Fecal calprotectin, MMP-9, and human beta-defensin-2 levels in pediatric inflammatory bowel disease

Int J Colorectal Dis. 2014 Jan;29(1):43-50. doi: 10.1007/s00384-013-1775-9.


Purpose: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Biomarkers / metabolism
  • Child
  • Feces / enzymology*
  • Female
  • Humans
  • Infant
  • Inflammation / pathology
  • Inflammatory Bowel Diseases / drug therapy
  • Inflammatory Bowel Diseases / enzymology
  • Inflammatory Bowel Diseases / metabolism*
  • Inflammatory Bowel Diseases / pathology
  • Leukocyte L1 Antigen Complex / metabolism*
  • Male
  • Matrix Metalloproteinase 9 / metabolism*
  • ROC Curve
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • Tumor Necrosis Factor-alpha / metabolism
  • beta-Defensins / metabolism*


  • Biomarkers
  • DEFB4A protein, human
  • Leukocyte L1 Antigen Complex
  • Tumor Necrosis Factor-alpha
  • beta-Defensins
  • MMP9 protein, human
  • Matrix Metalloproteinase 9