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While traditional therapies are often employed before surgical interventions, pharmacotherapy is typically reserved for cases of unstable AS condition. The gut microbiota has been implicated in numerous pathological conditions. However, its specific role in AS remains poorly understood. To address this knowledge gap, we applied Mendelian randomization (MR) to explore potential causal relationships between gut microbiota and AS. For this analysis, we utilized two large-scale genome-wide association study datasets: one comprising 18\u2009340 individuals across 24 cohorts for human gut microbiota, and another consisting of 9069 AS cases and 1550 controls for AS susceptibility. Following heterogeneity testing, assessment of horizontal pleiotropy and application of multiple MR methods and \u2018leave-one-out\u2019 analysis, we identified 10 bacterial traits associated with AS risk. These include four risk-increasing factors: Actinobacteria (class), Streptococcaceae (family), Enterorhabdus (genus), and the Ruminococcaceae NK4A214 group (genus); and six risk-decreasing factors: Lactobacillaceae (family), Rikenellaceae (family), Anaerotruncus (genus), Eubacterium oxidoreducens group (genus), Howardella (genus), and Oscillibacter (genus). This study provides novel insights into the gut-spine axis and suggests potential avenues for AS management through microbiota-targeted interventions.<\/jats:p>","DOI":"10.1093\/femsle\/fnag016","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:43:08Z","timestamp":1769776988000},"source":"Crossref","is-referenced-by-count":2,"title":["Affinity between gut microbiota and ankylosing spondylitis: insight from causal analysis"],"prefix":"10.1093","volume":"373","author":[{"given":"Zengkun","family":"Li","sequence":"first","affiliation":[{"name":"Key Laboratory of Emergency and Trauma of Ministry of Education, Key Laboratory of Haikou Trauma, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital, Hainan Medical University , Haikou 571199 ,","place":["China"]},{"name":"Hainan Medical University Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Emergency Surgery, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital, , Haikou 570102 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianying","family":"Pei","sequence":"additional","affiliation":[{"name":"Gansu Province Maternal and Child-Care Hospital , Lanzhou 730050 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiangwen","family":"Ruan","sequence":"additional","affiliation":[{"name":"The People\u2019s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences , Nanning 530021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongwang","family":"Cui","sequence":"additional","affiliation":[{"name":"Hainan Medical University Key Laboratory of Emergency and Trauma of Ministry of Education, Department of Emergency Surgery, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital, , Haikou 570102 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shicheng","family":"Li","sequence":"additional","affiliation":[{"name":"The People\u2019s Hospital of Guangxi Zhuang Autonomous Region, Guangxi Academy of Medical Sciences , Nanning 530021 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4282-6770","authenticated-orcid":false,"given":"Tongmeng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Emergency and Trauma of Ministry of Education, Key Laboratory of Haikou Trauma, Key Laboratory of Hainan Trauma and Disaster Rescue, The First Affiliated Hospital, Hainan Medical University , Haikou 571199 ,","place":["China"]},{"name":"NHC Key Laboratory of Tropical Disease Control, Engineering Research Center for Hainan Bio-Smart Materials and Bio-Medical Devices, School of Life Sciences and Medical Technology, Hainan Medical University , Haikou 571199 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