Circulating Levels of Soluble Receptor Activator of NF-κB Ligand and Matrix Metalloproteinase 3 (and Their Antagonists) in Asian Indian Patients with Ankylosing Spondylitis
Background. Bone loss in ankylosing spondylitis may be related to inflammation. Data from previous studies on circulating levels of sRANKL, OPG, MMP3, and TIMP is inconsistent; thus this study is planned to look at this aspect in Asian Indian patients. Methods. Cross-sectional study included patients with ankylosing spondylitis and age- and gender-similar controls. Serum levels of sRANKL, OPG, MMP-3, and TIMP-1 were measured by ELISA. Results. Included 85 patients (M？:？F = 82？:？3) having mean age (±SD) years and disease duration years. BASDAI, BASFI, BASMI, and ESR were , , and respectively. Patients had higher mean (±SD) OPG level ( , ？pg/mL, ). However, there was no difference in sRANKL ( , , ). Serum MMP-3 ( , ？ng/mL, ) and TIMP-1 ( , ？ng/mL, ) levels were higher in patients; however, there was no difference in MMP-3/TIMP-1 ratio. Conclusion. Circulating levels of OPG were higher; however, there was no difference in sRANKL in Asian Indian ankylosing spondylitis patients. Although both MMP-3 and TIMP-1 were raised, their ratio was not different from that of controls. 1. Introduction Patients with ankylosing spondylitis have been shown to have low bone mineral density at spine and propensity for vertebral fractures. The loss of bone mineral density has been shown to be more marked in late than early disease [1]. The bone loss may be related to inflammation, as in other chronic inflammatory diseases [2, 3]. Indeed, ankylosing spondylitis is characterized by chronic inflammation, as evidenced by elevated proinflammatory cytokines like tumour necrosis factor-α (TNFα) and interleukin-6 [4]. These may lead to bone loss by increased expression of receptor activator of NF-κB ligand (RANKL) on osteoblasts and stromal cells and its soluble form (sRANKL). RANKL and cytokines lead to osteoclast and other inflammatory cell activation and release of bone and cartilage degrading enzymes like cathepsin K and matrix metalloproteinases (MMPs) [5, 6]. Their natural antagonists, that is, osteoprotegerin (for RANKL) and tissue inhibitor of metalloproteinase or TIMP (for MMP) oppose their actions. Among the MMPs, there is promising data on the association of disease activity with MMP-3 [7]. There is inconsistent data on circulating levels of these molecules in ankylosing spondylitis, especially in Asian Indians. Thus this study was planned to look at levels of these molecules in this population. 2. Methods 2.1. Study Design This cross-sectional study was carried out in a North Indian university hospital between April 2010 and February 2011. Institutional ethical clearance
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