Cellular and molecular mechanisms of fibrosis
Open accessAbstract
Fibrosis is defined by the overgrowth, hardening, and/or scarring of various tissues and is attributed to excess deposition of extracellular matrix components including collagen. Fibrosis is the end result of chronic inflammatory reactions induced by a variety of stimuli including persistent infections, autoimmune reactions, allergic responses, chemical insults, radiation, and tissue injury. Although current treatments for fibrotic diseases such as idiopathic pulmonary fibrosis, liver cirrhosis, systemic sclerosis, progressive kidney disease, and cardiovascular fibrosis typically target the inflammatory response, there is accumulating evidence that the mechanisms driving fibrogenesis are distinct from those regulating inflammation. In fact, some studies have suggested that ongoing inflammation is needed to reverse established and progressive fibrosis. The key cellular mediator of fibrosis is the myofibroblast, which when activated serves as the primary collagen‐producing cell. Myofibroblasts are generated from a variety of sources including resident mesenchymal cells, epithelial and endothelial cells in processes termed epithelial/endothelial‐mesenchymal (EMT/EndMT) transition, as well as from circulating fibroblast‐like cells called fibrocytes that are derived from bone‐marrow stem cells. Myofibroblasts are activated by a variety of mechanisms, including paracrine signals derived from lymphocytes and macrophages, autocrine factors secreted by myofibroblasts, and pathogen‐associated molecular patterns (PAMPS) produced by pathogenic organisms that interact with pattern recognition receptors (i.e. TLRs) on fibroblasts. Cytokines (IL‐13, IL‐21, TGF‐β1), chemokines (MCP‐1, MIP‐1β), angiogenic factors (VEGF), growth factors (PDGF), peroxisome proliferator‐activated receptors (PPARs), acute phase proteins (SAP), caspases, and components of the renin–angiotensin–aldosterone system (ANG II) have been identified as important regulators of fibrosis and are being investigated as potential targets of antifibrotic drugs. This review explores our current understanding of the cellular and molecular mechanisms of fibrogenesis. Copyright © 2007 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
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Several cell types contribute to liver fibrosis, including hepatic stellate cells (HSCs) and other fibroblasts, liver sinusoidal endothelial cells (LSECs), and hepatocytes; the immune system also plays key roles.
“Several cell types contribute to liver fibrosis, including hepatic stellate cells (HSCs) and other fibroblasts, liver sinusoidal endothelial cells (LSECs), and hepatocytes; however, the immune system also plays key roles (2, 6).”
From Targeting macrophages in liver fibrosis (2026) · cites this paper as [6]
The Introduction identifies hepatic stellate cells as the primary source of myofibroblasts in liver fibrosis and describes a prominent role for CD4+ T cells in a model of liver fibrosis. It discusses epithelial and endothelial cells as possible sources of myofibroblasts in fibrosis generally, but does not identify hepatocytes or liver sinusoidal endothelial cells specifically as contributors to liver fibrosis. (LLM, conf=0.87)
Experimental — accuracy not yet measuredProlonged inflammation and remodeling can lead to fibrosis or hypertrophic scar formation due to dysregulation of the default healing process.
“In some cases, as will be discussed in further detail, prolonged inflammation and remodeling leading to fibrosis or hypertrophic scar formation may occur due to dysregulation of the default healing process [32,86,101,102].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [102]
Macrophages regulate fibrosis through production of cytokines that activate fibroblasts (TGF-β, PDGF, IGF-1), production of MMPs and TIMPs that drive ECM remodeling, and M1 factors (IL-1b) that drive feed-forward inflammation.
“Briefly, macrophages regulate the process of fibrosis through the production of cytokines which directly activate fibroblasts (TGF-β, PDGF, insulin like growth factor (IGF)-1), the production of MMPs and TIMPs which drive ECM remodeling, and M1 factors which drive a “feed-forward” state of inflammation and remodeling (IL-1b) [102].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [102]
Macrophages can also regulate or reverse fibrosis through secretion of matrix degrading MMPs and M2 factors (IL-10, RELMα, Arg-1) that suppress fibrosis.
“Macrophages, however, can also regulate or reverse fibrosis through the secretion of matrix degrading MMPs and other M2 factors that have been shown to suppress fibrosis (IL-10, RELMα, Arg-1) [102,138–140].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [102]
Persistent or dysregulated inflammation can result in fibrosis following tissue injury or infection.
“Persistent or dysregulated inflammation can result in fibrosis following tissue injury or in the setting of infection [101,102].”
From Macrophage polarization: an opportunity for improved outcomes in biomaterials and regenerative medicine (2012) · cites this paper as [102]
Excessive ECM deposition by myofibroblasts can lead to fibrosis, scarring, and loss of tissue function if not kept in check.
“However, if ECM synthesis in myofibroblasts is not kept in check, then excessive matrix deposition can lead to fibrosis, scarring, and loss of tissue function [120–122].”
From CCN1/CYR61: the very model of a modern matricellular protein (2011) · cites this paper as [120]
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“The fibrotic tissue that develops following CNS trauma and disease is the result of the evolutionarily conserved, ubiquitous, multicellular wound healing process that, under pathological conditions, becomes uncontrolled, thereby causing irreversible fibrosis (Wynn, 2008).”
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- Authors
- Wynn, T.
- Venue
- The Journal of Pathology
- Publisher
- Wiley
- Published
- 2007-12-27
- Volume
- 214
- Issue
- 2
- Pages
- 199-210
- ISSN
- 0022-3417 (ISSN-L)
- 1096-9896
- PMC
- PMC2693329
- OpenAlex
- W1980325398
- Cited by
- 4,495
- References
- 14
- Citations by year
- 2026: 226 · 2025: 255 · 2024: 321 · 2023: 312 · 2022: 300 · 2021: 361 · 2020: 285 · 2019: 257 · 2018: 238 · 2017: 224 · 2016: 220 · 2015: 245 · 2014: 210 · 2013: 216 · 2012: 236
- FWCI
- 9.58
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Pathology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health
- National Institute of Allergy and Infectious Diseases (Z01AI001019, Z01AI000829)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › TGF-β signaling in diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis
- Health Sciences › Medicine › Hepatology › Liver physiology and pathology
- Keywords
- fibrosis, fibrogenesis, myofibroblasts, extracellular matrix deposition, collagen, epithelial-mesenchymal transition, endothelial-to-mesenchymal transition, fibrocytes, fibroblast activation, pattern recognition receptors, Toll-like receptors, pathogen-associated molecular patterns, cytokines, chemokines, renin-angiotensin-aldosterone system, antifibrotic agents, idiopathic pulmonary fibrosis, liver cirrhosis, systemic sclerosis, renal fibrosis, cardiovascular fibrosis
- MeSH terms
- Angiotensin II, Chemotaxis, Fibroblasts, Fibrosis, Humans, Immunity, Innate, Interleukins, Cytokines, Transforming Growth Factor beta, Th1 Cells, Th2 Cells, Disease Progression, Chemokines
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