Markers of Extracellular Matrix Degradation in Premature Rupture of Fetal Membranes

Objective is to comprehensively study serum and homogenate levels of matrix metalloproteinase 9 (MMP-9), its tissue inhibitor (TIMP-1), and type I procollagen propeptide (PICP) in patients with premature rupture of membranes (PROM) to assess their diagnostic and pathogenetic significance, as well as their correlation with clinical and morphological parameters.

Materials and methods. A prospective case-control study was conducted. The main group consisted of 25 patients with PROM and preterm birth at 22–33 6 weeks. The control group consisted of 50 women with term births at 37–41 6 weeks. MMP-9, TIMP-1, and PICP levels were determined in blood serum and homogenate supernatant with ELISA.

Results. Patients with PROM showed a statistically significant imbalance in the MMP-9/TIMP-1 system compared to the control group. The median MMP-9 level was higher in the main group — 50.52 ng/mL versus 43.67 ng/ mL (p < 0.050), while the TIMP-1 level was lower — 44.74 ng/mL versus 51.15 ng/mL (p < 0.050). The MMP-9/TIMP-1 index was significantly higher in the PROM group (1.13 vs. 0.85; p < 0.010). The PICP level showed mixed dynamics. A direct relationship was found between the MMP-9/TIMP-1 index and the presence of histological chorioamnionitis (r = 0.670; p < 0.050).

Conclusion. The obtained data indicate a systemic imbalance in proteolysis in PROM, correlating with local inflammation. Combined analysis of MMP-9, TIMP-1, and PICP in serum and membranes represents a promising tool for assessing the risk and understanding the pathogenesis of PROM. 

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