{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T22:02:26Z","timestamp":1780524146549,"version":"3.54.1"},"reference-count":74,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T00:00:00Z","timestamp":1737504000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Ulcerative colitis (UC) is a chronic inflammatory disorder of the colon. Several preclinical studies investigated the beneficial effects of atorvastatin in colitis. Activation of sphingosine 1 phosphate (S1P)\/ tumor necrosis factor-alpha (TNF-<jats:italic>\u03b1<\/jats:italic>)\/ interleukin-6 (IL-6) pathways has been confirmed in the pathogenesis of UC and preclinical studies proved the efficacy of atorvastatin on these pathways.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To investigate the role of atorvastatin on S1P\/TNF-<jats:italic>\u03b1<\/jats:italic>\/IL-6 pathway in UC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients with mild to moderate UC were allocated into two groups in this pilot study. For 6\u202fmonths, Group 1 (placebo group) received both a placebo and 1\u202fg of mesalamine three times daily (t.i.d.). Group 2, (the atorvastatin group) received atorvastatin 80\u202fmg once daily and 1\u202fg of mesalamine t.i.d. A gastroenterologist evaluated the patients\u2019 colitis severity by partial Mayo score index (PMS). Serum IL-6, S1P, TNF-<jats:italic>\u03b1<\/jats:italic>, nitric oxide (NO), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and fecal calprotectin were measured before and after treatment. Short Form 36 questionnaire (SF-36) was also assessed. A clinical response was defined as a decline in the rectal bleeding sub score of at least one point, and a decrease in PMS of at least two points. Clinical remission was defined as a PMS of less than 2 and the absence of any single sub score greater than 1.<\/jats:p><\/jats:sec><jats:sec><jats:title>Primary outcome<\/jats:title><jats:p>Decreased PMS and improved quality of life.<\/jats:p><\/jats:sec><jats:sec><jats:title>Secondary outcome<\/jats:title><jats:p>Change in the level of measured biomarkers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared to the placebo group (<jats:italic>n<\/jats:italic>\u202f=\u202f24), the atorvastatin group (<jats:italic>n<\/jats:italic>\u202f=\u202f23) exhibited a significant decrease in the level of IL-6 (<jats:italic>p<\/jats:italic>\u202f=\u202f0.001), S1P (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0001), TNF-<jats:italic>\u03b1<\/jats:italic> (<jats:italic>p<\/jats:italic>\u202f=\u202f0.003), NO (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0001), CRP (<jats:italic>p<\/jats:italic>\u202f=\u202f0.015), ESR (<jats:italic>p<\/jats:italic>\u202f=\u202f0.012), PMS (<jats:italic>p<\/jats:italic>\u202f=\u202f0.013), and fecal calprotectin (<jats:italic>p<\/jats:italic>\u202f=\u202f0.0003), and improved SF-36 (<jats:italic>p<\/jats:italic>\u202f=\u202f0.006). In placebo group, the response rate was 83.33% (<jats:italic>n<\/jats:italic>\u202f=\u202f20\/24) for PMS, and the remission rate was 45.83% (<jats:italic>n<\/jats:italic>\u202f=\u202f11\/24). In the atorvastatin group, the response rate was 91.3% (<jats:italic>n<\/jats:italic>\u202f=\u202f21\/23), and the remission rate was 60.8% (<jats:italic>n<\/jats:italic>\u202f=\u202f14\/23) for PMS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Atorvastatin could be an adjunctive therapy for patients with UC.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:ext-link>https:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>, Identifier NCT05561062.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1490178","type":"journal-article","created":{"date-parts":[[2025,1,22]],"date-time":"2025-01-22T07:18:20Z","timestamp":1737530300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":12,"title":["Effect of a high dose atorvastatin as adjuvant therapy to mesalamine in attenuating inflammation and symptoms in patients with ulcerative colitis: a randomized controlled pilot study"],"prefix":"10.3389","volume":"11","author":[{"given":"Sumaiah J.","family":"Alarfaj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar M.","family":"El-Haggar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahar K.","family":"Hegazy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maha M.","family":"Maher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monir M.","family":"Bahgat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thanaa A.","family":"Elmasry","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Alrubia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amsha S.","family":"Alsegiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mostafa M.","family":"Bahaa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,22]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"380","DOI":"10.1016\/j.cgh.2018.08.001","article-title":"AGA clinical practice update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review","volume":"17","author":"Colombel","year":"2019","journal-title":"Clin Gastroenterol Hepatol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"2471","DOI":"10.3390\/ijms19092471","article-title":"Advances in imaging specific mediators of inflammatory bowel disease","volume":"19","author":"Dmochowska","year":"2018","journal-title":"Int J Mol 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