Role of hydrogen sulfide in portal hypertension and esophagogastric junction vascular disease

AIM: To investigate the association between endogenous hydrogen sulfide (H₂S) and portal hypertension as well as its effect on vascular smooth muscle cells.METHODS: Portal hypertension patients were categorized by Child-Pugh score based on bilirubin and albumin levels, prothrombin time, ascites and hepatic encephalopathy. Plasma H₂S concentrations and portal vein diameters (PVDs) were compared between portal hypertension patients and control participants, as well as between portal hypertension patients with varying degrees of severity. In addition, we established a rabbit hepatic schistosomiasis portal hypertension (SPH) model and analyzed liver morphology, fibrosis grade, plasma and liver tissue H₂S concentrations, as well as cystathionine γ-lyase (CSE) activity and phosphorylated extracellular signal-regulated kinase (pERK)1/2, B cell lymphoma (Bcl)-2 and Bcl-XL expression in portal vein smooth muscle cells, in addition to their H₂S-induced apoptosis rates.RESULTS: In portal hypertension patients, endogenous H₂S levels were significantly lower than those in healthy controls. The more severe the disease was, the lower were the H₂S plasma levels, which were inversely correlated with PVD and Child-Pugh score. Liver tissue H₂S concentrations and CSE expression were significantly lower in the SPH rabbit livers compared with the control animals, starting at 3 wk, whereas pERK 1/2 expressions gradually increased 12-20 wk after SPH model establishment. In portal vein smooth muscle cells, increasing H₂S levels led to increased apoptosis, while Bcl-2 and Bcl-XL expression decreased.CONCLUSION: H₂S prevents vascular restructuring caused by excessive proliferation of smooth muscle cells via apoptosis induction, which helps to maintain normal vascular structures.