“…168 Recent studies have shown that, not only inflammation and activation of HSC to produce extracellular matrix affect the progression of ALD to endstage liver diseases, but also pre-existing increases in liver stiffness promote pathological changes in liver cells. Studies conducted on hepatocytes plated on surfaces that mimic the stiffness of healthy (soft gels, 2 kDa) and cirrhotic (stiff gels, 55 kDa) livers revealed that cells grown on stiff surfaces exhibit lower albumin synthesis and cytochrome P450 enzyme activity 169 indicating that extracellular stiffness regulates hepatocyte function. Additionally, hepatocytes plated on stiff matrices and then exposed to second hits, including HCV-HIV coinfections, exhibited higher levels of apoptosis and viral infectivity.…”