This study was aimed to evaluate the source of endothelin-1 (ET-1) in cirrhotic patients. ET-1 is implicated in the pathogenesis of portal hypertension. However, the mechanism and source for increased plasma ET-1 in cirrhotic patients are still obscure. Plasma ET-1 levels in systemic (SV), superior mesenteric (SMV), and splenic venous (SPV) blood were measured in 23 patients with cirrhosis and 8 controls with normal liver. Fourteen removed spleens were immunohistochemically studied for ET-1, CD34, CD68, and CD20. In situ hybridization was done to localize ET-1 messenger RNA (mRNA). In cirrhosis, ET-1 levels in both SMV and SPV were higher than in SV. ET-1 in SV and SPV were significantly higher in cirrhotic patients than in control patients. Three groups of cells in the spleen expressed both protein and mRNA of ET-1: endothelial cells in the sinus, which were also stained for CD34; cells in the germinal center; and cells in the marginal zone of lymphoid sheaths and follicles, which were also stained for CD20 but not for CD34 and CD68. Endothelins (ETs) are a group of three related peptides of 21 amino acids (ET-1, ET-2, and ET-3) first described as potent vasoconstrictors. 1,2 At present, it is known that ETs exert a variety of biological, physiological, and metabolic actions through two types of receptors (ET A and ET B ) in humans. [3][4][5] In recent years, much attention has been paid to the role of ET-1 in hepatic circulation, particularly in relation to portal hypertension. [6][7][8] Since 1992, more than 10 investigative groups have shown the increased level of plasma ET-1 in patients with cirrhosis. [9][10][11][12][13][14][15][16][17][18][19] The grade of the ET-1 elevation seems to be related to the severity of cirrhosis 13,16 and the presence or absence of ascites. 10,11,19 The highest levels were observed in hepatorenal syndrome. 9 However, the physiological significance of elevated ET-1 levels in cirrhosis is still controversial. The role of endotoxin or plasma volume remains to be elucidated. 10,11,15 Furthermore, the origin and elimination of plasma ET-1 in cirrhosis have not been clarified.Of late, Gerbes et al. 14 and Moller et al. 17 suggested the hepatosplanchnic origin of ET-1 because the highest ET-1 concentrations were found in hepatic venous blood. Martinet et al. 18 showed that high ET-1 levels in the portal blood were reduced after portal decompression by transjugular intrahepatic portosystemic shunt. These studies, however, did not show from which organ or organs of the splanchnic region ET-1 was released in cirrhosis and portal hypertension.The present study was prospectively aimed to clarify this problem. While measuring plasma ET-1 levels in the systemic (SV), superior mesenteric (SMV), and splenic venous (SPV) blood in patients with cirrhosis of different Child-Turcotte classes and control patients with normal liver, we came to know that ET-1 was highest in the SMV in controls but that SPV ET-1 levels were significantly higher in cirrhosis.Therefore, the cellular source of ET-1 in t...