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=== Pathogens === Infection can degrade collagen via direct secretion<ref name=":1">{{Cite journal | last = Harrington | first = DJ | date = Jun 1996 | title = Bacterial collagenases and collagen-degrading enzymes and their potential role in human disease. | url = https://www.ncbi.nlm.nih.gov/pmc/articles/PMC174012/ | journal = Infection and Immunity|volume=64 | issue = 6 | pages = 1885–1891|issn=0019-9567|pmid=8675283}}</ref> of collagenases and other [[Enzyme|enzymes]] (in the case of [[bacteria]]) or increased host production of [[Matrix metalloproteinase|matrix metalloproteinases]] (MMPs) as part of the normal [[immune system|immune response]] (in the case of bacteria and [[Virus|viruses]]). Numerous bacteria secrete their own [[collagenase]]s.<ref name=":1" /><ref>{{Cite journal | last = Duarte | first = Ana Sofia | last2 = Correia | first2 = Antonio | last3 = Esteves | first3 = Ana Cristina | date = 2016 | title = Bacterial collagenases - A review | url =https://www.ncbi.nlm.nih.gov/pubmed/24754251 | journal = Critical Reviews in Microbiology|volume=42 | issue = 1 | pages = 106–126 |doi=10.3109/1040841X.2014.904270|issn=1549-7828|pmid=24754251}}</ref> [[Borrelia]] spirochetes upregulate production of human collagenase (MMP-1) and gelatinase B (MMP-9)<ref>{{Cite journal | last = Gebbia | first = Joseph A. | last2 = Coleman | first2 = James L. | last3 = Benach | first3 = Jorge L. | date = 2001-01-01 | title = Borrelia Spirochetes Upregulate Release and Activation of Matrix Metalloproteinase Gelatinase B (MMP-9) and Collagenase 1 (MMP-1) in Human Cells |url =https://iai.asm.org/content/69/1/456 | journal = Infection and Immunity|language=en|volume=69 | issue = 1 | pages = 456–462|doi=10.1128/IAI.69.1.456-462.2001|issn=0019-9567|pmid=11119537}}</ref>, an enzyme that can degrade both [[elastin]] and partially hydrolyzed collagen.<ref name="Baker2009">{{Cite book | title = Comprehensive Vascular and Endovascular Surgery | date = 2009 | url=https://www.sciencedirect.com/science/article/pii/B9780323057264000299 | pages = 465–472 | last = Baxter | first = B. Timothy | author-link= | last2 = MacTaggart | first2 = Jason | author-link2 = |isbn=978-0-323-05726-4|chapter=Pathogenesis of Aortic Aneurysms|language=en|edition=2nd|location=Philadelphia|publisher=Mosby|editor-last=Hallett|editor-first=John W.|editor2-last=Mills|editor2-first=Joseph L.|editor3-last=Earnshaw|editor3-first=Jonothan J.|editor4-last=Reekers|editor4-first=Jim A.|editor5-last=Rooke|editor5-first=Thom W.|doi=10.1016/b978-0-323-05726-4.00029-9|pmc=|pmid=|access-date=|quote=|via=}}</ref> Borrelia infection has been associated with damage to collagen and elastin fibres, causing "spontaneous ruptures of tendons after slight strain, dislocation of vertebrae and an accumulation of prolapsed intervertebral discs as well as ossification of tendon insertions."<ref>{{Cite journal | last = Müller | first = Kurt E | date = 2012-12-31 | title = Damage of Collagen and Elastic Fibres by Borrelia Burgdorferi – Known and New Clinical and Histopathological Aspects |url =https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3751012/ | journal = The Open Neurology Journal|volume=6 | pages = 179–186|doi=10.2174/1874205X01206010179|issn=1874-205X|pmc=3751012|pmid=23986790}}</ref> MMP-8 and MMP-9 are upregulated in bacterial [[meningitis]] and the latter is associated with an increased risk of [[blood-brain barrier]] breakdown and neurological sequale such as [[epilepsy]] and [[cognitive dysfunction]].