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Aberrant repair and fibrosis development in skeletal muscle
Open accessAbstract
The repair process of damaged tissue involves the coordinated activities of several cell types in response to local and systemic signals. Following acute tissue injury, infiltrating inflammatory cells and resident stem cells orchestrate their activities to restore tissue homeostasis. However, during chronic tissue damage, such as in muscular dystrophies, the inflammatory-cell infiltration and fibroblast activation persists, while the reparative capacity of stem cells (satellite cells) is attenuated. Abnormal dystrophic muscle repair and its end stage, fibrosis, represent the final common pathway of virtually all chronic neurodegenerative muscular diseases. As our understanding of the pathogenesis of muscle fibrosis has progressed, it has become evident that the muscle provides a useful model for the regulation of tissue repair by the local microenvironment, showing interplay among muscle-specific stem cells, inflammatory cells, fibroblasts and extracellular matrix components of the mammalian wound-healing response. This article reviews the emerging findings of the mechanisms that underlie normal versus aberrant muscle-tissue repair.
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![Figure 3 Inflammatory control of skeletal-muscle regeneration. Replacement of damaged muscle fibers is dependent on satellite cells, resident stem cells that are normally quiescent, and are located under the basal lamina of muscle fibers. Tissue damage leads to their activation, proliferation, differentiation and fusion to form new myofibers. However, their capacity to mediate repair is modified by the extent and type of injury, and consequently by their interaction with various cellular and soluble mediators, most importantly with infiltrating macrophages. The proposed paracrine interaction between macrophages and satellite cells is as follows. During the timely, regulated process of regeneration after acute injury (left), pro-inflammatory cytokines released from M1-macrophages may promote satellite-cell proliferation, whereas cytokines released by anti-inflammatory (M2c) and alternatively activated (M2a) macrophages, respectively, may favor their differentiation and fusion. In particular, interleukin (IL)-4 was shown to regulate fusion of myoblasts in vitro and in vivo [129]. It could be expected that, during chronic damage (right), such as in muscular dystrophies, the increased and persistent presence of the distinct macrophage cell types could modify the relative levels and kinetics of these cytokines, resulting in altered satellite-cell functions and aberrant regeneration, with progressive development of fibrosis and fat accumulation, ultimately leading to non-functional muscle tissue.](/paper-figures/547fee4a5a414107842cef47b823402a/aberrant-repair-and-fibrosis-development-in-skeletal-muscle-figure-3.jpg)


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“Previous work has shown that the accumulation of inflammatory macrophages and age-related declines in interferon-gamma signaling delay muscle repair following injury”
From Skeletal muscle aging, cellular senescence, and senotherapeutics: current knowledge and future directions (2021) · cites this paper as Mann et al., 2011
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1 retracted
RETRACTED ARTICLE: The role of nitric oxide during healing of trauma to the skeletal muscle
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“In addition, NO, which is released by local and invading cells during injury, can act as a pro-inflammatory molecule, and is able to activate MMP-2, which in turn releases HGF. Importantly, blockers of NOS function, such as nitro- Larginine methyl ester (L-NAME), have been shown to decrease the acute inflammatory reac…”
MethodInfluentialRetractedThe chemokine system in diverse forms of macrophage activation and polarization
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“A nomenclature for polarized macrophages has been proposed [24,25] and they are now referred to as classically and alternatively activated macrophages, or M1 and M2 macrophages, respectively (Figure 2, Figure 3).”
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Cellular and molecular mechanisms of fibrosis
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SATELLITE CELL OF SKELETAL MUSCLE FIBERS
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“These cells are associated with tissue repair and fibrosis in many tissues and organs, including muscle, skin, liver, lung, bone and cartilage [56].”
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“An important development in our understanding of muscle repair and fibrosis was the demonstration that a heterogeneous population of macrophages exists in regenerating muscle after injury, exhibiting opposing activities (either pro-inflammatory or anti-inflammatory) and different kinetics [23].”
