Rehab Ahmed Mohammed - Department of Physiology, Faculty of Medicine, Fayoum University, Egypt
Heba Mohamed Shawky - Department of Physiology, Faculty of Medicine, Cairo University, Egypt
Laila Ahmed Rashed - Department of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Egypt
Hala Mohamed Elhanbuli - Departments of Pathology, Faculty of Medicine, Fayoum University, Egypt
Dalia Nabil Abdelhafez - Departments of Pathology, Faculty of Medicine, Fayoum University, Egypt
Eman Sayed Said - Departments of Pharmacology, Faculty of Medicine, Fayoum University, Egypt
Ramadan Mostafa Shamardan - Departments of Anatomy, Faculty of Medicine, Fayoum University, Egypt
Rania Hosny Mahmoud - Departments of Medical Biochemistry and Molecular Biology, Faculty of Medicine, Fayoum University, Egypt

Objective(s): Liver fibrosis eventually develops into cirrhosis and hepatic failure, which can only be treated with liver transplantation. We aimed to assess the potential role of hydrogen sulfide (H۲S) alone and combined with bone marrow-derived mesenchymal stem cells (BM-MSCs) on hepatic fibrosis induced by bile-duct ligation (BDL) and to compare their effects to silymarin.Materials and Methods: Alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TB), and alkaline phosphatase (ALP) were investigated in serum. Gene expression levels of CBS (cystathionine β-synthase), CSE (cystathionine γ-lyase), and alpha-smooth muscle actin (α- SMA) were measured in liver tissues using RT-PCR. Hepatic protein kinase (Akt) was assessed by Western blot assay. Liver oxidative stress markers, malondialdehyde (MDA), and reduced glutathione (GSH) were analyzed by the colorimetric method. Lipocalin-۲ (LCN۲) and transforming growth factor-β (TGF-β) were measured using ELIZA. Liver tissues were examined by H&E and Masson trichome staining for detection of liver necrosis or fibrosis. Caspase ۳ expression was evaluated by immunohistochemistry. Results: H۲S and BM-MSCs ameliorated liver function and inhibited inflammation and oxidative stress detected by significantly decreased serum ALT, AST, ALP, TB, and hepatic MDA, Akt, TGF-β, LCN۲, and α-SMA expression and significantly increased CBS and CSE gene expression levels. They attenuated hepatic apoptosis evidenced by decreased hepatic caspase expression.Conclusion: Combined treatment with H۲S and BM-MSCs could attenuate liver fibrosis induced by BDL through mechanisms such as anti-inflammation, anti-oxidation, anti-apoptosis, anti-fibrosis, and regenerative properties indicating that using H۲S and MSCs may represent a promising approach for management of cholestatic liver fibrosis.

Bile duct ligation, Hydrogen sulfide, Liver fibrosis, Mesenchymal stem cells