Iron, hepatic stellate cells and fibrosis in chronic hepatitis C

Background/aims  In patients with chronic hepatitis C, hepatic iron concentration correlates with liver fibrosis. However, it is not clear whether this correlation merely reflects the presence of more active disease, or iron exacerbates chronic hepatitis C virus (HCV)-induced damage through activation of hepatic stellate cells and regeneration of hepatocytes. Materials and methods  We studied 72 HCV-positive patients, staged according to the Ishak’s score system. We measured hepatic iron concentration with spectrophotometry and evaluated the number of hepatic stellate cells (using monoclonal antibody against alpha smooth muscle actin) and proliferating hepatocytes (using monoclonal antibody against Ki67). Iron and ferritin serum levels were also determined. Results  Hepatic iron concentration correlated statistically with ferritin serum level (r = 0·59, P < 0·001), with grading (r = 0·47, P < 0·001) and staging (r = 0·51, P < 0·001) scores for chronic hepatitis in the whole group of patients. Hepatic iron concentration correlated positively with stellate cell number (r = 0·55, P = 0·004) and Ki67-positive hepatocyte number (r = 0·36, P = 0·08) in patients with chronic hepatitis C and low grading score (< 3). Conclusions  In patients with chronic hepatitis C and low grading score, hepatic iron could play a role in the activation of hepatic stellate cells and in the progression of fibrosis.