Research

Cerebrospinal fluid matrix metalloproteinase-9 increases during treatment of recurrent malignant gliomas

Eric T Wong^1,2 , David Alsop³ , Diana Lee^1,2 , Angela Tam^1,2 , Loretta Barron^1,2 , Julianne Bloom^1,2 , Shiva Gautam⁴ and Julian K Wu^1,5,6

¹Beth Israel Deaconess Medical Center, Brain Tumor Center & Neuro-Oncology Unit, Boston, MA 02215, USA

²Beth Israel Deaconess Medical Center, Department of Neurology, Boston, MA 02215, USA

³Beth Israel Deaconess Medical Center, Division of Neuroradiology, Boston, MA 02215, USA

⁴Beth Israel Deaconess Medical Center, Division of Biostatistics, Boston, MA 02215, USA

⁵Beth Israel Deaconess Medical Center, Division of Neurosurgery, Boston, MA 02215, USA

⁶Tufts-New England Medical Center, Department of Neurosurgery, Boston, MA 02111, USA

author email corresponding author email

Cerebrospinal Fluid Research 2008, 5:1doi:10.1186/1743-8454-5-1

Published:	11 January 2008

Abstract

Background

Matrix metalloproteinases (MMPs) are enzymes that promote tumor invasion and angiogenesis by enzymatically remodeling the extracellular matrix. MMP-2 and MMP-9 are the most abundant forms of MMPs in malignant gliomas, while a 130 kDa MMP is thought to be MMP-9 complexed to other proteinases. This study determined whether doxycycline can block MMP activity in vitro. We also measured MMP-2 and MMP-9 levels in cerebrospinal fluid (CSF) from patients with recurrent malignant gliomas.

Methods

To determine whether doxycycline can block MMP activity, we measured the extent of doxycyline-mediated MMP-2 and MMP-9 inhibition in vitro using epidermal growth factor receptor (EGFR) transfected U251 glioma cell lines. MMP activity was measured using sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) zymography. In addition, patients underwent lumbar puncture for CSF sampling at baseline, after 6 weeks (1 cycle), and after 12 weeks (2 cycles), while being treated with a novel chemotherapy regimen of irinotecan, thalidomide, and doxycycline designed to block growth/proliferation, angiogenesis, and invasion. Irinotecan was given at 125 mg/m²/week for 4 weeks in 6-week cycles, together with continuous doxycycline at 100 mg twice daily on Day 1 and 50 mg twice daily thereafter. Daily thalidomide dose in our cohort was 400 mg. Tumor progression was monitored by magnetic resonance imaging (MRI).

Results

Doxycyline in vitro completely abolished MMP-9 activity at 500 μg/ml while there was only 30 to 50% inhibition of MMP-2 activity. Four patients respectively completed 4, 3, 1, and 2 cycles of irinotecan, thalidomide, and doxycycline. Patient enrollment was terminated after one patient developed radiologically defined pulmonary embolism, and another had probable pulmonary embolism. Although CSF MMP-2 and 130 kDa MMP levels were stable, MMP-9 level progressively increased during treatment despite stable MRI.

Conclusion

Doxycycline can block MMP-2 and MMP-9 activities from glioma cells in vitro. Increased CSF MMP-9 activity could be a biomarker of disease activity in patients with malignant gliomas, before any changes are detectable on MRI.