Matrix metalloproteinase-2 and matrix metalloproteinase-9 in cholesteatoma and deep meatal skin

Morphopathogenesis of Adult Acquired Cholesteatoma

Background and Objectives. The aim of this study was to compare the distribution of proliferation markers (Ki-67, NF-κβ), tissue-remodeling factors (MMP-2, MMP-9, TIMP-2, TIMP-4), vascular endothelial growth factor (VEGF), interleukins (IL-1 and IL-10), human beta defensins (HβD-2 and HβD-4) and Sonic hedgehog gene protein in cholesteatoma and control skin. Methods. Nineteen patient cholesteatoma tissues and seven control skin materials from cadavers were included in the study and stained immunohistochemically. Results. Statistically discernible differences were found between the following: the Ki-67 in the matrix and the Ki-67 in the skin epithelium (p = 0.000); the Ki-67 in the perimatrix and the Ki-67 in the connective tissue (p = 0.010); the NF-κβ in the cholesteatoma matrix and the NF-κβ in the epithelium (p = 0.001); the MMP-9 in the matrix and the MMP-9 in the epithelium (p = 0.008); the HβD-2 in the perimatrix and the HβD-2 in the connective tissue (p = 0.004); and the Shh in the cholesteatoma's perimatrix and the Shh in the skin's connective tissue (p = 0.000). Conclusion. The elevation of Ki-67 and NF-κβ suggests the induction of cellular proliferation in the cholesteatoma. Intercorrelations between VEGF, NF-κβ and TIMP-2 induce neo-angiogenesis in adult cholesteatoma. The similarity in the expression of IL-1 and IL-10 suggests the dysregulation of the local immune status in cholesteatoma. The overexpression of the Sonic hedgehog gene protein in the cholesteatoma proves the selective local stimulation of perimatrix development.

Complex Evaluation of Tissue Factors in Pediatric Cholesteatoma

The aim of this study was to describe the appearance and distribution of tissue remodeling markers (MMP-2, MMP-9, TIMP-2, TIMP-4), Sonic hedgehog gene protein (Shh), pro- and anti-inflammatory cytokines (IL–1, IL–10), transcription factor (NF-κβ), proliferation marker (Ki–67), angiogenetic factor (VEGF), tissue defensins (HβD–2, HβD–4) of the pediatric cholesteatoma. Sixteen cholesteatoma samples were obtained from children, eleven skin controls from cadavers. Tissues were stained for MMP-2, MMP-9, TIMP-2, TIMP-4, Shh, IL–1, IL–10, NF-κβ, Ki–67, VEGF, HβD–2, HβD–4. Non-parametric statistic, Mann–Whitney, and Spearman’s coefficient was used. A statistically significant difference was seen between Shh and HβD–2 in perimatrix and control connective tissue, between NF-κβ in cholesteatoma and control skin, and between HβD–4 in matrix and skin epithelium. Complex intercorrelations between MMPs, NF-κβ and VEGF cause the intensification of angiogenesis in cholesteatoma. The persistent increase in Shh gene protein expression in cholesteatoma perimatrix suggests the stimulation of the cholesteatoma growth in children. Similar expression of IL-1 and IL-10 and their intercorrelation, proves there is a balance between pro- and anti-inflammatory cytokines. NF-κβ, and not Ki-67, seems to be the main inducer of cellular proliferation. The main antimicrobial protection is provided by HβD-2.

Effect of CT manifestations of cholesteatoma on MMP-2, MMP-9 and IL-6 in the serum of patients