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Muscle injury activates resident fibro/adipogenic progenitors that facilitate myogenesis
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“Whether FAP conversion also occurs during aging, and whether Basal lamina ECM deposition Satellite cell Fibro/adipogenic progenitor Resident macrophage Fibroblast Increased number of fibroblasts Fibrogenic-converted myogenic cells Myofiber Atrophic myofiber Young Old Figure 5 Myofiber growth and extracellular matrix (…”
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“Although muscle is noted for its high capacity for regeneration and repair of myofibers,(16) muscle fibrosis impairs muscle regeneration and enhances muscle susceptibility to further injury.(19,20) In current management after muscle injury, therapeutic stretching exercise has been applied in rehabilitation settings to…”
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“These changes are the end stage of a cascade of events proceeding from tissue damage via inflammation.(39) In diabetic patients with CECS, low oxygenation, tissue damage, and inflammation probably provide an environment for intramuscular fibrosis and fat infiltration.”
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Zfp697 is an RNA-binding protein that regulates skeletal muscle inflammation and regenerationPreprint
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InfluentialZhang, H., Li, W., Zhang, H., Lu, M. M., Zhao, X., Li, J., Hu, R., & Zhang, Y. (2025) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-025-06400-z · Cited by 2
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BackgroundCellular regulators of myoblast migration and myogenesis
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“Furthermore, the muscle regeneration and remodeling processes associated with sarcopenia cause persistent muscle inflammation (9), which may exacerbate the load on muscles with reduced tissue elasticity.”
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Lysophosphatidic acid mediates skeletal muscle fibrosis in denervation via activation of YAP/TAZ
Cruz-Soca, M., Córdova-Casanova, A., Faundez-Contreras, J., Martínez, N. W., Vaccaro-Rivera, F., Bazaes-Astorga, S., Gutiérrez‐Rojas, C., Gallardo, F. S., Rebolledo, D. L., Court, F. A., et al. (2026) · JCI Insight · doi:10.1172/jci.insight.198388 · Cited by 1
“Fibrosis is closely related to other pathological features in skeletal muscle, including degeneration, inflammation, and atrophy, ultimately exacerbating disease progression (19, 20).”
Shrestha, S., Politeski, A., & Dick, S. A. (2026) · Journal of Leukocyte Biology · doi:10.1093/jleuko/qiag054 · Cited by 1
“9 13 Concurrently, FAPs expand and provide structural and paracrine support to promote MuSC activation and differentiation.”
Different effects of 3‐week disuse on phenotype and gene expression in calf and thigh muscles
Orlova, M. A., Kurochkina, N. S., Zhedyaev, R. Y., Vavilov, N. E., Zgoda, V. G., Puchkova, А. A., Borzykh, A. A., Vepkhvadze, T. F., Lednev, E. M., Makhnovskii, P. A., et al. (2026) · The Journal of Physiology · doi:10.1113/jp290722 · Cited by 1
Macrophage regulation of extracellular matrix remodeling in aging skeletal muscle
Cui, C., Nazario, J. C., Stephen, I. A., Baranzini, M., Zhang, Y., De, S., Sen, P., Ferrucci, L., & Gorospe, M. (2026) · Ageing Research Reviews · doi:10.1016/j.arr.2026.103208 · Cited by 1
Preserved satellite cell pool in a laminin-α2-deficient model of congenital muscular dystrophy
Coelho, L. A., Ribeiro, A. F., Nogueira, L., de Vasconcelos, F. T. G. R., Bezerra, J. C., & Vainzof, M. (2026) · Disease Models & Mechanisms · doi:10.1242/dmm.052782 · Cited by 1
“Fibrosis is defined by the excessive accumulation of ECM proteins (Mann et al., 2011).”
Effect of green tea on aged rat skeletal muscle: a light and electron microscopic study
Elgamal, D. A., & Ahmed, S. (2012) · The Egyptian Journal of Histology · doi:10.1097/01.ehx.0000414274.75968.92 · Cited by 3
¿Podemos Mejorar La Cicatrización de un Desgarro Muscular Masivo?
