Evaluation and Staging of Liver Fibrosis - Core Concepts

Pathogenesis of Fibrosis with Chronic Hepatitis C: Hepatic fibrosis is a dynamic scarring process in which chronic inflammation stimulates production and accumulation of collagen and extracellular matrix proteins. The hepatic stellate cells are the primary cells responsible for producing these extracellular matrix proteins. Over time, with chronic hepatitis C infection, the total collagen content increases and fibrosis can develop, with potential progression to cirrhosis. This dynamic process can also involve remodeling and regression of the fibrous tissue via breakdown of the matrix proteins by the protease enzymes matrix metalloproteinases (MMP). Balance of the remodeling process occurs with inhibition of the remodeling by tissue inhibitors of matrix metalloproteinases (TIMP).