Effect of CT manifestations of cholesteatomatous otitis media on matrix metalloproteinase-2 (MMP-2), matrix metalloproteinase-9 (MMP-9) and interleukin-6 (IL-6) in the serum of patients was investigated. A total of 176 patients with cholesteatomatous otitis media were enrolled as the study group and 181 patients with simple otitis media were enrolled as the control group. Patients were admitted to the Changxing People's Hospital from January 2010 to December 2016. The patients in the study group were classified according to the 64-row spiral CT diagnosis. The expression levels of MMP-2, MMP-9 and IL-6 in the serum of the selected patients were detected by ELISA. MMP-2, MMP-9 and IL-6 expression levels in the study group were higher than those in the control group (P<0.05). MMP-2, MMP-9 and IL-6 expression levels in the serum of the patients with injured ossicular chain were significantly higher than those in the serum of patients with injured malleus or incus (P<0.05), and significantly higher than those in the serum of patients with intact ossicular chain (P<0.05). The levels of MMP-2, MMP-9 and IL-6 in the serum of the patients whose malleus or incus was injured were higher than those in the serum of the patients with intact ossicular chain (P<0.05). There was an obvious positive correlation between the injury degree of different sclerotins in CT manifestations of the patients in the study group and MMP-2, MMP-9, and IL-6 (P<0.05). The high expression levels of MMP-2, MMP-9 and IL-6 in the serum of patients with cholesteatomatous otitis media were positively correlated with the injury degree of ossicle, which may be a sign of poor prognosis of cholesteatomatous otitis media.

Matrix metalloproteinase-8/collagenase-2 in childhood otitis media with effusion

BACKGROUND

Matrix metalloproteinases (MMPs), gelatinases, have been associated with otitis media with effusion (OME), but the role of collagenase-2/matrix metalloproteinase-8 (MMP-8) in OME has not been studied previously. We studied the levels, isoenzyme distribution, and activation of MMP-8 in childhood OME, and also the levels of pro- and active forms of MMP-2 and -9 as well as 120 kDa gelatinase complexes were assessed.

METHODS

Seventy middle ear fluid (MEF) samples were collected from 54 children with OME and classified to mucoid (n = 39) or serous (n = 31). MMPs were studied from MEF samples by time-resolved immunofluorometric assay, Western immunoblotting, and gelatin-zymography.

RESULTS

MMP-8 was found in its active form in MEF of children with OME. MMP-8 levels were significantly higher in mucous relative to serous OME. The pro- or active MMP-2 and -9 were found in MEF, but no MEF type-specific differences were found.

CONCLUSION

Our results suggest that MMP-8 may play a role in the pathogenesis of childhood OME. New therapeutic strategies with MMP inhibitors targeting MMP-8, but allowing MMP-8 to carry out the protective action, may play a role in the future treatment of otitis media and OME. However, further studies of this topic are needed.

Elevated level of tenascin and matrix metalloproteinase 9 correlates with the bone destruction capacity of cholesteatomas

OBJECTIVES

Bone destruction is a key step in the progression of cholesteatomas. Some of the lesions can grow without affecting the surrounding anatomic structures, whereas others can cause severe bone destruction despite their limited size. This study aims to identify factors that could play important role during the invasion of the disease.

METHODS

Cholesteatoma tissue samples were examined immunohistochemically. Tissue samples were arranged on the basis of bone destruction (destructive cholesteatomas [DC] and nondestructive cholesteatomas [NDC]). Double-immunofluorescent labeling was performed to detect simultaneously 1) tenascin (TN) and cytokeratin; 2) matrix metalloproteinase 9 (MMP-9) and TN; 3) TN and Ki-67. An in situ apoptosis detection kit was used to detect apoptotic cells. External auditory canal skin samples were used as control.

RESULTS

1) In DCs, more widespread stromal TN labeling was seen compared with NDCs or external auditory canal skin samples. 2) More enhanced MMP-9 staining was detected in DCs compared with NDCs. 3) The proportion of Ki-67-positive cells in DC samples was significantly higher than in NDCs. 4) The percentage of apoptotic cells was higher in NDC than in DC samples.

CONCLUSION

Our present study demonstrates that levels of TN, MMP-9, and proliferative activity are increased in cholesteatomas. It has also been shown that increased levels of TN, MMP-9-positive cells, and proliferative activity of the lesions, as well as decreased levels of apoptosis, can be linked to more aggressive clinical behavior of cholesteatomas. Our findings also indicate that TN and MMP-9 can be key molecules of bone destruction during cholesteatoma progression.

