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P177 Faecal metalloprotease 9 is a reliable biomarker compared with faecal calprotectin in detecting endoscopic activity in patients with inflammatory bowel diseases.

A. Buisson*1, 2, E. Vazeille1, 2, R. Minet Quinard3, M. Goutte1, 2, D. Bouvier3, F. Goutorbe1, B. Pereira4, N. Barnich2, G. Bommelaer1, 2

1University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France, 2UMR 1071 Inserm/Université d’Auvergne; USC-INRA 2018, Microbes, Intestine, Inflammation and Susceptibility of the host, Clermont-Ferrand, France, 3University Hospital G. Montpied, Biochemistry laboratory, Clermont-Ferrand, France, 4GM – Clermont-Ferrand University and Medical Centre, Biostatistics Unit, Clermont-Ferrand, France

Background

As mucosal healing is to date the therapeutic goal to achieve in inflammatory bowel diseases (IBD), non-invasive tools are warranted to avoid repeated colonoscopies. Amongst them, faecal calprotectin (fCal) correlated with endoscopic scores and was able to detect endoscopic ulcerations in IBD. Matrix metalloprotease 9 (MMP-9) is involved in the degradation of the extracellular matrix and could play a role in the neutrophils trafficking and the angiogenesis. In the present study, we aimed to evaluate the accuracy of using faecal MMP-9 compared with fCal in detecting endoscopic activity in IBD.

Methods

Overall, 86 IBD adults underwent consecutively and prospectively colonoscopy, with Crohn’s disease (CD) Endoscopic Index of Severity (CDEIS) or Mayo endoscopic sub-score calculation for ulcerative colitis (UC), and stool collection. FCal was measured using quantitative immunochromatographic test. Faecal MMP-9 was quantified by ELISA. MMP-9 cut-off value was determined using a receiver operating curve.

Results

In 54 CD patients, faecal MMP-9 and calprotectin levels significantly correlated with CDEIS. The median values of faecal MMP-9 and fCal were respectively 38-fold and 9-fold higher in the CD patients presenting with endoscopic ulcerations than in those with no ulcer (p = 0.01 and p = 0.003, respectively). In ileal CD, faecal MMP-9 seemed to be better correlated with CDEIS than fCal (ρ = 0.73 vs ρ = 0.62, p < 0.001 for both). MMP-9 >350 ng/g detected endoscopic ulcerations in Crohn’s disease with a sensitivity of 0.90 and a specificity of 0.64, compared with faecal calprotectin > 250μg/g, showing a sensitivity of 0.90 and a specificity of 0.59 (Table 1). In 32 UC patients, faecal MMP-9 and calprotectin levels correlated with Mayo endoscopic sub-score (ρ = 0.58 and ρ = 0.57, respectively, p < 0.001 for both) and were significantly increased in ulcerative colitis patients with endoscopic activity (Figure 1).

Figure 1. Distribution of faecal calprotectin and faecal metalloprotease levels according to endoscopic activity in ulcerative colitis.

In UC patients, faecal MMP-9 > 900 ng/g predicted endoscopic activity (defined as Mayo endoscopic sub-score ≥ 2) with a sensitivity of 0.91 and a specificity of 0.80, compared with faecal calprotectin > 250 μg/g showing a sensitivity of 0.86 and a specificity of 0.80 (Table 1).

Table 1 Performances of faecal calprotectin and faecal matrix metalloprotease in detecting endoscopic ulcerations in Crohn’s disease and endoscopic activity (Mayo endoscopic sub-score > 1) in ulcerative colitis

Conclusion

Faecal MMP-9 measurement could be a reliable assay to assess endoscopic activity in IBD. These data should be confirmed in independent cohorts.