The relationship between Matrix Metalloproteinase-9 (MMP-9) serum levels with changes in NIHSS score in acute ischemic stroke (MMP-9 rs3918242 Genetic variant study)

Naili Sofi Riasari¹, Tugasworo D.², Husni Amin³

Background: MMP-9 (Matrix Metalloproteinase-9) is a proteolytic enzyme that plays a role in stroke pathological process, because of its ability to degrade the epithelial basal membrane. Its secretion increases rapidly after ischemic stroke onset. It gives a promising biomarker of stroke prognosis.^[1,2] Increased MMP-9 secretion raised hypothesis MMP-9 gene plays a role in the incidence of stroke susceptibility and its pathological process.^[3] The NIHSS (National Instititute of Health Stroke Scale) is clinical scale that provides information for predicting clinical outcomes of post-stroke patients.^[4] The aim of this study is to determine the role of MMP-9 rs3918242 genetic variant on the relationship between MMP-9 serum levels and changes in NIHSS scores in acute ischemic stroke.

Methode: Prospective cohort study, at RSUP. Dr. Kariadi Semarang during October 2018 – January 2019. Subjects meet the inclusion and exclusion criteria were taken for 8 cc venous blood samples onset 24-48 hours to examined for MMP-9 serum levels and MMP-9 genes; measured NIHSS scores on the 2^nd, 7^th and 14^th day of stroke onset.

Results: There were 51 subjects with a mean serum MMP-9 level of 1.223.24 ng / ml (normal 169-705 ng / ml). Elevated serum MMP-9 levels were associated with worsening clinical outcomes on 7th day onset (OR 7.728, 95% CI, 1,827 – 32,683) and 14th day of onset (OR 10,031, 95% CI, 1,321 – 76,149). Subjects with CC genotype had improved clinical outcomes on day 14 of onset (OR 11,950, 95% CI, 2,286 – 62,480). ROC curve analysis obtained serum MMP-9 levels onset 24-48 hours with a cutoff point of 899.5 ng / ml. Serum MMP-9 levels above 899.5 ng / ml are predictors of worsening clinical outcome in acute ischemic stroke patients.