Colmenero J, Bataller R, Sancho-Bru P, Domínguez M, Moreno M, Forns X, Bruguera M, Arroyo V, Brenner DA, Ginès P. Effects of losartan on hepatic expression of nonphagocytic NADPH oxidase and fibrogenic genes in patients with chronic hepatitis C. Am J Physiol Gastrointest Liver Physiol 297: G726 -G734, 2009. First published July 23, 2009 doi:10.1152/ajpgi.00162.2009.-Angiotensin II promotes liver fibrogenesis by stimulating nonphagocytic NADPH oxidase (NOX)-induced oxidative stress. Angiotensin II type 1 (AT1) receptor blockers attenuate experimental liver fibrosis, yet their effects in human liver fibrosis are unknown. We investigated the effects of losartan on hepatic expression of fibrogenic, inflammatory, and NOX genes in patients with chronic hepatitis C (CHC). Fourteen patients with CHC and liver fibrosis received oral losartan (50 mg/ day) for 18 mo. Liver biopsies were performed at baseline and after treatment. The degree of inflammation and fibrosis was evaluated by histological analysis (METAVIR). Collagen content was measured by morphometric quantification of Sirius red staining. Overall collagen content and fibrosis stage remained stable in the whole series, yet the fibrosis stage decreased in seven patients. Inflammatory activity improved in seven patients. The effect of losartan on hepatic expression of 31 profibrogenic and inflammatory genes and components of the NOX complex was assessed by quantitative PCR. Losartan treatment was associated with a significant decrease in the expression of several profibrogenic and NOX genes including procollagen ␣1(I) and ␣1(IV), urokinase-type plasminogen activator, metalloproteinase type 2, NOX activator 1 (NOXA-1) and organizer 1 (NOXO-1), and Rac-1. Losartan was well tolerated in all patients and was effective in attenuating the activity of the systemic renin-angiotensin system. No effects on serum liver tests or viral load were observed. We conclude that prolonged administration of losartan, an oral AT1 receptor blocker, is associated with downregulation of NOX components and fibrogenic genes in patients with CHC. Controlled studies are warranted to assess the effect of AT1 receptor blockers in chronic liver injury.angiotensin; liver fibrosis; antifibrogenic ACCUMULATING EVIDENCE INDICATES that the renin-angiotensin system (RAS) is a major mediator in liver fibrogenesis. Key components of the RAS are locally expressed in chronically injured livers and activated hepatic stellate cells de novo generate angiotensin II (5), the main effector peptide of this system. Angiotensin II induces an array of fibrogenic actions in hepatic stellate cells (HSC) including cell proliferation, migration, secretion of proinflammatory cytokines, and collagen synthesis (34). The fibrogenic and inflammatory actions of angiotensin II in the liver are largely mediated by angiotensin type 1 (AT1) receptors (5). The production of intracellular reactive oxygen species generated by the nonphagocytic NADPH oxidase (NOX) complex is a key event in the angiotensin II-mediated fibrogenesis (...