Microplastics, Cirrhosis and Portal Hypertension

The Impact of Microplastics and Nanoplastics on Liver Health and Cardiovascular Diseases in India

Cirrhosis and portal hypertension are associated with an hyperdynamic circulation and hepatic inflammation, leading to complications like ascites, variceal bleeding, acute kidney injury, and higher infection risk. Microplastics (MPs) are a global plastic pollution issue, and studies have found plastic MPs or nanoparticles (NPs) contaminating human, animal and environmental ecosystems.It has been noted that the accumulation of MPs increases with a reduction in size of the plastic particle. MPs are categorized into primary particles such as manufactured plastics including pellets and cosmetic microbeads and secondary particles which originate from mechanical and ultraviolet disruption of large plastic particles. MPs can be ingested via food or beverages, especially plastic packaged comestibles or inhaled as environmental pollutants. Contamination of medications such as antibiotics, intravenous fluids, albumin and medical devices is another source of exposure to microplastics in patients with chronic liver disease (CLD)In particular exposure to endoscopic interventions, liver biopsy, and invasive procedures such as paracentesis and interventional radiology procedures can lead to plastic exposure and deposition of MPs in the liver and other tissues in patients with cirrhosis. It may be hypothesized that these may contribute to hepatic inflammation and progression of cirrhosis and portal hypertension.

Globally, there is new research on the influence of MPs on the environment, plant and animal ecosystems and human health.

Polystyrene (PS) microspheres that concentrate in the liver, intestine and the kidneys of mammals disrupt lipid and energy metabolism, impair mucus secretion, and alter the microbiome. Therefore, studies are required to assess how and to what extent, MPs impact human health, and affect chronic diseases like cirrhosis and reduce longevity.

The study investigators will assess the presence of MPs in the liver, kidneys and intestine of patients with liver cirrhosis and compare it with those without underlying liver disease and determine the impact on portal hypertension and fibrosis, and cardiovascular and metabolic function.

Study Overview

• Status: Recruiting
• Conditions: Cirrhosis; Portal Hypertension Related to Cirrhosis; Cirrhosis and Chronic Liver Disease; Microplastics; Nanoplastics; Pollution
• Intervention / Treatment: Diagnostic test: Assessment of microplastics in tissue

Detailed Description

First, because the methodology requires chemical digestion, it is unclear where in the liver MPs are deposited. For instance, it is indeterminate if MPs are deposited intracellularly, in Kupffer cells, endothelium or hepatocytes/cholangiocytes. In the present study histopathological assessments of the liver tissue will be performed to determine the presence of the MPs.

• Furthermore, the study will assess various polymer types of MP in cirrhotic liver tissue including commonly observed plastic polymers PS (polystyrene), PE (polyethylene), PP (polypropylene), PVC (polyvinyl chloride), PET (polyethylene terephthalate), PC (polycarbonate), and PMMA (polymethyl methacrylate).
• Therefore, potential cellular sites of deposition in the liver will be assessed. If the MPs were in the systemic circulation, without any liver parenchymal residues, such particles should also be identified in spleen and kidney samples.
• histopathology and electron microscopy of the liver tissue which should clarify the specific accumulation sites.

• Study Type: Observational
• Enrollment (Estimated): 30

Contacts and Locations

• Study Contact: Name: Madhumita Premkumar, MD DM; Phone Number: 01722754777; Email: drmadhumitap@gmail.com

Study Locations

• India
  • Chandigarh
    • Chandigarh, Chandigarh, India, 160012
      • Recruiting
      • Dr. Madhumita Premkumar
      • Contact: Dr. Madhumita Premkumar, MD; Phone Number: +919540951061; Email: drmadhumitap@gmail.com
    • Chandigarh, Chandigarh, India, 160012
      • Recruiting
      • PGIMER Chandigarh
      • Contact: Prerna Premkumar; Phone Number: 01722754777; Email: drmadhumitap@gmail.com
      • Contact: Email: drmadhumitap@gmail.com
      • Principal Investigator: Dr. Madhumita Premkumar, MD DM

