S tellate cells, perisinusoidal mesenchymal cells residing in the subsinusoidal space of Disse, are the primary source of excessive extracellular matrix (ECM) in liver injury. 1,2 Following liver damage of any etiology, hepatic stellate cells (HSC) undergo a response known as "activation," which is the transition of quiescent cells into proliferative, fibrogenic, and contractile myofibroblasts. The paradigm for HSC activation defines a two-stage process: "initiation," meaning early changes in gene expression and phenotype, rendering the cells responsive to other cytokines and stimuli; and "perpetuation," as a consequence of the effects of these stimuli on maintaining the activated phenotype and the induction of a fibrotic response. 2 The features of activated HSC in vivo observed in animal models of hepatic fibrosis are recapitulated when cells are cultured on plastic. These include morphologic changes to a myofibroblast-like cell with the appearance of ␣-smooth muscle actin (␣-sma) filaments, loss of retinol content and decreased autofluorescence, increase in the rough endoplasmic reticulum, proliferation, and induction of ECM production, including a dramatic elevation in type I collagen. 2 In contrast, cells maintained on a basement membrane-like substratum (Matrigel) remain quiescent. 3 Direct stimulation of HSC proliferation and collagen synthesis by products generated from hepatocytes is a leading hypothesis to account for iron-and alcohol-related fibrosis. 4,5 Several studies have evaluated the role of conditioned medium from hepatocytes in stimulating HSC. Chen et al. 6 found an inhibitory effect of medium from murine hepatocytes on HSC proliferation; Gressner 7 showed a strong stimulation of HSC proliferation in 0.2% fetal bovine serum (FBS) during a 48-hour coculture with parenchymal, rat hepatoma, and human hepatoma cells. Faouzi et al. 8 found that tumoral rat hepatocyte-conditioned medium induces the activation of rat HSC in culture, and Hu et al. 9 showed that conditioned medium from CCl 4 -treated hepatocytes induces stellate cell activation. In cocultures of freshly isolated hepatocytes and