TOPLINE:

Children with newly diagnosed ulcerative colitis (UC) had higher serum levels of lipocalin‑2 (LCN-2), matrix metalloproteinase‑9 (MMP-9), and MMP‑9/LCN‑2 complex than their healthy peers, with LCN-2 showing the best diagnostic performance.

METHODOLOGY:

• Endoscopy is routinely used to monitor disease activity in inflammatory bowel disease but is limited by cost, access, and risk for complications, whereas common biomarkers often lack accuracy and consistency.
• Researchers conducted a prospective, cross‑sectional observational study to measure serum levels of LCN‑2, MMP‑9, and the MMP‑9/LCN‑2 complex in children aged 6-18 years with newly diagnosed UC and to correlate these levels with disease severity.
• They included treatment‑naive children with UC at a pediatric unit in Rome, Italy, between 2023 and 2024, and age- and sex-matched them with healthy children undergoing routine blood testing.
• Assessments included clinical evaluation using the pediatric UC activity index, standard laboratory tests, endoscopic evaluation using the UC endoscopic index of severity (UCEIS), and measurement of serum levels of LCN-2, MMP-9, and the MMP-9/LCN-2 complex.
• Researchers evaluated the diagnostic performance of each biomarker using measures such as the area under the receiver operating characteristic curve (AUROC), sensitivity, and specificity to distinguish healthy children from patients and to stratify disease severity and extent.

TAKEAWAY:

• The analysis included 32 children with newly diagnosed UC (mean age, 11.86 years; 34% girls) and 38 healthy children (mean age, 11.47 years). Children with UC had higher mean serum levels of LCN-2, MMP-9, and the MMP-9/LCN-2 complex than their healthy peers (P < .0001 for all).
• LCN-2 had the highest AUROC and overall diagnostic performance across all parameters, outperforming both MMP-9 and the MMP-9/LCN-2 complex in distinguishing children with UC from healthy children.
• Levels of LCN-2 and MMP-9 were higher among children with moderate-to-severe endoscopic disease activity (UCEIS > 4) than among those with mild disease (UCEIS ≤ 4; P = .03 for both), while MMP-9/LCN-2 complex levels did not differ.
• LCN-2 levels were inversely correlated with albumin levels (Spearman correlation rho [r] = -0.47; P = .01), whereas MMP-9 levels correlated positively with C-reactive protein levels (r = 0.42; P = .02) and UCEIS (r = 0.57; P = .004).

IN PRACTICE:

“Our findings suggest that the serum free form of LCN-2, rather than its conjugated form with MMP-9 (the MMP-9/LCN-2 complex), could have clinical utility,” the authors wrote. “First, it may help distinguish the extent of colonic involvement, and second, it could assist in assessing its relationship with UC severity, potentially addressing the limitations of current biomarkers.”

SOURCE:

The study was led by Giulia D’Arcangelo, Sapienza University of Rome, Italy. It was published online in Digestive and Liver Disease.

LIMITATIONS:

The study included only 32 children with UC; thus, the findings had limited generalizability. Researchers did not include tissue or fecal tests to confirm that serum markers reflected colonic inflammation. The study had no follow‑up or validation cohort.

DISCLOSURES:

The research did not receive any external funding. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.