Fecal calprotectin, MMP-9, and human beta-defensin-2 levels in pediatric inflammatory bowel disease.
OBJECTIVE
Fecal MMP-9 and human beta-defensin-2 (HBD-2)levels, potential markers of intestinal inflammation, are in sufficiently explored in pediatric inflammatory bowel disease(IBD). The aim was to study fecal MMP-9 and HBD-2 in pediatric IBD to compare their performance to calprotectin and to study whether they would provide additional value in categorizing patients according to their disease subtype.


METHODS
Fecal calprotectin, MMP-9, and HBD-2 levels were measured with ELISA in 110 pediatric patients with IBD(Crohn’s disease, n = 68; ulcerative colitis (UC), n = 27; unclassified, n = 15; median age, 14). To compare the performance of the fecal markers, the area under the receiver operating characteristics curve (±95 % CI) was used. In addition,the best cut-off values of each measure to differentiate IBD patients and controls (n = 27 presenting with diarrhea, abdominal pain, and/or anemia) were derived by maximizing sensitivity and specificity.


RESULTS
Of the fecal markers studied, calprotectin performed best for separation of IBD and non-IBD patients with the are a under curve (AUC) of 0.944 (95 % CI, 0.907 to 0.981). For MMP-9, AUC was 0.837 (95% CI, 0.766 to 0.909), the levels being significantly higher in active IBD and in UC compared with Crohn’s disease (p = 0.0013), but categorization of these patient groups did not take place. HBD-2 did not categorize any of the studied groups.


CONCLUSIONS
Calprotectin was the best fecal marker in pediatric IBD, but MMP-9 showed almost comparable performance in UC, suggesting applicability as a surrogate marker of inflammation. Fecal HBD-2 did not bring information to the disease characteristics of pediatric IBD patients.
Kaija-Leena
KL
Kolho
Taina
T
Sipponen
Elsa
E
Valtonen
Erkki
E
Savilahti
D000293:Adolescent; D015415:Biomarkers / Q000378:metabolism; D002648:Child; D005243:Feces / Q000201:enzymology*; D005260:Female; D006801:Humans; D007223:Infant; D007249:Inflammation / Q000473:pathology; D015212:Inflammatory Bowel Diseases / Q000188:drug therapy / Q000201:enzymology / Q000378:metabolism* / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000378:metabolism*; D008297:Male; D020780:Matrix Metalloproteinase 9 / Q000378:metabolism*; D012372:ROC Curve; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors / Q000378:metabolism; D023083:beta-Defensins / Q000378:metabolism*
D015415:Biomarkers; C106641:DEFB4A protein, human; D039841:Leukocyte L1 Antigen Complex; D014409:Tumor Necrosis Factor-alpha; D023083:beta-Defensins; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9