MMP9 and aneurysm: Clinically, the evidence linking ACE inhibition to modulation of MMP-9 in human vascular disease is suggestive but still limited: small translational and animal-model studies (e.g., perindopril in aneurysm models) report reduced remodeling enzyme activity, yet large-scale trials of ACE inhibitors in aneurysm progression or myocardial remodeling have not been designed with MMP-9 suppression as a primary endpoint [83].