Serum Matrix Metalloproteinase-7 as a Diagnostic and Prognostic Biomarker for Extrahepatic Biliary Atresia

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Aim: Serum Matrix metalloproteinase-7 as a diagnostic and prognostic biomarker for extrahepatic biliary atresia Methods: This was a prospective, single center, case control study where consecutive infants less than 6 months of age with obstructive jaundice (n=20) at MAMC from April 2021 to March 2023 were enrolled. Age and sex-matched controls (n=20) were also taken. Serum MMP-7 were tested in all 40 infants. In Case group, additional tests performed were, CBC, LFT to derive APRI and FIB-4 scores, Ultrasound Abdomen, Hepatobiliary scintigraphy, Per-operative cholangiogram, Pre and/or intraoperative liver biopsy. The Results: participants were substratied into EHBA (n = 11) and NH (n = 9) based on post priming hepatobiliary scintigraphy and Per-operative cholangiogram. Median serum MMP-7 level in EHBA was 23 ng/ml that was found to be 6 times higher than Neonatal hepatitis and 13 times higher than in normal infants. Median serum MMP-7 levels in NH group and normal infants were 4ng/ml and 1.8ng/ml respectively. MMP-7 values in males were higher than 4.99 (based on the cut offs from review of literature) that was statistically signicant as compared to female counter parts (p<0.05). Based on age categorization, almost 50% of children <90 days old and all children >90 days had MMP-7 value >4.99 which had signicant statistical values for both case and control groups (p<0.05). The Metavir and Ishak brosis category were divided into F0 – no brosis, Early and Advanced brosis stages. From among the Metavir brosis group which did not have any brosis, 33.3% had MMP-7 >4.99, whereas all patients from early and advanced stages had MMP-7 >4.99. Conclusion: oncentrations of MMP-7 in EHBA may be used to substratify patients of neonatal cholestasis into EHBA and NH. The strong correlation of MMP-7 with histopathological injury has also suggested that MMP-7 may be used as a prognostic biomarker of liver brosis in EHBA.