Serum matrix metalloproteinase-7 as a diagnostic and prognostic biomarker in primary biliary cholangitis

Objectives This study aimed to assess the diagnostic and prognostic value of serum matrix metalloproteinase-7 (MMP-7) in patients with primary biliary cholangitis (PBC). Methods Serum MMP-7 was measured using chemiluminescence immunoassay in 184 PBC patients and 94 healthy controls. PBC patients were stratified into cirrhotic ( n = 75) and non-cirrhotic ( n = 109) subgroups; 65 underwent liver biopsy with Ludwig classification. Liver function tests, platelet count, the aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) were assessed. Diagnostic performance was evaluated via group comparisons, Spearman correlation, and receiver operating characteristic curve analysis. Results MMP-7 levels were significantly higher in PBC patients compared with healthy controls [5.12 (3.73–6.97) vs. 2.46 (1.93–2.84) ng/mL, p < 0.001], and further elevated in cirrhotic vs. non-cirrhotic [6.99 (5.80–11.80) vs. 4.11 (3.59–5.25) ng/mL] and in advanced vs. early fibrosis [7.13 (5.78–11.02) vs. 3.83 (3.52–5.61) ng/mL; p < 0.001]. For cirrhosis discrimination, MMP-7 achieved an area under the curve (AUC) of 0.830 (95% CI: 0.765–0.894); combining it with APRI/ FIB-4 did not significantly improve accuracy (combined AUC = 0.849, p = 0.224). For advanced fibrosis, AUC was 0.877 (95% CI: 0.794–0.959). MMP-7 correlated with APRI, FIB-4, and histological stage ( p < 0.01). After 3–4 months of ursodeoxycholic acid treatment, MMP-7 decreased significantly and paralleled alkaline phosphatase decline. Conclusion Serum MMP-7 is elevated in PBC and correlates with disease severity, including cirrhosis and advanced fibrosis. It shows robust diagnostic performance as a standalone biomarker and demonstrates promise for monitoring treatment response, underscoring its potential clinical utility as a complementary non-invasive tool in PBC management.