Hepatic fibrosis is a chronic liver disease associated with an accumulation of extracellular matrix (ECM) proteins. Causative agents include hepatotoxins like excessive ethanol, bile acids, glucose and free fatty acids. Hepatotoxins initiate a cascade of pro-inflammatory events which eventually activate Hepatic stellate cells (HSCs). Activated HSCs secrete cytokines that perpetuate their activated state. Continued liver injury results in an accumulation of activated HSCs and myofibroblasts which in turn synthesize large amounts of ECM, mainly collagen, leading to tissue fibrosis and eventually to liver cirrhosis.