title: Alpha-SMA expression in hepatic stellate cells and quantitative analysis of hepatic fibrosis in cirrhosis and in recurrent chronic hepatitis after liver transplantation.
abstract: BACKGROUND
  The alpha isotype of actin expressed by hepatic stellate cells reflects their activation to myofibroblast-like cell and has been directly related to experimental liver fibrogenesis, and indirectly to human fibrosis in chronic liver disease.
  
  
  OBJECTIVE
  To evaluate the changes in distribution and percentage of alpha-smooth muscle actin-positive hepatic stellate cells and the correlation with the degree of the fibrosis in cirrhotic livers, as well as in patients with recurrent HCV chronic hepatitis after liver transplantation.
  
  
  METHODS
  Human liver biopsies were divided in four groups: (1) normal livers obtained from cadaveric liver donors (n=35), (2) cirrhosis post-HBV hepatitis (n=11), (3) cirrhosis post-HCV hepatitis (n=10), and (4) post-transplant recurrent HCV chronic hepatitis (n=13). Samples were stained with anti-alpha-smooth muscle actin antibody by immunoperoxidase method and semi-quantitatively evaluated. Liver fibrosis was assessed from specimens stained with Masson's trichrome and quantified by computer image analysis.
  
  
  RESULTS
  The percentage of alpha-smooth muscle actin-positive hepatic stellate cells was significantly higher in the HBV cirrhosis, HCV cirrhosis and post-transplant HCV recurrent hepatitis groups (36.1+/-15.2, 23.8+/-19.7 and 27.8+/-16.4%, respectively) compared to the liver donor group (2.9+/-4.0%). The alpha-smooth muscle actin-positive hepatic stellate cells to fibrous tissue ratio were significantly higher in the post-transplant recurrent HCV hepatitis group (2.36+/-1.12) compared to both the donor livers and the HCV cirrhosis groups (0.74+/-1.09 and 1.03+/-0.91, respectively). The alpha-smooth muscle actin-positive hepatic stellate cell percentage and fibrosis correlated positively in the post-transplant recurrent HCV hepatitis group and negatively in the HCV cirrhosis group. No difference in the immunohistochemical and morphometrical variables was found between the HCV cirrhosis and HBV cirrhosis groups.
  
  
  CONCLUSIONS
  These results indirectly confirm that, in vivo, alpha-smooth muscle actin expression is a reliable marker of hepatic stellate cells activation which precedes fibrous tissue deposition even in the setting of recurrent HCV chronic hepatitis after liver transplantation, and it could be useful to identify the earliest stages of hepatic fibrosis and monitoring the efficacy of the therapy. In the presence of advanced cirrhosis other factors, rather than alpha-smooth muscle actin-positive hepatic stellate cells, may sustain fibrosis deposition.
authors.affiliation: Department of Human Anatomy, University of Rome 'La Sapienza', via Alfonso Borelli, 50, 00161 Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Carpino
authors.forename: S
authors.initials: S
authors.lastname: Morini
authors.forename: S
authors.initials: S
authors.lastname: Ginanni Corradini
authors.forename: A
authors.initials: A
authors.lastname: Franchitto
authors.forename: M
authors.initials: M
authors.lastname: Merli
authors.forename: M
authors.initials: M
authors.lastname: Siciliano
authors.forename: F
authors.initials: F
authors.lastname: Gentili
authors.forename: A
authors.initials: A
authors.lastname: Onetti Muda
authors.forename: P
authors.initials: P
authors.lastname: Berloco
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: A F
authors.initials: AF
authors.lastname: Attili
authors.forename: E
authors.initials: E
authors.lastname: Gaudio
mesh_terms: D000199:Actins / Q000378:metabolism*; D000328:Adult; D005260:Female; D006521:Hepatitis, Chronic / Q000378:metabolism*; D006801:Humans; D007150:Immunohistochemistry; D008099:Liver / Q000166:cytology*; D008103:Liver Cirrhosis / Q000473:pathology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000378:metabolism*; D011184:Postoperative Period
chemical_list: D000199:Actins