Although increased plasma enzyme activities could be diagnostic for tissue damage, the mechanisms controlling cellular enzyme release remain poorly understood. We found a selective and drastic elevation of serum enzyme activities accompanying rat liver regeneration after partial hepatectomy (PH), apparently controlled by a mechanism dependent on flow-bearing physical forces. In fact, this study assesses a putative role of calcium mobilization and nitric oxide (NO) production underlying rat liver enzyme release. The role of increased shear stress (by enhancing viscosity during perfusion) and the participation of cell calcium and NO were tested in isolated livers subjected to increasing flow rate. After PH, there was a drastic elevation of serum activities for liver enzyme markers, clearly predominating those of mitochondrial localization. Liver enzyme release largely depended on extracellular calcium entry, probably mediated by stretch-sensitive calcium channels, as well as by increasing NO production. However, these effects were differentially observed when comparing liver enzymes from cytoplasmic or mitochondrial compartments. Moreover, a possible role for cell-mediated mechanotransduction in liver enzyme release was suggested by increasing shear stress (high viscosity), which also selectively affected the release of the enzymes tested. Therefore, we show, for the first time, that flow-induced shear stress can control the amount of hepatic enzymes released into the bloodstream, which is largely regulated through modifications in cell calcium mobilization and production of liver NO, events markedly elevated in the proliferating rat liver. Liver Transpl 17:334-343, 2011. V C 2011 AASLD.Received May 13, 2010; accepted November 16, 2010.Above-normal plasma enzyme activities are considered as diagnostic features for several diseases, 1 and it seems that every organ can elicit a specific pattern of enzyme release. In fact, this phenomenon usually follows a respective gradient of concentration between an organ, such as the liver, and the blood compartments. [2][3][4] Moreover, values of released enzymes are much higher than the apparent disappearance rates constants and are consistent akin to decreasing concentration levels within the plasma, as reported for lactate dehydrogenase (LDH) and aspartate (AST) and alanine (ALT) aminotransferases after acute liver injury. 5 However, the mechanisms controlling cellular enzyme release remain poorly understood.A drastic increase of serum activities of ''liver enzyme markers'' does not necessarily have to reflect liver cell death, and indeed we demonstrated recently that an important fraction of the released hepatic enzymes depends largely on hemodynamic changes in the rat liver. 6 Taking advantage of the model of twoAbbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; ATP, adenosine triphosphate; [Ca 2þ ] i , intracellular calcium