Look what you make my tissues do: The role of metalloproteinases and their inhibitors in Bothrops snakebites

BACKGROUND: Bothrops envenomation induces extensive local tissue destruction and a robust inflammatory response, largely driven by the host's endogenous molecular pathways. Among these, Matrix Metalloproteinases (MMPs), zinc-dependent endopeptidases responsible for extracellular matrix (ECM) degradation, play a central role. The clinical severity of envenomation is therefore strongly influenced by the balance between MMPs and their specific inhibitors, the TIMPs. This study investigated the contribution of MMP-1, MMP-2, MMP-7, MMP-9, and MMP-10 and TIMP-1, TIMP-2, TIMP-3, and TIMP-4 to the inflammatory response following Bothrops snakebites. METHODS AND FINDINGS: In this study, we prospectively enrolled 30 patients, classified them as Mild or Severe, and quantified circulating MMPs and TIMPs concentrations before and after antivenom administration using a multiplex Luminex platform. Early inflammatory markers and initial MMPs activation (MMP-2, MMP-7, MMP-9, MMP-10) did not differ significantly between groups. However, post-antivenom molecular trajectories diverged sharply. Mild cases exhibited effective enzymatic regulation, restoring the MMPs/TIMPs profile toward a state that favored ECM turnover and tissue repair. In contrast, Severe cases showed persistent dysregulation, with a sustained imbalance that hindered ECM reorganization and perpetuated damaging inflammatory pathways. CONCLUSION: These findings suggest that the regulation of MMP/TIMP balance following antivenom therapy may be associated with clinical evolution. Further studies are required to determine whether these molecular patterns can be validated as prognostic markers or therapeutic targets.