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Cirrhosis Healthy liver control tissue will be taken from autopsy patients with consent

Description

Inclusion Criteria:

• Age range of 18-70 years
• Cirrhosis, as diagnosed by histology or clinical, laboratory and USG findings.
• Undergoing elective surgery or liver transplantation

Exclusion Criteria:

• • Hepatocellular carcinoma

  • Pregnancy or lactation
  • Patients with HIV or retroviral therapy
  • Prior liver interventions like locoregional therapy, presence of HCC, prior abdominal surgery

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Intervention / Treatment

Patients with Cirrhosis; Cirrhosis and Portal Hypertension who are getting elective surgery or liver transplantation

Diagnostic test: Assessment of microplastics in tissue; After meeting inclusion and exclusion criteria, 30 patients with cirrhosis will be included in this study with written informed consent from patient (surgical cases) or scheduled liver biopsy. Diagnosis of chronic liver disease will be based on history, physical examination, laboratory investigations, upper gastrointestinal endoscopy as recorded in the patient file, imaging studies (ultrasonography and doppler of splenoportal venous axis). Underlying etiology of liver disease will be recorded. Complications of cirrhosis like hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP), upper gastrointestinal bleed, hepatic encephalopathy, acute kidney injury will be recorded from the patient's casefile. Tissue Sample Processing Standard laboratory solvents (i.e., acetonitrile, methanol, and water (LiChrosolv and SupraSolv grade) will be procured. The contact of laboratory surfaces and equipment will be minimized to reduce the risk of background contamination by plastics.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
The primary outcome is to assess MPs in human liver tissue, analysing their morphology, size, and composition (4-30 µm) in tissue samples from the liver inpatients with cirrhosis as compared with controls without cirrhosis	MPs in liver cirrhosis	At time of enrolment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
• Identification of Various polymer types, including PS, PVC, PET, PMMA, POM, and PP and surface alterations indicative of long-term deposition.	Assessment of type of microparticles	At enrolment
• Determination of plastic pollution exposure in patients with cirrhosis by detailed history of diet, oral and parenteral medication, interventions including prior biopsy and endoscopy	Assessment of gastric and duodenal mucosa for micronanoplastics during elective endoscopy.	At the time of elective endoscopy
Assessment of micronanoplastics in peripheral blood	Dried blood spots assessment of micronanoplastics	At enrolment

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Association of microplastics with degree of liver fibrosis and inflammation	Comparison of presence of microplastics with histopathological inflammation and presence of fibrosis grade.	At enrolment

Collaborators and Investigators

• Sponsor: Post Graduate Institute of Medical Education and Research, Chandigarh
• Collaborators: Vellore Institute of Technology University
• Investigators: Principal Investigator: Madhumita Premkumar, PGIMER Chandigarh

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2026
• Primary Completion (Estimated): January 30, 2027
• Study Completion (Estimated): February 25, 2027

Study Registration Dates

• First Submitted: December 1, 2025
• First Submitted That Met QC Criteria: December 1, 2025
• First Posted (Actual): December 12, 2025

Study Record Updates

• Last Update Posted (Actual): May 15, 2026
• Last Update Submitted That Met QC Criteria: May 13, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Cirrhosis; Portal hypertension; Microplastics; Nanoplastics; Plastic pollution
• Additional Relevant MeSH Terms: Pathologic Processes; Digestive System Diseases; Liver Diseases; Pathological Conditions, Signs and Symptoms; Fibrosis; Hypertension, Portal; Investigative Techniques; Clinical Laboratory Techniques; Diagnostic Techniques and Procedures; Diagnosis; Immunologic Techniques; Immunologic Tests; Histocompatibility Testing
• Other Study ID Numbers: PGI/IEC/2025/EIC000779

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No