Fecal MMP-9: A new noninvasive differential diagnostic and activity marker in ulcerative colitis

Anita Annaházi, Tamás Molnár, Klaudia Farkas, András Rosztóczy, Ferenc Izbéki, Krisztina Gecse, Orsolya Inczefi, Ferenc Nagy, Imre Földesi, Mónika Szucs, Marta Dabek, Laurent Ferrier, Vassilia Theodorou, Lionel Bueno, Tibor Wittmann, Richárd Róka

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Background: Ulcerative colitis (UC) is characterized by frequent relapses, with the presence of colorectal inflammation and mucosal lesions. Matrixmetalloprotease 9 (MMP-9) is elevated in colonic biopsies, urine, and blood plasma of UC patients. MMP-9 has been suggested as a predictor of UC in the urine of children; however, 20% of the controls tested positive. So far, fecal MMP-9 levels have never been measured. Our aims were: 1) to compare fecal MMP-9 levels in UC patients to control subjects and a functional gastrointestinal disorder characterized by diarrhea (IBS-D); 2) to test the correlation between UC disease activity and fecal levels of MMP-9; and 3) to correlate fecal MMP-9 levels with a known fecal marker of UC activity, calprotectin. Methods: UC (n 1/4 47), IBS-D (n 1/4 23) patients, and control subjects (n 1/4 24) provided fecal samples for MMP-9 analysis. In UC patients, disease severity was evaluated by the Mayo score. Fecal MMP-9 and calprotectin levels were measured by enzyme-linked immunosorbent assay and lateral flow assay, respectively. Results: MMP-9 was undetectable or #0.22 ng/mL in the feces of all controls and IBS-D patients. In UC patients, fecal MMP-9 levels significantly correlated with the overall Mayo score (P , 0.001), the endoscopic score (P , 0.001), and the serum C-reactive protein levels (P 1/4 0.002). Additionally, in UC patients fecal MMP-9 levels showed a significant correlation with a known disease activity marker, fecal calprotectin (P 1/4 0.014). Conclusions: These results highlight fecal MMP-9 as a useful tool in the differential diagnosis of diarrheic disorders and in the noninvasive evaluation of disease activity and mucosal healing in UC.

Original languageEnglish
Pages (from-to)316-320
Number of pages5
JournalInflammatory bowel diseases
Issue number2
Publication statusPublished - Feb 1 2013



  • Calprotectin
  • Disease activity score
  • MMP-9
  • Ulcerative colitis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

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