Comparison of Serum MMP-1 Value Levels in Spondylitis

Tuberculose with Degenerative Spine Disease

Alamsyah Faritz Siregar

, Otman Siregar

, Nazar Moesbar

Resident of Orthopaedic and Traumatology, Faculty of Medicine Universitas Sumatera Utara/ Haji Adam

Malik Hospital-Medan

Consultant of Orthopaedic and Traumatology, Spine Division, Faculty of Medicine Universitas Sumatera Utara/ Haji

Adam Malik Hospital-Medan

Staff of Orthopaedic and Traumatology, Spine Division, Faculty of Medicine UniversitasSumatera Utara/ Haji Adam

Malik Hospital-Medan

Keywords: Matrix metalloproteinase; MMP-1; spondylitis tuberculous; degenerative spine disease.

Abstract: The purpose of this study was to determine differences in serum MMP-1 values in tuberculous spondylitis

with degenerative diseases of the spine. Eighteen (18) subjects were divided into 2 groups, with nine (9)

subjects of spondylitis tuberculose and 9 subjects of degenerative spine disease in the period from December

2017 to November 2018 who were included in the inclusion criteria included in this study and blood sampling

was taken for examination of serum MMP-1 levels. Distribution of samples of spondylitis tuberculous and

degenerative spine diseases with total 18 subjects, with 10 women (55.6%) and men as many as 8 subjects

(44.4%), with the youngest age of the study subject 13 years old and the oldest age is 73 years old research

subjects with mean and standard deviation of 43.72 ± 15.88 years. There were significant differences in serum

MMP-1 levels between spondylitis tuberculous and degenerative spine diseases with a significance value of

0.016 (p<0.05) with mean serum MMP-1 levels in the spondylitis tuberculous study group 1055.56 ± 390.86

and mean in the control group 666.67 ± 250.00. Patients suffering from spondylitis tuberculous have higher

serum MMP-1 levels than patients with degenerative spine disease, although MMP-1 is not a specific marker

examination for spondylitis tuberculous, the results of this study can be suggestive into that can help to

evaluate enzyme activity in patients with spondylitis tuberculous disease.

1 INTRODUCTION

Tuberculosis (TB) is one of the long-known diseases

and is still the leading cause of death in the world. The

prevalence of TB in Indonesia and other developing

countries is quite high. In 2006, new cases in

Indonesia amounted to> 600,000 and most people

suffer from productive age (15–55 years).

About 20% of pulmonary TB infections will

spread out of the lungs (extrapulmonary TB). Eleven

percent of extrapulmonary TB is osteoarticular TB,

and about half of patients suffer from spinal TB

infection. Half have lesions in the spine with

neurologic deficits 10 % - 45% of sufferers

Matrix metalloproteinase (MMP) is a zinc-

dependent protease, which plays a role in the process

of degradation of the extracellular matrix and

modulates the inflammatory response by facilitating

and inhibiting different cytokines. Research shows

that MMP-1 is the main collagenase in TB patients,

and the expression of MMP-1 is suppressed by p-

aminosalicylic acid, which is an anti-tuberculous

agent that has been used for 70 years.

Two gelatinases, MMP-2 and MMP-1, have the

ability to reduce original IV collagen and

denaturation of type I collagen (gelatin). Both

circulation and resident inflammatory cells have the

capacity to synthesize MMP-1. Research into

experimental studies has provided evidence that the

MMP-1 level was significantly higher in the

bronchoalveolar fluid of patients with active cavitary

tuberculosis, and lung extract of mice infected with

M. tuberculosis, compared to the control group. An

increased significance of MMP-1 was also observed

in cerebrospinal fluid (CSF) in tuberculous

meningitis patients and also compared with people

suffering from viral meningitis, where usually these

enzymes are not usually found in cerebrospinal fluid.

There are previous studies shown that M.

tuberculosis can stimulate the expression of MMP-1

Siregar, A., Siregar, O. and Moesbar, N.

Comparison of Serum MMP-1 Value Levels in Spondylitis Tuberculose with Degenerative Spine Disease.

