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The purpose of this study is to investigate whether ONO-4819CD is safe and effective in the treatment of mild to moderate ulcerative colitis.

Ulcerative colitis is a relapsing disease of unknown cause characterized by bloody diarrhea. Therapy usually involves 5-aminosalicylates, corticosteroids and immunosuppressants. However, steroid resistance and dependency can become problematic. Immunosuppressive drugs, such as azathioprine, are beneficial but may have serious side effects. Therefore, new therapeutic approach is needed.

Prostaglandin E2 is one of the prostanoids, which is involved with innate immunity. PGE2 induces oral tolerance to specific antigen in the small intestine and downregulates the production and release of proinflammatory cytokines by macrophages and neutrophils. Accordingly, PGE2 is considered to be the mediator of mucosal protection.

Recently, it was elucidated that disruption of EP4 gene, which is one of PGE receptors, caused severe colitis in mice. Moreover, EP4-selective agonist (AE1-734) was also revealed to ameliorate severe dextran sodium sulfate-induced colitis in mice. We therefore examined the effects of 2 weeks intravenous EP4-selective agonist therapy for patients with mild to moderate ulcerative colitis.

Inclusion Criteria:

1. Clinical diagnosis of ulcerative colitis
2. Mild to moderate ulcerative colitis refractory to 5-aminosalicylates therapy.
3. 20 years and above
4. Must obtain written informed consent

Exclusion Criteria:

1. Corticosteroids therapy within two weeks before enrollment
2. Immunosuppressive therapy within three months before enrollment
3. Leukocytapheresis therapy within one month before enrollment
4. Blood transfusion within two weeks before enrollment
5. Impaired renal function
6. Impaired hepatic function
7. Uncontrolled hypertension/hypotension
8. Uncontrolled arrhythmia
9. Impaired cardiac function
10. Cancer
11. Uncontrolled diabetes
12. Interstitial pneumonia
13. Glaucoma
14. History of colon resection
15. Infectious diseases needing medical treatments
16. Drug allergy
17. Pregnancy