Cooperation of Liver Cells in the Process of Liver Fibrosis

Abstract

Fibrosis is the common response to chronic liver injury from various origins including metabolic diseases, viral infections, alcohol abuse, and various chemicals. Liver fibrosis is characterized by both quantitative and qualitative changes in the composition and distribution of extracellular matrix (ECM) that are reflected by a three- to fivefold net increase of ECM and replacement of low-density basement membrane-like material by interstitial type matrix abundant in fibril-forming collagens (Friedman 1993; Gressner 1998). This gross remodeling of ECM in the fibrotic liver represents an imbalance between the deposition and degradation of ECM molecules. Hepatic stellate cells, which are involved in the regulation of ECM production and degradation (Table 10), have been found to play a pivotal role in the initiation and progression of hepatic fibrosis (Friedman 1993, 2000; Gressner 1998). Following acute or chronic liver injury, hepatic stellate cells transdifferentiate: they proliferate, lose lipid droplets, change morphology from the star-shaped cells to that of myofibroblasts with the expression of smooth muscle α-actin (reviewed by Gressner 1998), and migrate to sites of tissue damage (Ikeda et al. 1999; Marra et al. 1998b). Activation of stellate cells that initiates the development of the inflammatory process results from multiple interactions between many cell types (injured hepatocytes, Kupffer cells, endothelial cells, platelets, infiltrating inflammatory cells) mediated by cytokines and reactive oxygen species, and from the changes in the composition of the perisinusoidal matrix (Arthur 2000; Gressner 1998).