Liver disease mortality has risen by over 400% in the past five decades, with cirrhosis representing the final, irreversible stage of chronic liver injury. Cirrhosis disrupts normal liver function and is frequently complicated by variceal bleeding, hepatic encephalopathy, infection, and progression to multi-organ failure. These outcomes are underpinned by dysfunction across the gut-liver-brain-immune axis, a complex network that plays a central role in disease progression and poor clinical outcomes.

This research theme is focussed on advancing mechanistic understanding of this axis and its role in driving systemic complications. Current work is examining the immunological, microbial, and neurological pathways that propagate organ failure and reduce resilience in patients with advanced liver disease. Particular attention is being given to characterising biomarkers of decompensation and immune dysregulation, with the aim of developing predictive tools and personalised therapeutic strategies.

Building on recent advances, the programme integrates discovery science with translational approaches to enable early-phase experimental medicine studies. There is a strong emphasis on identifying novel therapeutic targets and accelerating the development of interventions that can modify disease trajectory or prevent deterioration. Ongoing research is contributing to international clinical trial platforms focused on reducing hospitalisation, improving cognitive outcomes, and preventing infection-related complications in cirrhosis.

Future priorities include scaling up pre-clinical and human studies, developing integrated multi-omics datasets, and leveraging real-world cohorts to validate findings. The team is committed to delivering research with global impact, with the ultimate goal of informing practice-changing treatments that improve survival and quality of life for patients with end-stage liver disease.