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Ulcerative colitis (UC) is characterized by epithelial barrier disruption, mucosal immune activation, and sustained intestinal inflammation. We developed a biologically interpretable public-transcriptomic signature using Gene Expression Omnibus datasets GSE75214, GSE38713, and GSE92415. A literature-curated panel of 35 mucosal barrier injury-related genes was integrated with differential expression, LASSO regression, random forest prioritization, and ridge logistic regression. Six genes ( LCN2 , DEFB1 , S100A8 , MUC1 , VIL1 , and TJP3 ) were retained as a locked transcriptomic score. Because the original feature-selection steps used the complete development cohort, we added 50 repetitions of stratified five-fold outer cross-validation. All preprocessing and ridge tuning were restricted to each outer-training fold; the locked score achieved a mean out-of-fold AUC of 0.9660 (SD 0.0031). A stricter sensitivity analysis that repeated differential-expression filtering, LASSO, random-forest ranking, deterministic six-gene selection, and ridge fitting within each outer-training fold achieved a mean out-of-fold AUC of 0.9600 (SD 0.0094). The refitted locked model retained discrimination in GSE38713 (AUC 0.8974, 95% CI 0.8040–0.9909) and GSE92415 (AUC 0.9894, 95% CI 0.9744–1.0000) when one development-derived cutoff was applied unchanged. The six-gene score did not significantly outperform VIL1 alone in the development cohort (DeLong P = 0.4026). The signature should therefore be interpreted as a molecular pattern associated with UC mucosal inflammation and barrier remodeling rather than as a UC-specific clinical diagnostic test.
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he et al. (2026) studied this question.
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