DOI: 10.5220/0009840900050008

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 5-8

ISBN: 978-989-758-469-5

in the lungs of infected organisms, but no studies have

examined how the expression of MMP-1 in

tuberculous spondylitis when compared with the

control group, therefore researchers are interested in

trying evaluating and comparing the expression of

MMP-1 in tuberculous spondylitis using serum levels

in the blood of patients suffering from tuberculous

spondylitis and compared to the control group, in this

case the control group in this study were patients with

degenerative diseases of the spine.

2 PRELIMINARY

Before discussing the results of the study, because this

study had never been done before, it was conducted

with a small scale preliminary study using 8 balanced

subjects with 4 subjects (4 subjects with tuberculous

spondylitis, 4 subjects with the degenerative spine) to

obtain a mean and standard deviation from each one

group.

Table 1. Shows that the distribution of tuberculous

spondylitis samples and spinal degenerative diseases

in the preliminary study was as many as 8 subjects

with 5 women (62.5%) and men as many as 3

(37.5%). With a mean and standard deviation of 38.63

± 18.24 years. It shows that the mean of subjects with

spinal degenerative disease 750 ± 288.67 and mean

tuberculous spondylitis 1125 ± 629.15.

Table 1: ST, Spondylitis Tuberculosis; DSD, Degenerative Spine Disease;

Variable

Type of Disease

DSD

Gender M/F

2/2

1/3

MMP-1

1125 ± 629.15

750 ± 288.67

Mean Age

38.63 ± 18.24

3 METHOD

The sample size is calculated based on the categorical

numerical unpaired analytic formula, the minimum

sample size can be obtained as many as 17.04 ~ 18

subjects. All data are processed and presented in a

table form and then further classified into 1) general

description, 2) demographic description of the

subjects of the serum MMP-1 value in tuberculous

spondylitis with degenerative disease in the spine 3)

normality test data on serum MMP-1 values

tuberculous spondylitis with degenerative diseases of

the spine, 4) analysis of the influence of whether there

are differences in serum MMP-1 values in

tuberculous spondylitis with degenerative diseases of

the spine.

4 RESULTS

From the results of the statistical analysis of the

comparison of serum MMP-1 values in tuberculous

spondylitis (ST) with degenerative spine disease

(DSD), the results were significant that the serum

MMP-1 value was greater and this was indicated by a

p-value of 0.016 ( p <0.05). Table 3. Distribution of

the results of serum MMP-1 levels in tuberculous

spondylitis and spinal degenerative diseases 18

subjects, diagnosed with 9 tuberculosis spondylitis

(50%) and 9 degenerative spinal diseases (50%) with

mean and standard the deviation of the serum MMP-

1 tuberculosis spondylitis level was 1055.56 ± 390.86

while the mean and standard deviation of serum

MMP-1 values in spinal degenerative diseases was

666.67 ± 250.00. From the results of the statistical

analysis of the comparison of serum MMP-1 values

in tuberculous spondylitis (ST) with degenerative

spine disease (DSD), the results were significant that

the serum MMP-1 value was greater and this was

indicated by a p-value of 0.016 ( p <0.05).

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

Table 2: ST, Spondylitis Tuberculosis; DSD, Degenerative Spine Disease.

Variable

Type of Disease

DSD

Mean MMP-1 (nm/ml)

1055.56

666.67

± 390.86

± 250.00

p-Value

0.016

Older Age

13 years

43 years

Younger Age

62 years

73 years

TB Drug Consumption

8.89 ± 4.70 weeks

5 DISCUSSION

The main objective of this study was to determine

whether there was a difference between serum MMP-

1 levels in spondylitis tuberculosis and degenerative

diseases of the spine. In a previous study conducted

by Hrabec et al., 2002 also found that serum MMP-1

levels in patients with active pulmonary tuberculosis

had significantly higher levels of the control group.

This finding is in accordance with the study

conducted that there were significant differences in

MMP-1 levels in patients with spondylitis

tuberculosis with the control group.

6 CONCLUSION

MMP-1 values in spondylitis tuberculosis were

significant and greater compared to degenerative

spine disease and this was indicated by a p-value of

0.016 (p <0.05).

CONFLICT OF INTEREST

Non declared in this study.

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