ORIGINAL ARTICLE Matrix Metalloproteinases in Obesity After Gastric Bypass Surgery—an Experimental Study Radu Mihail Mirica 1,2 & Mihai Ionescu 1 & Alexandra Mirica 3 & Octav Ginghina 1,2 & Razvan Iosifescu 1,2 & Adrian Rosca 4 & Laura Gaman 5 & Leon Zagrean 4 & Nicolae Iordache 1,2 Received: 22 January 2020 /Accepted: 5 June 2020 # Association of Surgeons of India 2020 Abstract Matrix metalloproteinases (MMPs) are enzymes involved in the modulation of extracellular matrix (ECM) and adipocytes and preadipocyte differentiation. The pathophysiology of obesity has characterized by many cellular and molecular processes such as inflammatory processes, macrophage infiltration of adipose tissue, and remodeling of ECM via MMP. The purpose of the study was to determine if we can consider MMPs as a marker of effectiveness in bariatric surgery and if sulodexide administration pre- and postoperative has a benefit in terms of tissue remodeling of weight loss. An experimental study has performed using 40 obese Wistar rats (10 rats in the control group and 30 obese rats in study groups). Those in the study group were divided into three groups and underwent gastric bypass (B group), sulodexide administration (S group), gastric bypass, and sulodexide adminis- tration (BS group). Sulodexide was administered because of its antithrombotic effect in the procoagulant status of obese subjects. The pre- and postoperative weight, glucose level, cholesterol, triglycerides, MMP-2, and MMP-9 were analyzed. We compared the results to see if bariatric surgery modifies the MMPs status and if there is a correlation between the weight loss and the other parameters and also if sulodexide has any contribution to the results. The MMP-2 and MMP-9 activities were detectable, but MMP-2 was significantly higher than MMP-9. MMP-2 correlates with body weight parameters before surgery and after surgery, after significant bodyweight reduction as a result of bariatric surgery (r = 0.478, p = 0.017). There is a strong correlation between the weight loss, glucose level, and cholesterol and the values of MMP-2 (r = 0.92, p = 0.022, respectively, r = 0.759, p = 0.033). MMP-9 is correlated with weight loss and triglycerides level. But it was not as sensitive as MMP-2. Sulodexide administration in group S had a positive influence on the MMP-2 and MMP-9 compared with the values of groups B and C but without statistical significance. MMP-2 and MMP-9 are the two most important ECM enzymes involved in adipose tissue remodeling after bariatric surgery. The correlations between cholesterol, triglycerides, glucose, weight loss, excess weight, and body mass index (BMI) parameters and MMPs level demonstrate the direct relationship of these enzymes in obesity. Although we believe that more in- depth studies are required, MMPs may be considered a marker of the effectiveness of bariatric surgery. Keywords Metabolic surgery . Obesity . Matrix metalloproteinases . Diabetes . Gastric sleeve . Gastric bypass Introduction The pathophysiology of obesity has many cellular and molec- ular processes, such as inflammatory processes, macrophage infiltration of adipose tissue, and remodeling of ECM via MMPs. Infiltration of adipose tissue with macrophages is a characteristic sign of obesity-specific fat inflammation. This process also is essential in regulating ECM and fibrogenesis at this level [1]. Similar changes also occur in steatosis liver in obese subjects [2–4]. The remodeling of tissues depends on the breakdown and reformation of the ECM. Due to their ability to break down the ECM, proteinases such as MMPs are principally responsible * Alexandra Mirica dr.alexandramirica@gmail.com 1 Emergency Clinical Hospital “St. John”, Bucharest, Romania 2 Department of General Surgery, “St. John” Hospital University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania 3 Emergency Clinic Hospital for Children “Grigore Alexandrescu”, Bucharest, Romania 4 Department Physiology and Neuroscience, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania 5 Department of Biochemistry, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania Indian Journal of Surgery https://doi.org/10.1007/s12262-020-02462-x