Burucker, A. V., Gonçalves, M. S., Proboste, I. A., Mena, R. C., Poblete, D. F., Ángulo, M. G., Rodríguez, R. C., & Molina, P. C. (2018) · Revista Chilena de Ortopedia y Traumatología · doi:10.1055/s-0038-1641564 · Cited by 1
Immune System Regulation of Muscle Injury and Disease
Kastenschmidt, J. M., Mannaa, A. H., Muñoz, K. J., & Villalta, S. A. (2019) · Springer eBooks · doi:10.1007/978-3-030-03095-7_7 · Cited by 1
Soares, I. D. S. (2019) · Anais do VIII Seminário de Integração Científica da Universidade do Estado do Pará · doi:10.31792/21759766.viiisic.2019.322-326 · Cited by 1
MITOS ASSURINI DO TROCARÁ: FONTES DE SABERES INTERDISCIPLINARES
Assurini, V., Assurini, W., Assurini, M., & Assurini, T. (2019) · Anais do VIII Seminário de Integração Científica da Universidade do Estado do Pará · doi:10.31792/21759766.viiisic.2019.161 · Cited by 1
Skeletal Muscle-Resident Pericyte Responses to Conditions of Use and Disuse
Munroe, M., Dvoretskiy, S., & Boppart, M. D. (2021) · Stem cell biology and regenerative medicine · doi:10.1007/978-3-030-62129-2_9 · Cited by 1
Bani, A., Putera, I., Susanto, E., & Nora, R. L. D. (2022) · Current Eye Research · doi:10.1080/02713683.2022.2153871 · Cited by 1
“may potentially alter muscle regeneration as M2 macrophage affect myoblast activity.(6,8,16,31) Compared to M1, M2 macrophages have more anti-inflammatory properties.”
BackgroundCirculating TGF-β1 Levels: Linking Muscle and Trauma
La, L., & Tuan, R. S. (2023) · Biomarkers in disease · doi:10.1007/978-3-031-07395-3_37 · Cited by 1
Maldonado, L., Orozco-Aguilar, J., Valero‐Breton, M., Tacchi, F., Cifuentes-Silva, E., & Cabello‐Verrugio, C. (2023) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-26163-3_12 · Cited by 1
Targeting Hub Genes Involved in Muscle Injury Induced by Jumping Load Based on Transcriptomics
Shi, X.-L., Wang, Y., Liu, H., & Han, R. (2023) · DNA and Cell Biology · doi:10.1089/dna.2022.0285 · Cited by 1
Cathepsin B Levels Correlate with the Severity of Canine Myositis
Pasquale, V. D., Vaccaro, E., Rossin, F., Ciampa, M., Scarcella, M., Paciello, O., & Tafuri, S. (2025) · Biomolecules · doi:10.3390/biom15050743 · Cited by 1
“Interestingly, elevated expression levels of cathepsin S were found in muscle biopsies from IM-affected individuals and in human myoblasts cultured in the presence of IFN-gamma In IM, advanced stages are characterized by the replacement of muscle by fibrous tissue [26,27].”
