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The role of collagenase in emphysema

BioMed Central
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  • Review
  • Biology
  • Economics
  • Medicine


α1-AT = alpha-1-antitrypsin; COPD = chronic obstructive pulmonary disease; ECM = extracellular matrix; MMP = matrix metalloproteinase; MMP-1 = collagenase; MMP-12 = metalloelastase; MT-MMP = membrane type matrix metalloproteinase. Available online Introduction Emphysema is a common, debilitating pulmonary condi- tion, the impact of which is felt worldwide, placing an enormous economic strain on international health care infrastructures. In the UK, data from 1996 indicate that the medical cost of chronic obstructive pulmonary disease (COPD) was approximately £846 million or about £1154 per person per year [1]. In the USA, over 106,000 people die from COPD yearly making it the fourth leading cause of death nationwide [2]. Moreover, while death rates for heart disease and stroke have declined by roughly 50% over the past 30 years, the death rate for COPD has risen by 71% [2]. In 1993, it was estimated that 14.7 billion dollars were spent in the USA on direct COPD-related health care expenditures, costing roughly the equivalent of £764 per person per year [1]. As the life expectancy of the populations of industrialized nations continues to increase, it is certain that the costs of emphysema in terms of lives lost and strains on limited health care resources will continue to grow. Elastase/anti-elastase hypothesis In light of these statistics on the global impact of this disease, it is surprising to realize that even the basic pathophysiology of emphysema is still being debated. While it is clearly established that cigarette smoke is the principal cause of emphysema, the mechanism by which cigarette smoke exposure leads to the destruction of lung architecture seen in emphysema is controversial. Elastin is an important component of the extracellular matrix (ECM) that is believed to confer upon the lung the resilience needed to undergo repetitive physiologic stress. For over 30 years, the leading hypothesis has been that emphy- sema resulted from a

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