To define a possible role for changes in the regulation of antigen presentation in fulminant hepatic failure (FHF) , we studied the expression of co-stimulatory molecules CD80 (B7-1) , CD86 (B7-2) , and CD40 along with their ligands CD28 and CD154. We analyzed the liver tissue from patients with FHF (n ؍ 18) , chronic liver disease (n ؍ 30) , and acute hepatitis (n ؍ 3) and from normal controls (n ؍ 9) by immunohistochemistry and examined the temporal relationship between CD80/CD86 and CD40 expression and disease in the mouse models of galactosamine-lipopolysaccharide and galactosamine-tumor-necrosis-factor-induced FHF. In human controls , faint CD80/CD86 immunoreactivity was restricted to Kupffer cells, and CD40 expression was expressed on bile ducts , macrophages , and sinusoidal endothelial cells (SECs). In FHF , immunoreactivity for CD80 and CD86 was observed on significantly higher numbers of cells, including SECs. Increased CD80/CD86 expression corresponded to increased numbers of CD28-positive lymphocytes. The expression of CD40 was also clearly elevated on virtually all cell types in FHF. In both murine models , CD40 and CD80/CD86 expression was up-regulated before tissue damage could be detected. Our data suggest that up-regulated expression of co-stimulatory molecules might lead to an excessive antigen presentation in FHF as an early step in the pathogenesis before the onset of tissue damage. (Am J Pathol 1999, 154:1711-1720) Hepatitis B virus infection or drug toxicity can initiate a sequence of severe inflammatory reactions that may lead to rapid organ failure and death. Although the precise pathogenesis is poorly understood, enhanced immune activation, including aberrant antigen presentation and T-cell activation, may essentially contribute to hepatocyte destruction in fulminant hepatic failure (FHF). A balance in the interaction between antigen-presenting cells (APCs) and lymphocytes is of special importance to the liver, as the hepatic immune system is confronted with a high number of antigens that reach the liver via the portal tract and that normally do not elicit immune responses.Recently, it has become evident that a sufficient immune response depends on an efficient T cell activation via co-stimulatory molecules.1-4 The interaction of CD80 (B7-1) and CD86 (B7-2) with their counter-receptors on T lymphocytes (CD28 and CD152) provides a particularly potent co-stimulatory signal, which amplifies the response of T cells. Although antigen presentation followed by co-stimulation induces full T-cell activation, such antigen presentation that lacks co-stimulatory signals results in tolerance or anergy for the specific antigen. [5][6][7] CD80 is a 44-to 60-kd member of the immunoglobulin superfamily with a limited expression on professional APCs such as macrophages, dendritic cells, and activated B cells. CD86 is a 75-to 115-kd cell surface glycoprotein with 25% amino acid homology to CD80. It also has a restricted expression on APCs.Regulation of co-stimulation may also involve the CD40 molec...