<ref>{{Cite journal | last = Tiveron | first = Marcos Gradim | last2 = Pomerantzeff | first2 = Pablo Maria Alberto | last3 = de Lourdes Higuchi | first3 = Maria | last4 = Reis | first4 = Marcia Martins | last5 = de Jesus Pereira | first5 = Jaqueline | last6 = Kawakami | first6 = Joyce Tieko | last7 = Ikegami | first7 = Renata Nishiyama | last8 = de Almeida Brandao | first8 = Carlos Manuel | last9 = Jatene | first9 = Fabio Biscegli | date = 2017-04-21 | title = Infectious agents is a risk factor for myxomatous mitral valve degeneration: A case control study | url = https://www.ncbi.nlm.nih.gov/pubmed/28431520 | journal = BMC infectious diseases|volume=17 | issue = 1 | pages = 297|doi=10.1186/s12879-017-2387-8|issn=1471-2334|pmc=5399830|pmid=28431520}}</ref> [[Herpes simplex virus]]<ref name=":2">{{Cite journal | date = 2006-12-13 | title = Herpes-simplex virus encephalitis is characterized by an early MMP-9 increase and collagen type IV degradation | url =https://www.sciencedirect.com/science/article/pii/S0006899306029246 | journal = Brain Research|language=en|volume=1125 | issue = 1 | pages = 155–162|doi=10.1016/j.brainres.2006.09.093|issn=0006-8993}}</ref>, [[Human herpesvirus 6|HHV-6]]<ref>{{Cite journal | date = 2014-11-01 | title = Serum levels of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinases-1 in human herpesvirus-6–infected infants with or without febrile seizures |url =https://www.sciencedirect.com/science/article/pii/S1341321X14002682 | journal = Journal of Infection and Chemotherapy|language=en|volume=20 | issue = 11 | pages = 716–721|doi=10.1016/j.jiac.2014.07.017|issn=1341-321X}}</ref> and [[Coxsackie B]]<ref>{{Cite journal | last = De Palma | first = Armando M. | last2 = Verbeken | first2 = Erik | last3 = Van Aelst | first3 = Ilse | last4 = Van den Steen | first4 = Philippe E. | last5 = Opdenakker | first5 = Ghislain | last6 = Neyts | first6 = Johan | date = 2008-12-05 | title = Increased gelatinase B/matrix metalloproteinase 9 (MMP-9) activity in a murine model of acute coxsackievirus B4-induced pancreatitis |url =https://www.ncbi.nlm.nih.gov/pubmed/18929380 | journal = Virology|volume=382 | issue = 1 | pages = 20–27|doi=10.1016/j.virol.2008.08.046|issn=1096-0341|pmid=18929380}}</ref><ref>{{Cite journal | date = 2006-03-01 | title = Matrix metalloproteinases and tissue inhibitors of metalloproteinases in coxsackievirus-induced myocarditis |url =https://www.sciencedirect.com/science/article/pii/S1054880705001729 | journal = Cardiovascular Pathology|language=en|volume=15 | issue = 2 | pages = 63–74|doi=10.1016/j.carpath.2005.11.008|issn=1054-8807}}</ref> infection result in increased production of MMP-9, which is associated with Type IV and Type V collagen degradation.<ref name=":2" /><ref>{{Cite journal | last = Zeng|first = Z.S. | last2 = Cohen | first2 = A.M. | last3 = Guillem | first3 = J.G. | date = May 1999 | title = Loss of basement membrane type IV collagen is associated with increased expression of metalloproteinases 2 and 9 (MMP-2 and MMP-9) during human colorectal tumorigenesis |url =https://www.ncbi.nlm.nih.gov/pubmed/10334190 | journal = Carcinogenesis|volume=20 | issue = 5 | pages = 749–755|issn=0143-3334|pmid=10334190}}</ref><ref>{{Cite journal | last = Van den Steen | first = Philippe E. | last2 = Dubois | first2 = Bénédicte | last3 = Nelissen | first3 = Inge | last4 = Rudd | first4 = Pauline M. | last5 = Dwek | first5 = Raymond A. | last6 = Opdenakker | first6 = Ghislain | date = Jan 2002 | title = Biochemistry and Molecular Biology of Gelatinase B or Matrix Metalloproteinase-9 (MMP-9) | url = https://www.tandfonline.com/doi/abs/10.1080/10409230290771546 | journal = Critical Reviews in Biochemistry and Molecular Biology|language=en|volume=37 | issue = 6 | pages = 375–536|doi=10.1080/10409230290771546|issn=1040-9238}}</ref> Coxsackie B infection induces immune cells to secrete MMP-2, MMP-3, MMP-8, MMP-9 and MMP-12.