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In terms of bilirubins effects on immune cells, a 2017 study showed (139) that unconjugated bilirubin upregulates CD39 and thus inhibits Th17 immunoreactivity, this promotes several cancers, such as breast, colorectal, and ovarian cancers (140142), and thus, the inhibition of TH17 by unconjugated bilirubin can play a role in inhibiting related cancer effects

In clinical studies of Ulcerative Colitis, it helps both with healing the mucus lining of the colon as well as alleviating inflammation

Recent research suggests that factors that modify the above mechanisms, e.g., obesity and Western diet, also alter gut microbiota, degrade the integrity of the gut protective barrier, and expose colonocytes to toxins

In addition, peroxisome-driven ePL biosynthesis can foster lipid peroxidation and ferroptosis in ovarian and renal cancer cells [100, 101]