Matrix metalloproteinases, but not cathepsins B, H, and L or their inhibitors in peripheral blood of patients with rheumatoid arthritis are potentially useful markers of disease activity

Objective: The clinical activity of rheumatoid arthritis (RA) is not reliably reflected by laboratory measures. Proteolytic enzymes involved in the cascade of joint destruction are potentially useful parameters to monitor the extent of joint inflammation in RA. This study compares the validity of two classes of proteolytic enzymes, matrix metalloproteinases (MMP) and lysosomal cysteine proteinases (cathepsin B, I-I, and L) as well as their respective inhibitors to serve as parameters of RA disease activity. Methods: The proteolytic activity of cathepsins B, H, and L was determined by fluorometry in sera of 20 patients with active RA and of 20 healthy donors. In addition, the concentrations of cathepsin B and L as well as of cathepsin inhibitors stefin A, stefin B, and cystatin C were measured by ELISA. The plasma concentrations of MMP-1 (collagenase), MMP-3 (stromelysin), tissue inhibitor of metalloproteinases 1 (TIMP-1), and of MMP-1/TIMP-1 complex (MT complex) were analyzed by ELISA as well. Results: A significant increase of MMP-1, MMP-3, and MT complex was observed in RA plasma, compared to normal controls, whereas TIMP-1 concentrations did not differ. In contrast, neither serum activity nor protein concentration of any of the cathepsins or cathepsin inhibitors were elevated in RA. Conclusion: Despite ample evidence in the literature that cathepsin activity contributes to the pathogenesis of inflammatory joint disease, this is not reflected by the conditions in peripheral blood. In contrast to the cysteine proteinases, MMP-1 and MMP-3 as well as MT complex are elevated in RA. In the context of findings in the literature, this stresses the importance of MMP as disease activity markers, compared to cysteine proteinases or their inhibitors.