MORPHOLOGY OF HEPATIC STELLATE CELLS IN PATIENTS WITH FULMINANT OR SUBFULMINANT HEPATITIS REQUIRING LIVER-TRANSPLANTATION

Hepatic stellate cells were studied by immuno-cytochemistry with anti smooth muscle a-actin antibody (an activation marker for these cells) and electron microscopy, in eleven patients transplanted for fulminant or subfulminant hepatitis. Numerous smooth muscle a-actin positive ce lls were found in necrotic areas. In both fulminant and subfulminant h epatitis, hepatic stellate cells appeared enlarged, often irregular, w ith spikes. There were numerous signs of activation and many contained numerous small lipid droplets. In the cases of fulminant hepatitis, h epatic stellate cells presented, at times, some subcellular damage. He patic stellate cells processes, often in several layers, displayed num erous cytoplasmic microfilaments with conspicuous dense plaques below the plasma membrane. Hepatic stellate cells were never surrounded by a basement membrane. The extracellular matrix was loose and granulofibr illar. In areas of multiacinar nodules (in cases of map-like pattern), hepatic stellate cells were grossly normal. These results are in agre ement with in vitro data showing that acutely damaged hepatocytes acti vate hepatic stellate cells but do not fully transform them into myofi broblasts.