Activities of matrix metalloproteinases and tissue inhibitor of metalloproteinase-2 in idiopathic hemotympanum and otitis media with effusion

CONCLUSION

The expression profile of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase-2 (TIMP-2) was specific to the type of middle ear effusion. Further studies are necessary for elucidating its correlation with the sequelae of otitis media with effusion (OME) and idiopathic hemotympanum.

OBJECTIVES

We aimed to investigate the relative activities of gelatinases (MMP-2 and -9), stromelysin-1 (MMP-3), and matrilysin-1 (MMP-7), as well as measuring TIMP-2 levels in the serous and mucous effusions of OME and hemorrhagic effusion of the idiopathic hemotympanum.

MATERIALS AND METHODS

Middle ear effusions were collected from patients with OME and idiopathic hemotympanum, and were classified as mucoid, serous, or hemorrhagic. MMP activity in the effusion samples was examined by gelatin and casein zymography. Levels of TIMP-2 were measured by ELISA. Human temporal bone sections, with and without otitis media (OM), were examined histologically.

RESULTS

One case showed tympanic membrane thinning in the OM group, but none in the control group. While MMP-2 was present in all effusions, the active form of MMP-2 was found only in mucous effusions. MMP-3 and MMP-7 activity was detected only in the mucous effusions. MMP-9 exhibited activity in all effusions, with the highest levels in mucous effusions. TIMP-2 levels were markedly elevated in serous effusions.

Matrix metalloproteinase 2: an important genetic marker for cholesteatomas

AIM

This study is to determine the MMP2s presence in cholesteatomas and whether complicating cholesteatomas show a higher immunohistochemical expression of matrix metalloproteinase 2. Cholesteatoma produces enzymes that cause bone erosion like matrix metalloproteinase 2 (MMP2).

MATERIAL AND METHODS

We analyzed the expression of MMP2 in invasive (causing complications) compared to latent cholesteatomas (not causing complications). A cross-sectional study with nineteen slides and paraffin blocks of cholesteatomas derived from mastoidectomies were located and processed, including 8 invasive and 11 latent cholesteatomas. Immunohistochemical technique was empregated to MMP2.

RESULTS

The results are expressed as 0, + (to low), ++ and +++(high) according to the quantity and color of the immunohistochemical staining of MMP2. Higher expression of MMP2 was observed in 7 (87.5%) of the 8 invasive cholesteatomas. With respect to latent cholesteatomas, higher expression of MMP2 was observed in 27.3% (3 cases), with Fishers exact test indicating a significant difference (p=0.015).

CONCLUSIONS

Cholesteatoamas express MMP2 and Invasive cholesteatomas had high MMP2 compared to latent cholesteatomas.

The localization of matrix metalloproteinases-8 and -13 in cholesteatoma, deep-meatal and post-auricular skin: a comparative analysis

CONCLUSION

The presence of matrix metalloproteinase (MMP)-8 and MMP-13 was found to be significantly higher in cholesteatoma compared with post-auricular skin. The results show that the control group used has implications for further studies.

OBJECTIVES

To compare the presence of MMP-8 and MMP-13 in cholesteatoma, deep meatal and post-auricular skin. Our null hypothesis was that there was no difference in expressions of MMP-8 and MMP-13 in the three groups.

MATERIALS AND METHODS

The study was carried out in a secondary care specialist centre and used prospective retrieval of specimens for immunohistological localization of MMP-8 and MMP-13. Eleven patients undergoing cholesteatoma surgery were recruited for the study. Eleven cholesteatoma specimens, 10 deep meatal skin specimens and 10 post-auricular skin specimens were analysed. Specimens were analysed by immunohistochemistry using monoclonal antibodies to MMP-8 and MMP-13. Two observers scored the slides independently in a blind fashion.

RESULTS

The presence of MMP-8 and MMP-13 was found to be significantly higher in cholesteatoma compared to post-auricular skin (p=0.02, p=0.03, respectively). There were no significant differences in expression of MMP-8 and MMP-13 between cholesteatoma and deep meatal skin (p=0.08, p=0.09, respectively). There were no significant differences in the control groups.

