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Epigenetic modifications, especially DNA methylation, have become a research hotspot in complex diseases. We aim to explore the changes in runt\u2010related transcription factor 2 (RUNX2) gene promoter methylation and transcription level in AS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We detected the RUNX2 gene promoter methylation in 83 AS patients and 83 healthy controls (HCs), then inspected the mRNA difference of RUNX2 between 30 AS patients and 30 HCs by the quantitative real\u2010time reverse transcription polymerase chain reaction (qRT\u2010PCR).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The RUNX2 gene promoter was hypomethylated in AS patients compared to HCs (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). The research involved 4 CpG regions and 74 CpG sites of RUNX2, of which CpG\u20102, CpG\u20104 regions, and 18 CpG sites have been differentially methylated. The CpG\u20104 island methylation was negatively correlated with C\u2010reactive protein (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05) in AS patients. In the qRT\u2010PCR validation phase, the mRNA level of RUNX2 in AS patients was significantly higher than HCs (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05), and in AS patients who were treated with biologics, the methylation level of CpG\u20102 island showed a negative correlation to mRNA (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.05). ROC results indicated that RUNX2 methylation and its transcription level have good potential to distinguish AS patients from HCs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The RUNX2 gene promoter was hypomethylated in AS patients. Meanwhile, the qRT\u2010PCR verified the up\u2010regulated expression on the transcription level, suggesting the abnormal methylation of RUNX2 contributes to the pathogenesis of AS.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1756-185x.14955","type":"journal-article","created":{"date-parts":[[2023,10,30]],"date-time":"2023-10-30T12:41:36Z","timestamp":1698669696000},"page":"2526-2533","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Differences of <scp>RUNX2<\/scp> gene promoter methylation and transcription level in ankylosing spondylitis"],"prefix":"10.1111","volume":"26","author":[{"given":"Feier","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health Anhui Medical University  Hefei China"},{"name":"The Key Laboratory of Major Autoimmune Diseases Anhui Medical University  Hefei 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