MMP-9 and non-invasive markers in evaluating MASLD and atherosclerosis

Matrix metalloproteinases (MMP-9) play a vital role in extracellular matrix remodeling in metabolic-associated steatotic liver disease (MASLD) and cardiovascular diseases such as atherosclerosis. This study assesses MMP-9 levels in conjunction with non-invasive scoring systems (BAAT, BARD, FIB-4, NAFLD Fibrosis Score, and the ALT/AST ratio) aiming to enhance early diagnosis and disease monitoring.

The study included 88 participants: 25 normal individuals and 63 MASLD patients with varying grades (S1 to S3). Atherosclerosis was staged into four stages. The current study measured MMP-9 concentrations in MASLD patients and analyzed their correlation with MASLD grades, atherosclerosis stages, and non-invasive scoring systems (BAAT, BARD, FIB-4, NAFLD Fibrosis Score, and the ALT/AST ratio).

Elevated MMP-9 levels were significantly associated with S2 and S3 MASLD grades (p = 0.02, 0.04; respectively) compared to controls and atherosclerosis progression (p = 0.05). Although ROC analysis showed AUC = 0.90 for discriminating advanced plaque, only two patients in our cohort had advanced plaque, which limits the generalizability of this result. Spearman correlation analysis reveals a positive correlation between MMP-9 concentration and the progression of MASLD (r = 0.4, p ≤ 0.01), atherosclerosis (r = 0.3, p ≤ 0.05), and BAAT (r = 0.254, p ≤ 0.05). BAAT score also correlated with BARD and FIB-4 scores ((r = 0.3, p ≤ 0.05, and r = 0.5 p ≤ 0.01; respectively). The highest correlation was seen between NAFLD Fibrosis score and FIB-4 (r = 0.7, p ≤ 0.01).

MMP-9 is a probable biomarker for assessing MASLD and may improve cardiovascular risk evaluation, especially when combined with BAAT score.