ArticleScientific reports2026
Associations of plasma MMP-9 and MPO with functional outcome in moderate to severe acute ischemic stroke.
Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Inflammation plays a pivotal role in acute ischemic stroke (AIS), with neutrophil granulocytes acting as major contributors to the post-stroke immune response. Upon degranulation, neutrophils release matrix metalloproteinase-9 (MMP-9) and myeloperoxidase (MPO), both of which may influence functional outcomes following AIS. The aim of this study was to investigate the association between systemic levels of MMP-9 and MPO, functional outcome, and neutrophil counts in patients with moderate to severe AIS, with a focus on their pathophysiological relevance rather than standalone prognostic performance. This prospective single-center cohort study included patients with moderate to severe AIS in the anterior circulation (NIHSS score ≥ 6 points and /or indication for mechanical recanalization). Venous blood was sampled in order to assess plasma concentrations of MMP-9 via zymography as well as MPO plasma levels via ELISA. Furthermore, differential blood count was determined simultaneously to venous biomarker sampling. Poor outcome was defined as mRS score ≥ 3. Uni- and multivariable regression analyses were performed. Between 07/2020 and 09/2022 a total of 279 patients with blood samples taken up to 48 h after symptom onset with a median NIHSS score of 13 and a median age of 79 were included. Of these patients, 81.0% underwent mechanical recanalization and 42.7% received systemic thrombolytic therapy. Systemic MMP-9 and MPO plasma levels were significantly higher in patients with poor functional outcome compared to patients with good functional outcome at 3-months (MMP-9: 359.1 vs. 303.5 ng/ml, p = 0.0006; MPO: 27.0 vs. 19.2 ng/ml, p = 0.0010). Both biomarkers were associated with a poor outcome in unadjusted analyses [MMP-9: unadjusted OR = 15.63 (95% CI: 3.54-80.69), p = 0.0005; MPO: unadjusted OR = 4.02 (95% CI: 1.84-9.21), p = 0.0007]. In addition, MMP-9 and MPO concentrations correlated with neutrophil counts (MMP-9: r = 0.39, p < 0.0001; MPO: r = 0.31, p < 0.0001). In conclusion, systemic MMP-9 and MPO plasma concentrations are associated with functional outcome in patients with moderate to severe AIS and reflect neutrophil-driven inflammatory processes. Their value appears to lie in complementing established clinical predictors rather than serving as independent prognostic markers.
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