Study of the effect of anti-IgE (omalizumab) on serum level of matrix metalloproteinase-9 as a marker of remodeling in severe asthmatic patients

BackgroundAsthma is an airway disorder associated with chronic inflammation that may result in airway remodeling. Matrix metalloproteinases-9 MMP-9 recently exhibited an important role in airway remodeling process in patients with severe asthma. The aim of the present study was to study the effect of anti-IgE (omalizumab) on serum level of matrix metalloproteinase-9 as a marker of remodeling in severe asthmatic patients.Patients and methodsThe present study included 50 subjects with severe uncontrolled asthma diagnosed according to GINA guidelines. Omalizumab was prescribed for all included patients because they were not controlled on the maximal dose of the usual standard medications including repeated courses of systemic steroids. Pulmonary function tests, asthma control test, fraction of exhaled nitric oxide (FENO) level, and serum MMP9 were detected for all enrolled patients.ResultsThere was a significant decrease in the number of exacerbations after 24 and 36 months of starting omalizumab (4.3 ± 2.7 and 3.2 ± 1.2 respectively) in comparison with the baseline level (6.2 ± 2.1) with p < 0.05. There was also a significant increase in the ACT score in comparison with the baseline level (11.1 ± 5.1) at 12, 24, and 36 months of starting omalizumab (13.4 ± 4.6, 15.6 ± 2.3 and 21.3 ± 3.2 respectively; p < 0.05). The baseline FEV1 % pred. was 53.4 ± 12.5. After 24 and 36 months there was significant improvement in the FEV1 % pred. (58.3 ± 6.2 and 61.2 ± 3.4 respectively; p < 0.05). The baseline serum MMP-9 was 267.6 ± 26.8 ng/ml at the baseline and it decreased significantly at 12, 24, and 36 months after starting omalizumab with the p value <0.05 (211.4 ± 19.8, 188.3 ± 31.4 and 136.15 ± 30.2 ng/ml respectively).ConclusionOmalizumab can reduce asthma exacerbations and improve asthma control and pulmonary function. The reducing effect of omalizumab on metalloproteinase-9 serum level may contribute to decreased airway remodeling in patients with severe asthma.