Abstract Background Approximately 60% of patients with ulcerative colitis (UC) exhibit steroid resistance or dependence, highlighting the need for reliable biomarkers to predict therapeutic response1. This study employed a systems biology and machine learning approach to integrate microRNA (miR) and mRNA expression data from both rectal biopsies and plasma samples from UC patients undergoing corticosteroid therapy, aiming to uncover the molecular mechanisms underlying steroid refractoriness. Methods Whole-transcriptome and miR profiling were performed at baseline and after three days of corticosteroid therapy. Corticosteroid-treated UC patients were classified as responders (R) or non-responders (NR) after seven days of treatment. Mathematical modelling and protein-miR interaction mapping were used to identify mechanistically relevant biomarker candidates. Selected findings were validated in a TNBS-induced colitis mouse model. Results Key transcriptional co-regulators such as NCOA3, CBP, NCOR1, and NRIP1 were differentially expressed between R and NR, influencing glucocorticoid receptor (GCR) signalling. Multiple miRNAs, including miR-145-5p, miR-10b-5p, and miR-16-5p, were identified as potential biomarkers and regulators of inflammatory and GCR-related pathways. The cross-correlation between plasma and tissue miRs revealed consistent molecular patterns, some of which were also conserved in the murine model, supporting the existence of cross-species steroid response mechanisms. Conclusion This integrative multi-omic approach provides new insights into molecular steroid-refractoriness in UC and offers a promising framework for developing predictive tools and advancing personalised therapeutic strategies in inflammatory bowel disease. Reference: 1. Llaó J et al. J Crohns Colitis. 2014;8(11). Conflict of interest: Dr. Ginés Mir, Iris: No conflict of interest Suau, Roger: No conflict of interest Naves, Juan E.: No conflict of interest Bernal, Carla: No conflicts Clua, Laura: No conflict of interest Monfort-Ferré, Diandra: No conflict of interest Pluvinet, Raquel: No conflict of interest Sánchez Herrero, José Francisco: No conflict of interest Segú, Cristina: No conflict of interest Aransay, Ana Maria: No conflict of interest Mañosa Ciria, Miriam: No conflict of interest Sumoy, Lauro: No conflict of interest Serena, Carolina: No conflict of interest Domènech Moral, Eugeni: No conflict of interest Manyé Almero, Josep: No conflict of interest
Mir et al. (Thu,) studied this question.