Triple-staining to identify apoptosis of hepatic cells in situ.

To identify apoptosis of nonparenchymal cells in fibrotic livers, we established a triple staining method which combined immunohistochemistry for cell markers and Masson staining for collagen as well as terminal deoxynucleotidyl transferase UTP nick end labeling (TUNEL). Five microm formalin fixed, paraffin-embedded liver sections were prepared for staining. Firstly, TUNEL staining was carried out to detect apoptosis of liver cells. Then, the sections were subjected to immunohistochemistry for alpha-smooth muscle actin (alpha -SMA) or KP-1 to identify hepatic stellate cells or Kupffer cells. Finally, Masson staining was performed to show the relationship between apoptosis and collagens. In addition, we optimized different conditions of fixation, digestion and color development which may affect the results.