Reply to: “Regression of fibrosis: The need for quantitative methods of assessment”
Authors: Elizabeth L. Ellis, Derek A. Mann
Journal: Journal of Hepatology (2012)

Regression of fibrosis: The need for quantitative methods of assessmentJournal of HepatologyVol. 57Issue 6PreviewWe read with interest the timely review on the clinical evidence for regression of liver fibrosis [1]. We were surprised that in such a review there was no mention of the validated quantitative methods of histological assessment of fibrosis. We feel that this is a serious omission for reasons we detail below. Full-Text PDF Open AccessClinical evidence for the regression of liver fibrosisJournal of HepatologyVol. 56Issue 5PreviewFibrosis is a common pathological process for the majority of liver diseases which in a significant minority of patients leads to end-stage cirrhosis and/or hepatocellular carcinoma. Data emerging from small rodent models of chronic liver disease have demonstrated that fibrotic extracellular matrix can be remodelled and near-normal hepatic architecture regenerated upon cessation of injury. Moreover, regression of liver fibrosis in these model systems can be stimulated with drugs that target the activities of fibrogenic hepatic stellate cells. Full-Text PDF Open Access We note the omission described by Dr. Tsochatzis and colleagues. We fully agree that the collagen proportionate area (CPA) method is a valuable tool for quantification of fibrotic collagen in diseased liver and that its correlation with HVPG is an important observation. However, to our knowledge, CPA has not yet been validated as a methodology for the assessment of regression of human liver fibrosis. Critically, the focus of our review was to survey the currently available data in the published literature that provides evidence for regression of fibrosis across the distinct liver disease etiologies. Due to this focus and space limitations, we were unable to undertake a detailed consideration of emerging technologies that might be applied for detailed analysis of fibrosis regression, including CPA. We are pleased that Dr. Tsochatzis has highlighted the likely utility of CPA and look forward to future work that examines its application in studies of fibrosis regression. We thank the Journal of Hepatology for providing a forum for this interesting discussion.Conflict of interestThe authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. We note the omission described by Dr. Tsochatzis and colleagues. We fully agree that the collagen proportionate area (CPA) method is a valuable tool for quantification of fibrotic collagen in diseased liver and that its correlation with HVPG is an important observation. However, to our knowledge, CPA has not yet been validated as a methodology for the assessment of regression of human liver fibrosis. Critically, the focus of our review was to survey the currently available data in the published literature that provides evidence for regression of fibrosis across the distinct liver disease etiologies. Due to this focus and space limitations, we were unable to undertake a detailed consideration of emerging technologies that might be applied for detailed analysis of fibrosis regression, including CPA. We are pleased that Dr. Tsochatzis has highlighted the likely utility of CPA and look forward to future work that examines its application in studies of fibrosis regression. We thank the Journal of Hepatology for providing a forum for this interesting discussion. Conflict of interestThe authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.