPs are inhibited by specific antibiotics or
other drugs. Vast efforts are being expended in this regard by drug companies, not
so much with aneurysm in mind, but with an aim of modifying post-myocardial
infarction remodeling. We need to keep in mind as well that there can conceivably
be dramatic adverse effects from inhibiting MMP activity too broadly or severely.
For example, MMPs play a role in eliminating arterial atheromas as they form.