Etiopathogenesis of cholesteatoma

Cholesteatoma is a destructive lesion of the temporal bone that gradually expands and causes complications by erosion of the adjacent bony structures. Bone resorption can result in destruction of the ossicular chain and otic capsule with consecutive hearing loss, vestibular dysfunction, facial paralysis and intracranial complications. Surgery is the only treatment of choice. The etiopathogenesis of cholesteatoma, however, is still controversial. This review was designed to understand the reasons for these disparities and to reduce or eliminate them. Future studies focused on developmental, epidemiological, hormonal and genetic factors as well as on treatment are likely to contribute to further understanding of cholesteatoma pathogenesis.

Detection of macrophage migration inhibitory factor (MIF) in human cholesteatomas and functional implications of correlations to recurrence status and to expression of matrix metalloproteinases-3/9, retinoic acid receptor-beta, and anti-apoptotic galectin-3

OBJECTIVES

To investigate whether the expression of the macrophage migration inhibitory factor (MIF) 1) is detectable, 2) changes in relation to recurrence and infection status, and 3) relates to the levels of expression of growth regulators/differentiation markers, including galectin-1, -3, and -8, retinoid acid receptors (RAR)]-alpha, -beta, and -gamma, binding sites for sarcolectin, and invasion markers (cathepsins -B and -D, and matrix metalloproteinases [MMP]-2, -3, and -9) in human cholesteatomas.

STUDY DESIGN

An analysis of 56 cholesteatomas resected by the same surgeon using canal wall up and canal wall down surgical procedures.

METHODS

The immunohistochemical levels of expression of MIF and the proteases were quantitatively determined (using computer-assisted microscopy) on routine histologic slides by specific antibodies, and statistically correlated to parameters of the other markers determined previously in conjunction with data on apoptosis/proliferation.

RESULTS

MIF expression was detected. It was significantly higher in the epithelium (P =.002) and vessels (P =.04) of the connective tissues (but not in the connective tissue itself) of recurrent as opposed to non-recurrent cholesteatomas. The MIF expression is significantly correlated (P =.006) to the RAR beta expression in non-infected cholesteatomas, and to MMP-3 (P <.01) and anti-apoptotic galectin-3 (P =.01) in infected cholesteatomas. The level of MIF expression was also correlated significantly to MMP-9 (P = 0.003), RAR beta (P <.001), and galectin-8 (P =.003) expression in the cholesteatomas regardless of their infection status.

CONCLUSIONS

MIF expression in human cholesteatomas is related to the levels of biologic aggressiveness reflected in their recurrence status and MMP expression, and to the differentiation status reflected in their galactin and RAR beta expressions. Together with galectin-3, it could cooperate to form an anti-apoptotic feedback loop.

[Alterations of the basal membrane in middle ear cholesteatoma]

Cholesteatoma epithelium is characterized by a keratinocyte disregulation accompanied by destruction of the ossicles and other bony parts of the temporal bone. Immunohistochemical methods using antibodies to fibronectin, tenascin and metalloproteinases were used to assess the alterations of the instrinsic and extrinsic components of the basement membrane. Spatial orientation of the basement membrane was preserved in histological sections. Collagen type IV, tenascin, fibronectin, basic fibroblastic growth factor (bFGF), and matrix metalloproteinases (MMPs) are related to the matrix, perimatrix of normal or pathological tissues. They were studied immunohistologically in twenty cholesteatomas, eight samples of normal auditory canal skin, and six specimens of normal middle ear mucosa. Cholesteatomas displayed alterations of the basal membrane, with presence of MMPs and a linear immunoreactivity for collagen type IV and laminin, disrupted in areas with intense inflammation. The electronic microscope revealed protrusions, duplications, thickening and disruptions of the lamina densa of the basement membrane. Thus, we conclude, that MMPs and bFGF could play an important role maintaining the proliferative activity and the aggressive behaviour of cholesteatoma in the middle ear.