The big picture
My day-to-day clinical work brings me into contact with:
1. Children with rare, severe liver disease (e.g. biliary atresia); and
2. Young people with a common systemic metabolic condition which has slow and variable progression (i.e. MASLD (metabolic dysfunction-associated steatotic liver disease))
I want to find a way that I can help both groups of people through my research. I think that this will be possible because there is increasing evidence (across multiple organ systems) that there are fundamental, conserved mechanisms that play a role in different pathologies. For example, similar patterns of pro-inflammatory macrophages are observed in kidney scarring, lung scarring, and liver scarring. There is also some evidence of this from a genetic level where the same common genetic variants can influence the development or severity of range of related conditions (e.g. autoimmune diseases). Therefore, I hypothesise that there will be shared disease mechanisms between rare, severe liver diseases and MASLD.
My long-term vision is to find novel drivers of liver fibrosis and inflammation in children affected with rapidly progressing liver diseases and then apply these discoveries to both common and rare liver disease. This may be in the form of treatments, new tests for risk stratification, or broadening our understanding of the disease processes. I am sure that there will be differences in exactly how such mechanisms manifest when comparing biliary atresia and MASLD. Though, starting with severe liver disease may give novel avenues for identification of disease mechanisms that would not be found if we started with the more common, slower progressing conditions.
At the time of writing (January 2026) I have some (unpublished) preliminary data to support one disease mechanism that appears to be important in both biliary atresia and MASLD (at least in adults).
It is taken some time for this research vision to evolve. I am sure it will develop further in the future. For example, I have not yet figured out how my interest in germline human genetics fits into this. I also have not entirely mapped out how far I will follow disease mechanisms that relate to cancer, i.e. whether this is work I would pursue myself or leave to a collaborator.
