Matrix metalloproteinases (MMPs) play an important role in central nervous system infections. We analysed the levels of 8 different MMPs in the cerebrospinal fluid (CSF) of 89 adult patients infected with tick-borne encephalitis (TBE) virus and compared them with the levels in a control group. MMP-9 was the only MMP that showed significantly increased CSF levels in TBE patients. Serum MMP-9 levels were subsequently measured in 101 adult TBE patients at various time points during the neurological phase of TBE and at follow-up. In addition, serum MMP-9 was analysed in 37 paediatric TBE patients. Compared with control levels, both paediatric and adult TBE patients had significantly elevated serum MMP-9 levels. In most adult patients, serum MMP-9 levels peaked at hospital admission, with higher serum MMP-9 levels observed in patients with encephalitis than in patients with meningitis. Elevated serum MMP-9 levels were observed throughout hospitalisation but decreased to normal levels at follow-up. Serum MMP-9 levels correlated with clinical course, especially in patients heterozygous for the single-nucleotide polymorphism rs17576 (A/G; Gln279Arg) in the MMP9 gene. The results highlight the importance of MMP-9 in the pathogenesis of TBE and suggest that serum MMP-9 may serve as a promising bioindicator of TBE in both paediatric and adult TBE patients.

Department of Children's Infectious Disease Faculty of Medicine and University Hospital Masaryk University CZ 61300 Brno Czechia

Department of Infectious Diseases and Preventive Medicine Veterinary Research Institute CZ 62100 Brno Czechia

Department of Infectious Diseases and Preventive Medicine Veterinary Research Institute CZ 62100 Brno Czechia; Institute of Parasitology Biology Centre of the Czech Academy of Sciences CZ 37005 Ceske Budejovice Czechia

Department of Infectious Diseases and Preventive Medicine Veterinary Research Institute CZ 62100 Brno Czechia; Institute of Parasitology Biology Centre of the Czech Academy of Sciences CZ 37005 Ceske Budejovice Czechia; Department of Experimental Biology Faculty of Science Masaryk University CZ 62500 Brno Czechia

Department of Infectious Diseases Hospital Ceske Budejovice CZ 37001 Ceske Budejovice Czechia; Faculty of Science University of South Bohemia CZ 37005 Ceske Budejovice Czechia

Department of Infectious Diseases Hospital Ceske Budejovice CZ 37001 Ceske Budejovice Czechia; Royal Liverpool University Hospital Prescot St Liverpool L7 8XP UK

Department of Infectious Diseases University Hospital Brno and Faculty of Medicine Masaryk University CZ 62500 Brno Czechia

Federal Research Center Institute of Cytology and Genetics Siberian Branch Russian Academy of Sciences 10 Lavrentyeva Ave Novosibirsk 630090 Russia

Institute of Molecular Genetics of the Czech Academy of Sciences CZ 14220 Prague Czechia

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