Published online before print February 12, 2004, doi: 10.1161/01.ATV.0000121571.78696.dc
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© 2004 American Heart Association, Inc.
Atherosclerosis and Lipoproteins |
Clinical and Biochemical Results of the Metalloproteinase Inhibition with Subantimicrobial Doses of Doxycycline to Prevent Acute Coronary Syndromes (MIDAS) Pilot Trial
From the Department of Medicine (Cardiology) (D.L.B., K.K.D., B.A.V., C.N.), Albert Einstein College of Medicine, Bronx, NY; Beth Israel Medical Center (D.L.B.), New York, NY; and the Department of Oral Biology and Pathology (H.-M.L., L.M.G.), School of Dental Medicine, State University of New York at Stony Brook, Stony Brook, NY.
Correspondence to Dr David L. Brown, Division of Cardiovascular Interventions, Beth Israel Medical Center, Dazian 11, First Avenue at 16th Street, New York, NY 10003. E-mail dabrown{at}chpnet.org
Background— Vulnerable plaque demonstrates intense inflammation in which macrophages secrete matrix metalloproteinases (MMPs) that degrade the fibrous cap, ultimately leading to rupture, in situ thrombosis, and an associated clinical event. Thus, inhibition of MMP activity or more general suppression of vascular inflammation are attractive targets for interventions intended to reduce plaque rupture. We hypothesized that subantimicrobial doses of doxycycline (SDD) (20 mg twice daily) would benefit patients with coronary artery disease by reducing inflammation and MMP activity and thus possibly prevent coronary plaque rupture events.
Methods and Results— We conducted a prospective, randomized, double-blind, placebo-controlled pilot study of 6 months of SDD or placebo treatment to reduce inflammation and prevent plaque rupture events. A total of 50 patients were enrolled, of whom 24 were randomized to placebo and 26 to SDD. At 6 months, there was no difference in the composite endpoint of sudden death, fatal myocardial infarction (MI), non-fatal MI, or troponin-positive unstable angina in SDD compared with placebo-treated patients (8.4% versus 0%, P=0.491). Biochemical markers of inflammation were assessed in plasma at study entry and after 6 months of therapy in 30 patients. In SDD-treated patients, high-sensitivity C-reactive protein (CRP) was reduced by 46% from 4.8±0.6 µg/mL to 2.6±0.4 µg/mL (P=0.007), whereas CRP was not significantly reduced in placebo patients. Interleukin (IL)-6 decreased from 22.1±3.7 pg/mL at baseline to 14.7±1.8 pg/mL at 6 months in SDD-treated patients (P=0.025) but did not decrease significantly in placebo-treated patients. On zymography, pro-MMP-9 activity was reduced 50% by SDD therapy (P=0.011), whereas it was unchanged by placebo treatment.
Conclusion— SDD appears to exert potentially beneficial effects on inflammation that could promote plaque stability. These findings should be investigated in a larger study.
Key Words: inflammation • plaque rupture • metalloproteinase • cytokines • antibiotics
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