<ref>{{Cite journal | last = Cheung|first = Caroline | last2 = Luo | first2 = Honglin | last3 = Yanagawa | first3 = Bobby | last4 = Leong | first4 = Hon Sing | last5 = Samarasekera | first5 = Dinesh | last6 = Lai | first6 = John C.K. | last7 = Suarez | first7 = Agripina | last8 = Zhang | first8 = Jingchun | last9 = McManus | first9 = Bruce M. | date = Mar 2006 | title = Matrix metalloproteinases and tissue inhibitors of metalloproteinases in coxsackievirus-induced myocarditis |url =https://www.ncbi.nlm.nih.gov/pubmed/16533694 | journal = Cardiovascular Pathology: The Official Journal of the Society for Cardiovascular Pathology|volume=15 | issue = 2 | pages = 63–74|doi=10.1016/j.carpath.2005.11.008|issn=1054-8807|pmid=16533694}}</ref><ref>{{Cite journal | last = Meng|first = Xiao-hui | last2 = Wang | first2 = Yi | last3 = Zhuang | first3 = Jian-xin | last4 = Han | first4 = Xiu-zhen | last5 = Chen | first5 = Yao | last6 = Jin | first6 = You-peng | last7 = Wang | first7 = Yu-lin | last8 = Yu | first8 = Yong-hui | last9 = Spires | first9 = James P. | date = Aug 2004 | title = Dynamic changes in myocardial matrix metalloproteinase activity in mice with viral myocarditis |url =https://www.ncbi.nlm.nih.gov/pubmed/15361294 | journal = Chinese Medical Journal|volume=117 | issue = 8 | pages = 1195–1199|issn=0366-6999|pmid=15361294}}</ref><ref>{{Cite journal | last = Rutschow|first = Susanne | last2 = Leschka | first2 = Sebastian | last3 = Westermann | first3 = Dirk | last4 = Puhl | first4 = Kerstin | last5 = Weitz | first5 = Anneke | last6 = Ladyszenskij | first6 = Leonid | last7 = Jaeger | first7 = Sebastian | last8 = Zeichhardt | first8 = Heinz | last9 = Noutsias | first9 = Michel | date = 2010-03-25 | title = Left ventricular enlargement in coxsackievirus-B3 induced chronic myocarditis--ongoing inflammation and an imbalance of the matrix degrading system | url = https://www.ncbi.nlm.nih.gov/pubmed/20035743 | journal = European Journal of Pharmacology|volume=630 | issue = 1-3 | pages = 145–151|doi=10.1016/j.ejphar.2009.12.019|issn=1879-0712|pmid=20035743}}</ref> ==== Infection and Ehlers-Danlos Syndromes ==== [[Ehlers-Danlos syndrome|Ehlers-Danlos Syndromes]] are a group connective tissue disorders caused by genetic defects in the production of collagen. Type III, [[hypermobile EDS]] (hEDS), is also thought to be genetic but as a genetic marker has not yet been identified; it is diagnosed via signs and symptoms. A 2018 case study of a patient who met the diagnostic criteria for hEDS and had a chronic Bartonella infection found their hEDS symptoms resolved with antibiotic treatment for Bartonella.<ref name=":0">{{Cite journal | last = Mozayeni|first = Bobak Robert | last2 = Maggi | first2 = Ricardo Guillermo | last3 = Bradley | first3 = Julie Meredith | last4 = Breitschwerdt | first4 = Edward Bealmear | date = Apr 2018 | title = Rheumatological presentation of Bartonella koehlerae and Bartonella henselae bacteremias |url =https://journals.lww.com/md-journal/Pages/articleviewer.aspx?year=2018&issue=04270&article=00032&type=Fulltext | journal = Medicine|language=en-US|volume=97 | issue = 17| pages = e0465|doi=10.1097/MD.0000000000010465|issn=0025-7974}}</ref> [[Mycoplasma pneumoniae]] has been associated with mitral valve degeneration, a complication of EDS.<ref>{{Cite journal | last = Tiveron | first = Marcos Gradim | last2 = Pomerantzeff | first2 = Pablo Maria Alberto | last3 = de Lourdes Higuchi | first3 = Maria | last4 = Reis | first4 = Marcia Martins | last5 = de Jesus Pereira | first5 = Jaqueline | last6 = Kawakami | first6 = Joyce Tieko | last7 = Ikegami | first7 = Renata Nishiyama | last8 = de Almeida Brandao | first8 = Carlos Manuel | last9 = Jatene | first9 = Fabio Biscegli | date = 2017-04-21 | title = Infectious agents is a risk factor for myxomatous mitral valve degeneration: A case control study | url = https://www.ncbi.nlm.nih.gov/pubmed/28431520 | journal = BMC infectious diseases|volume=17 | issue = 1 | pages = 297|doi=10.1186/s12879-017-2387-8|issn=1471-2334|pmc=5399830|pmid=28431520}}</ref>
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