title: Fecal MMP-9: a new noninvasive differential diagnostic and activity marker in ulcerative colitis.
abstract: BACKGROUND
  Ulcerative colitis (UC) is characterized by frequent relapses, with the presence of colorectal inflammation and mucosal lesions. Matrix-metalloprotease 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 = 47), IBS-D (n = 23) patients, and control subjects (n = 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 = 0.002). Additionally, in UC patients fecal MMP-9 levels showed a significant correlation with a known disease activity marker, fecal calprotectin (P = 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.
authors.affiliation: First Department of Medicine, University of Szeged, Szeged, Hungary. annanita3@yahoocom
authors.forename: Anita
authors.initials: A
authors.lastname: Annaházi
authors.forename: Tamás
authors.initials: T
authors.lastname: Molnár
authors.forename: Klaudia
authors.initials: K
authors.lastname: Farkas
authors.forename: András
authors.initials: A
authors.lastname: Rosztóczy
authors.forename: Ferenc
authors.initials: F
authors.lastname: Izbéki
authors.forename: Krisztina
authors.initials: K
authors.lastname: Gecse
authors.forename: Orsolya
authors.initials: O
authors.lastname: Inczefi
authors.forename: Ferenc
authors.initials: F
authors.lastname: Nagy
authors.forename: Imre
authors.initials: I
authors.lastname: Földesi
authors.forename: Mónika
authors.initials: M
authors.lastname: Szűcs
authors.forename: Marta
authors.initials: M
authors.lastname: Dabek
authors.forename: Laurent
authors.initials: L
authors.lastname: Ferrier
authors.forename: Vassilia
authors.initials: V
authors.lastname: Theodorou
authors.forename: Lionel
authors.initials: L
authors.lastname: Bueno
authors.forename: Tibor
authors.initials: T
authors.lastname: Wittmann
authors.forename: Richárd
authors.initials: R
authors.lastname: Róka
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000150:complications / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D003113:Colonoscopy; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000209:etiology; D004797:Enzyme-Linked Immunosorbent Assay; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000175:diagnosis / Q000378:metabolism; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism*; D008875:Middle Aged; D012372:ROC Curve; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex; D020780:Matrix Metalloproteinase 9