(A) In normal liver, LSECs express high levels of ALK1 receptors, favoring TGFβ/ALK1 signaling, which shifts signaling away from the TGFβ/ALK5 pathway and thereby downregulates TSP-1 gene expression. Furthermore, LSECs in normal liver shed HB-EGF from the cytosolic membrane, which maintains HSC quiescence. (B) In fibrotic liver, increased levels of TGFβ and lower expression of the ALK1 receptor favor TGFβ/ALK5 signaling in BM-derived LSECs, resulting in increased TSP-1 expression. TSP-1 binds to CD47 and CD36, which inhibits both sGC and cGMP-dependent protein kinase I (cGKI), as well nitric oxide synthase activation. ADAMTS13 is also upregulated and inhibits the NO pathway by binding to CD36. The consequent downregulation of the NO pathway by TSP-1 and ADAMTS13 prevents maturation of BM-derived LSECs, manifested by lack of fenestration and downregulation of key HB-EGF sheddases. Inability to release HB-EGF permits HSC activation.