Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization

Abstract This study aimed to identify risk factors and potential targets associated with non-responsiveness to 5-Aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC). Patients with mild to moderate UC were grouped based on their responsiveness to 5-ASA. Regression analysis was conduc...

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Main Authors: Zhi-Ning Ye, Xin-Tian Liu, Yue-Ming Gu, Shu-Xian Mao, Dan-Hong Liang, Kai Zhan, Hao-Qiang Lei, Shao-Gang Huang
Format: Article
Language:English
Published: Nature Portfolio 2025-03-01
Series:Scientific Reports
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Online Access:https://doi.org/10.1038/s41598-025-89620-x
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author Zhi-Ning Ye
Xin-Tian Liu
Yue-Ming Gu
Shu-Xian Mao
Dan-Hong Liang
Kai Zhan
Hao-Qiang Lei
Shao-Gang Huang
author_facet Zhi-Ning Ye
Xin-Tian Liu
Yue-Ming Gu
Shu-Xian Mao
Dan-Hong Liang
Kai Zhan
Hao-Qiang Lei
Shao-Gang Huang
author_sort Zhi-Ning Ye
collection DOAJ
description Abstract This study aimed to identify risk factors and potential targets associated with non-responsiveness to 5-Aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC). Patients with mild to moderate UC were grouped based on their responsiveness to 5-ASA. Regression analysis was conducted to identify risk factors for non-responsiveness, while Mendelian randomization (MR) analysis was used to evaluate the potential targets. Among 50 patients (11 non-responders and 39 responders), non-responders exhibited higher incidences of fever, back pain, allergy history, and ankylosing spondylitis, as well as elevated monocyte count and alanine aminotransferase (ALT) level, but a lower aspartate aminotransferase-to-ALT (AST/ALT) ratio (all P < 0.05). Allergy history was a risk factor (OR 140.50, P = 0.021), while a high AST/ALT ratio was a protective factor (OR 0.001, P = 0.023) for non-responsiveness. The area under the receiver operating characteristic curve for the AST/ALT ratio was 0.80. MR analysis showed that inhibition of the inhibitor of nuclear factor kappa-B kinase subunit alpha (CHUK) by 5-ASA, targeting ALT, increased the risk of UC (OR 1.02, P = 0.002). Our findings suggested that allergy history and the AST/ALT ratio were associated with non-responsiveness to 5-ASA, and CHUK was identified as a potential target for ALT-related non-responsiveness. Trial Registration: ChiCTR2400084086|| http://www.chictr.org.cn/ , Chinese Clinical Trial Registry, 2024-05-10.
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spelling doaj-art-3e0b9cbf5fc547faa6dcc031b69efb8e2025-08-20T02:51:27ZengNature PortfolioScientific Reports2045-23222025-03-0115111310.1038/s41598-025-89620-xRisk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomizationZhi-Ning Ye0Xin-Tian Liu1Yue-Ming Gu2Shu-Xian Mao3Dan-Hong Liang4Kai Zhan5Hao-Qiang Lei6Shao-Gang Huang7The Affiliated Dongguan Hospital of Guangzhou University of Chinese MedicineThe Affiliated Dongguan Hospital of Guangzhou University of Chinese MedicineThe Affiliated Dongguan Hospital of Guangzhou University of Chinese MedicineDepartment of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese MedicineThe Affiliated Dongguan Hospital of Guangzhou University of Chinese MedicineThe Affiliated Dongguan Hospital of Guangzhou University of Chinese MedicineHuangpu People’s Hospital of ZhongshanDepartment of Gastroenterology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou University of Chinese MedicineAbstract This study aimed to identify risk factors and potential targets associated with non-responsiveness to 5-Aminosalicylic acid (5-ASA) in patients with ulcerative colitis (UC). Patients with mild to moderate UC were grouped based on their responsiveness to 5-ASA. Regression analysis was conducted to identify risk factors for non-responsiveness, while Mendelian randomization (MR) analysis was used to evaluate the potential targets. Among 50 patients (11 non-responders and 39 responders), non-responders exhibited higher incidences of fever, back pain, allergy history, and ankylosing spondylitis, as well as elevated monocyte count and alanine aminotransferase (ALT) level, but a lower aspartate aminotransferase-to-ALT (AST/ALT) ratio (all P < 0.05). Allergy history was a risk factor (OR 140.50, P = 0.021), while a high AST/ALT ratio was a protective factor (OR 0.001, P = 0.023) for non-responsiveness. The area under the receiver operating characteristic curve for the AST/ALT ratio was 0.80. MR analysis showed that inhibition of the inhibitor of nuclear factor kappa-B kinase subunit alpha (CHUK) by 5-ASA, targeting ALT, increased the risk of UC (OR 1.02, P = 0.002). Our findings suggested that allergy history and the AST/ALT ratio were associated with non-responsiveness to 5-ASA, and CHUK was identified as a potential target for ALT-related non-responsiveness. Trial Registration: ChiCTR2400084086|| http://www.chictr.org.cn/ , Chinese Clinical Trial Registry, 2024-05-10.https://doi.org/10.1038/s41598-025-89620-xUlcerative colitis5-Aminosalicylic acidResponsivenessAllergyAspartate aminotransferase-to-alanine aminotransferase ratioInhibitor of nuclear factor kappa-B kinase subunit alpha
spellingShingle Zhi-Ning Ye
Xin-Tian Liu
Yue-Ming Gu
Shu-Xian Mao
Dan-Hong Liang
Kai Zhan
Hao-Qiang Lei
Shao-Gang Huang
Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
Scientific Reports
Ulcerative colitis
5-Aminosalicylic acid
Responsiveness
Allergy
Aspartate aminotransferase-to-alanine aminotransferase ratio
Inhibitor of nuclear factor kappa-B kinase subunit alpha
title Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
title_full Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
title_fullStr Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
title_full_unstemmed Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
title_short Risk factors for non-responsiveness to 5-aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and Mendelian randomization
title_sort risk factors for non responsiveness to 5 aminosalicylic acid in patients with ulcerative colitis identified using retrospective clinical study and mendelian randomization
topic Ulcerative colitis
5-Aminosalicylic acid
Responsiveness
Allergy
Aspartate aminotransferase-to-alanine aminotransferase ratio
Inhibitor of nuclear factor kappa-B kinase subunit alpha
url https://doi.org/10.1038/s41598-025-89620-x
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