New PSC Support Research Uncovers Critical Link Between Liver and Small Intestine
PSC Support has funded important research to better understand the connection between the liver and the digestive system in primary sclerosing cholangitis (PSC). The digestive system is extremely complex, and while research has historically focused on the large intestine (bowel) due to its known link with inflammatory bowel disease (IBD), this study specifically focused on the small intestine. Led by Dr Nicholas Ilott, the team investigated how the flow of bile acids from the liver might affect the small intestine’s ability to function.
How does PSC affect the small intestine?
The small intestine has previously been overlooked in PSC research because it does not usually show obvious symptoms. Dr Ilott hypothesised that a reduced flow of bile acids from the liver to the small intestine in PSC may still impact the barrier function of the small intestine, even without visible signs of disease. Bile acids, produced by the liver, help to digest fats and keep the intestinal barrier intact.
What is the link between liver function and gut protection?
Using advanced scientific methods (single cell RNA-sequencing), the team confirmed that cells forming the small intestinal barrier in people with PSC express lower levels of protective genes. These lower levels were more pronounced in patients with particularly high levels of the liver enzyme, alkaline phosphatase (ALP). Using models of PSC, Dr Ilott was able to show that these protective genes are decreased when the liver isn’t functioning as it should and this is probably because of bile acids.
What do these findings mean for future PSC treatments?
This initial work could be a key target for new medicines.
Dr Ilott commented, "Our initial insights that have been aided by funding from PSC Support suggest that we may be able to target the small intestine – perhaps by changing the gut microbiome – to stop PSC from progressing".
The team will now pursue further work to determine if these protective mechanisms are critical in the overall progression of PSC.
Next Steps
PSC Support is proud to fund research that is unlocking fundamental understanding of PSC and its potential drivers. We need your help to continue funding vital projects like this.
Turning Ambition into Action in 2026:
Our Fortnight in Focus
At PSC Support, we want a world without PSC. We work tirelessly behind the scenes to drive research and improve lives. Here is a snapshot of what we've been up to:
Building Partnerships: We led an international discussion on removing barriers that delay research, ensuring that drug development is built around the practical realities of living with PSC.
Building Partnerships: We joined an AMMF webinar to share specialist transplant knowledge with healthcare professionals to help ensure that clinicians are aware of evolving care options and can better support patients facing transplant and CCA.
Building Partnerships: We presented the latest the PSC Working Group's achievements at the European Reference Network meeting of liver experts to drive collaboration and improve clinical standards worldwide.
Empowering our Community: We signed an international declaration advocating for rare disease research to be a priority in health policy, ensuring long-term funding for PSC.
Improving Care: We initiated collaborations with clinical experts to streamline specialist referral pathways, ensuring patients get the right care at the right time.
Organisational Excellence: We refined our strategic objectives to ensure every penny donated is focused on the most impactful work for our community.
Organisational Excellence: We met with our Board of Trustees to report on work so far this year to ensure the charity continues to meet the highest standards of governance and ensure we are delivering the maximum benefit for people with PSC.
Progressing Research: There are now 55 volunteers in our Patient Panel! The ensures that a diverse range of lived experiences directly shapes future PSC research and care.
Progressing Research: We reviewed research summaries for a pharmaceutical partner to ensure that study results are communicated clearly and transparently to our community.
Progressing Research: We provided patient leadership on a major new steering committee to ensure research into liver complications remains grounded in patient needs.
Progressing Research: The UK PSC Care Guidelines are going to be updated! We joined the national steering committee to update them, ensuring the "rulebook" for how doctors treat PSC is co-written by the patients who live with it.