Bile acids in alcohol-related hepatitis

To see our latest courses, or to donate to the St Mark's Hospital Foundation, please visit our channel description for details. Title: Bile acids in alcohol-related hepatitis Speaker: Luke Tyson Event: St Mark's Academic Institute Grand Round Year: 2026 Mechanisms, Biomarkers and Clinical Implications Alcohol-related hepatitis (AH) is a severe manifestation of alcohol-associated liver disease, characterised by rapid-onset jaundice, hepatic dysfunction and substantial mortality. Despite advances in understanding its pathophysiology, reliable diagnostic biomarkers and effective therapeutic strategies remain limited. In this presentation, consultant hepatologist Dr Luke Tyson discusses research investigating bile acid metabolism in AH, focusing on disease-specific metabolic changes, underlying mechanisms and potential clinical applications. Drawing on data from multicentre UK clinical trials and biobanks, the study compares patients with severe AH against those with decompensated cirrhosis and healthy controls. Using complementary mass spectrometry techniques, the research identifies a distinct serum bile acid profile in AH, characterised by markedly elevated total bile acids, particularly conjugated primary bile acids. These findings are replicated across two independent cohorts and remain significant following sensitivity analyses accounting for disease severity and bilirubin concentrations. The presentation explores potential mechanisms underlying these alterations, including reduced expression of hepatic bile acid transporters, impaired biliary secretion and increased fibroblast growth factor 19 (FGF-19). The findings also highlight hepatocyte growth factor (HGF) as a potential contributor to transporter downregulation, suggesting a multifactorial disruption of bile acid homeostasis. Analysis of faecal bile acids further supports altered enterohepatic circulation and provides additional insight into the mechanisms of cholestasis in AH. The study also evaluates the diagnostic potential of serum bile acids and examines associations between inflammatory mediators, growth factors and bile acid transport. Although selected bile acids demonstrate promising discriminatory performance, prospective validation in patients undergoing liver biopsy is necessary to establish their independent diagnostic value. Overall, this research advances understanding of bile acid dysregulation in alcohol-related hepatitis and identifies potential avenues for future investigation. Restoring bile acid transport may offer therapeutic benefits by alleviating cholestasis, reducing harmful bile acid accumulation and potentially improving appetite, an important determinant of clinical outcomes. The findings also establish a rationale for further investigation of HGF and FGF-19 in AH pathogenesis and treatment development.