As noted by my previous blog (New Way to Diagnose Biliary Atresia), I am enthusiastic about the development of MMP-7 (Serum Matrix Metalloproteinase-7) as a biomarker for biliary atresia.

A new study (Wu J-F , Jeng Y-M, Chen H-L, Ni Y-H, Hsu H-Y, Chang M-H. Quantification of serum matrix metallopeptide 7 levels may assist the diagnosis and outcome prediction for biliary atresia. J Pediatr. 2019;208:30–7) and associated editorial provide additional data and nuance.

• S Harpavat. J Pediatr DOI: https://doi.org/10.1016/j.jpeds.2019.01.026 Full text of editorial: MMP-7: The Next Best Serum Biomarker for Biliary Atresia?

Key points:

• “Wu et … studied 100 cholestatic infants presenting consecutively to their institution over a 10-year period, including 36 eventually diagnosed with biliary atresia. Median serum MMP-7 levels were significantly higher in biliary atresia at the time of diagnosis, with an optimal serum MMP-7 level of >1.43 ng/mL for predicting biliary atresia.  In comparison, similarly high MMP-7 levels were found in only 1 infant who was cholestatic without biliary atresia.”
• “The authors found that serum MMP-7 levels were significantly lower in the 14 infants ≤30 days old diagnosed with biliary atresia, compared with the 22 infants >30 days old at diagnosis. In some cases, serum MMP-7 levels in younger infants with biliary atresia overlapped with those from infants with other liver diseases, such as neonatal hepatitis.”
• After Kasai portoenterostomy: “Serum MMP-7 levels were significantly higher 6 months post-Kasai portoenterostomy in infants who later required liver transplant, with a serum MMP-7 level of >10.30 mg/dL optimally predicting transplant 3-4 years after Kasai portoenterostomy … serum MMP-7 levels are still high even in patients who do not need liver transplant.”
• The authors “highlight 1 complication with using serum MMP-7 levels: values can vary widely among different enzyme-linked immunosorbent assay kits used.”

Related blog posts:

• Blood Test is Better Than a Liver Biopsy for Bilary Atresia
• Will We Still Need a Liver Biopsy to Diagnose Biliary Atresia in a Few Years?
• Helpful Review on Biliary Atresia | gutsandgrowth
• Newborn bilirubin measurements for biliary atresia
• Neonatal cholestasis for neonatologists
• Guideline links for TEF and Infant Cholestasis
• Neonatal Cholestasis Lecture
• Diagnosing biliary atresia earlier | gutsandgrowth

Sagrada Familia -work in progress.  Amazing.