Inflammatory bowel diseases (IBDs), i.e., Crohn's disease (CD) and ulcerative colitis (UC), are characterized by chronic relapsing inflammatory disorders of the gastrointestinal tract, impairing quality of life. [1][2][3][4][5] Although the etiology of IBDs still remains unclear, nationwide epidemiologic studies have clarified that the geographic incidence varies substantially, with higher rates in Northern and Western Europe, and Northern America than in Central and Southern Europe and many developing countries.2-5) Epidemiologic and linkage studies strongly suggested the importance of a genetic factor for susceptibility to IBDs, but a genome-wide screening has identified a number of candidate loci, indicating the complexity of IBDs.6) Among candidates, recent attention has focused on the gene MDR1/ABCB1 and its product, multidrug resistant transporter MDR1/P-glycoprotein, which is a glycosylated membrane protein of 170 kDa, belonging to the ATP-binding cassette superfamily of membrane transporters, [7][8][9][10][11][12] as a consequence of several non-clinical and clinical investigations as summarized below. In 1998, Panwala et al. reported that mdr1a-/-knock-out mice were susceptible to a spontaneous UC-like intestinal inflammation under specific pathogen-free conditions. 13) Since mdr1a-/-knock-out mice are immunologically normal, the development of spontaneous colitis is presumably due to a defect in the barrier function of the intestinal epithelium. They also indicated that infection with Helicobacter bilis induced diarrhea, weight loss, and IBDs in mdr1a-/-knockout mice.14-16) Macroscopic, microscopic and biochemical examinations have confirmed that the colitis which develops in this model is similar to that of human IBDs, [14][15][16][17] and very recently, it has been confirmed that MDR1 mRNA expression in colonic tissues is down-regulated in patients with UC, but not with CD.18) Next, MDR1 is located on chromosome 7 at q21.1, 19) which was one of the loci of susceptibility toIBDs identified by a genome-wide analysis in an UK cohort, 6) and the linkage in this region has recently been confirmed by genome scan meta-analysis. 20) Finally, in 2003Finally, in -2005, independent groups in Germany and Scotland indicated that a silent genetic polymorphism in exon 26, C3435T, is associated with susceptibility to UC, but not to CD, 21,22) though the results are disputed. [23][24][25][26] In the present study, the MDR1 polymorphisms of T-129C in the promoter region, a silent C1236T in exon 12, G2677A, T in exon 21, resulting in Ala893Thr and Ala893Ser, respectively, and C3435T were examined in 66 Japanese UC patients and 173 healthy subjects, and their value for predicting UC was analyzed independently. The effects of the G2677T/C3435T haplotype proposed by Johne et al. were also evaluated,27) as well as those of the haplotype assigned by 4 polymorphisms. Here, the patients were stratified into 2 subpopulations based on age at onset; early onset patients and later onset patients, since epidemiologic investigatio...