Orthobiologic Augmentation to Improve Rotator Cuff Repair Outcomes: Current and Future Strategies
Jabara, J. T., Kiani, S., Youn, A., & Feeley, B. T. (2025) · Journal of the American Academy of Orthopaedic Surgeons · doi:10.5435/jaaos-d-25-00069 · Cited by 1
Fibrosis-Inducing Strategies in Regenerating Dystrophic and Normal Skeletal Muscle
Pessina, P., & Muñoz‐Cánoves, P. (2016) · Methods in molecular biology · doi:10.1007/978-1-4939-3810-0_7 · Cited by 1
Fausto, D. A., Ferraz, A. L. J., Delgado, E. F., Andrade, S. C. S., Coutinho, L. L., & Feijó, G. L. D. (2018) · animal · doi:10.1017/s1751731118001490 · Cited by 1
The Bioengineering of Exogenic Organs and/or Cells for Use in Regenerative Medicine
Aravalli, R. N., Shiao, M. L., Lu, W.-C., Xie, H. M., Pearce, C., Toman, N. G., Danczyk, G., Sipe, C. J., Miller, Z. D., Crane, A. T., et al. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-813068-1.00015-4 · Cited by 1
TUDO O QUE MEU AMOR DESEJAR: UM ESTUDO SOBRE OS TRABALHOS DE MAGIA NOS TERREIROS EM BELÉM DO PARÁ
Sena, F. O. D. (2019) · Anais do VIII Seminário de Integração Científica da Universidade do Estado do Pará · doi:10.31792/21759766.viiisic.2019.374-377 · Cited by 1
O BELO RELIGIOSO CONVENIENTE DE ARNOLD SCHÖNBERG
da Silva, S. W. D. (2019) · Anais do VIII Seminário de Integração Científica da Universidade do Estado do Pará · doi:10.31792/21759766.viiisic.2019.411-414 · Cited by 1
Behavior of skeletal muscle after severe burn injury
Quintana, H. T., & Gomes, D. M. C. F. (2020) · World Journal of Advanced Research and Reviews · doi:10.30574/wjarr.2020.5.2.0042
“These elements serve to stabilize the tissue, and act as a scaffold for the new fibers [49].”
BackgroundBMP1.3 protein as potential target in treatment of fibrosis
Bordukalo-Nikšić, T., & Kufner, V. (2021) · Rad Hrvatske akademije znanosti i umjetnosti Medicinske znanosti · doi:10.21857/y7v64t0oxy · Cited by 1
“Chronic inflammatory processes in dystrophic muscle result in excessive accumulation of ECM components, leading to the replacement of muscle with fibrotic tissue (84).”
BackgroundBone Metastases: Systemic Regulation and Impact on Host
Suresh, S., & Guise, T. A. (2022) · Springer eBooks · doi:10.1007/978-3-031-09518-4_3 · Cited by 1
Research Progress of Skeletal Muscle Injury Repair and Treatment Strategies
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The effect of antiretrovirals on myoblast proliferation : migration and differentation.
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Benfotiamine reduces pathology and improves muscle function in mdx micePreprint
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Pathophysiological remodeling of the skeletal muscle microenvironment in patients with lung cancerPreprint
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Leucine-Protein Supplemented Recovery and Exercise
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Metadata
- Authors
- Mann, C. J., Perdiguero, E., Kharraz, Y., Aguilar, S., Pessina, P., Serrano, A. L., & Muñoz-Cánoves, P.
- Affiliations
- Universitat Pompeu Fabra (ES)
- Venue
- Skeletal Muscle
- Published
- 2011-05-04
- Volume
- 1
- Issue
- 1
- Pages
- 21-21
- ISSN
- 2044-5040 (ISSN-L)
- PMC
- PMC3156644
- OpenAlex
- W2076787014
- Cited by
- 853
- References
- 129
- Citations by year
- 2026: 37 · 2025: 59 · 2024: 55 · 2023: 53 · 2022: 59 · 2021: 71 · 2020: 81 · 2019: 85 · 2018: 76 · 2017: 51 · 2016: 68 · 2015: 48 · 2014: 49 · 2013: 33 · 2012: 27
- FWCI
- 14.30
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Skeletal Muscle (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Repositori digital de la UPF (Universitat Pompeu Fabra) (submittedVersion, cc-by)
- Funders
- Ministerio de Ciencia e Innovación (PLE2009)
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Muscle Physiology and Disorders
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
- Health Sciences › Medicine › Surgery › Wound Healing and Treatments
- Keywords
- muscle fibrosis, muscle repair, muscular dystrophy, satellite cells, muscle stem cells, fibroblast activation, inflammatory cell infiltration, extracellular matrix, wound healing, microenvironment
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