Paradoxical hepcidin–iron dysregulation in primary sclerosing cholangitis

BACKGROUND: Primary sclerosing cholangitis (PSC) is a chronic, progressive liver disease characterised by biliary inflammation. Its exact aetiology remains unclear. This study aimed to use a combination of diagnostic methods and blood analysis to better understand the metabolic changes accompanying PSC. METHODS: PSC patients (n = 60) and healthy controls (n = 60) were evaluated by magnetic resonance imaging and spectroscopy (hepatic fat and iron content), ultrasonography, standard blood analysis expanded with markers of iron metabolism, and colonoscopy. RESULTS: PSC patients exhibited significant liver fibrosis and elevated liver enzymes. Serum hepcidin was increased (p < 0.01), but PSC patients did not show any markers of anaemia. Serum iron concentration and transferrin saturation were increased compared with healthy controls (p < 0.0001 and p < 0.001, respectively) but did not reach levels seen in hemochromatosis. In contrast, the liver iron content was lower in PSC patients (p < 0.0001). CONCLUSION: PSC patients demonstrated an atypical pattern of iron metabolism: elevated circulating iron and depleted liver iron stores despite increased hepcidin levels. This paradox suggests a disruption of hepcidin-mediated iron regulation, potentially sustaining a proinflammatory environment. Further investigation is warranted to clarify underlying mechanisms and therapeutic implications. TRIAL REGISTRATION: Clinical Trials I.D.: NCT06026449.