Mechanisms and Treatments of Fibrosis

  • Immune cells play a crucial role in regulating the production of extracellular matrix (ECM) by fibroblasts and determining the extent of fibrosis in response to inflammation.
  • The researchers analyzed skin and lung samples from patients with diffuse cutaneous systemic sclerosis, and identified epiregulin – EGFR signaling as a critical pathway between dendritic cells and fibroblasts in maintaining elevated ECM production and accumulation in fibrotic tissue.
  • Epiregulin expression in DC3 dendritic cells, triggered by type I interferon, was found to activate EGFR on fibroblasts, creating a positive feedback loop through NOTCH signaling.
  • In mouse models of skin and lung fibrosis, the presence of epiregulin was necessary for the persistence of fibrosis in both tissues. This effect could be reversed by genetic deficiency or a neutralizing antibody targeting epiregulin.
  • Therapeutic administration of an epiregulin antibody was able to reverse fibrosis in patient skin and lung explants, suggesting that epiregulin represents a potential biologic drug target for treating fibrosis.
  • Epiregulin is revealed as a crucial immune signal that maintains fibrosis in the skin and lungs across multiple diseases, making it a promising target for developing antifibrotic treatments.

Cutaneous wound healing stages:

  1. Vasoconstriction and hemostasis:
  • Formation of stable fibrin clot.
  • Stops blood loss.
  • Provides a scaffold for migrating immune cells.
  1. Inflammatory phase:
  • Accumulation of immunomodulatory mediators in the wound bed.
  • Rapid recruitment of neutrophils.
  • Infiltration of monocytes and activation of skin-resident immune cells.
  • Proinflammatory cytokines (e.g., TNF-α and IL-1) orchestrate the response to pathogens.
  • Immune cells release trophic factors and immunomodulatory molecules.
  1. Proliferative phase:
  • Formation of granulation tissue.
  • Myofibroblast differentiation advances wound closure.
  • Migration of epidermal stem cells and proliferation/differentiation of transiently amplifying cells.
  • Neovascularization for oxygen and nutrient delivery.
  1. Remodeling phase:
  • Pruning of newly formed vasculature.
  • Extensive rearrangement of extracellular matrix (ECM).
  • Formation of rigid scar tissue.
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Chronic wounds and market implications:

  • Lifetime prevalence of chronic wounds in developed countries is 1-2%.
  • Chronic wounds represent a severe burden for patients and a socioeconomic challenge.
  • The annual global market for wound care-related products is projected to reach $15-22 billion by 2024, representing 2-3% of total healthcare budgets in developed countries.
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  • Crosstalk between Kupffer cells (KCs) and hepatic stellate cells (HSCs) is significant in various liver disease conditions, including alcohol-associated liver disease (AALD) fibrosis.
  • Targeting the KC-HSC crosstalk is a crucial focus for therapeutic interventions in liver diseases.
  • A novel modular nanosystem was developed using self-assembly with boric acid and catechol interactions.
  • Polymers modified with CXCR4-inhibiting moieties were utilized in the nanosystem design.
  • The polymers were used to encapsulate anti-miR-155, aiming to downregulate miR-155 expression in KCs and inhibit CXCR4 signaling in activated HSCs.
  • In a mouse model of AALD fibrosis, the simultaneous inhibition of miR-155 and CXCR4 in different liver cell types showed enhanced antifibrosis effects.
  • The study demonstrates the significance of blocking the undesirable crosstalk between HSCs and KCs in reversing AALD fibrosis.

New studies showed:

  1. Cardiac fibroblasts may exhibit heterogeneity in activation, proliferation, and function during cardiac fibrosis.
  2. Endocardium-derived fibroblasts show preferential proliferation and expansion in response to pressure overload.
  • Dual recombinase-mediated genetic lineage tracing was used to investigate this phenomenon.
  1. Regional expansion of activated fibroblasts occurs after injury, matching the distribution pattern of endocardium-derived fibroblasts in the heart.
  • Fibroblast-specific proliferation tracing revealed this expansion.
  1. Ablation of endocardium-derived fibroblasts reduces cardiac fibrosis and mitigates the decline of heart function after pressure overload injury.
  • Specific targeting of this fibroblast subpopulation has therapeutic potential.
  1. Wnt signaling plays a mechanistic role in the activation and expansion of endocardium-derived fibroblasts during cardiac remodeling.
  • Wnt signaling promotes the process.
  1. Endocardium-derived fibroblasts are identified as a key fibroblast subpopulation responsible for severe cardiac fibrosis after pressure overload injury.
  1. The origins of wound myofibroblasts and scar tissue are unclear.
  2. Injury induces a transient migratory state in adipocytes.
  3. Migratory adipocytes do not contribute to scar formation.
  4. Migratory adipocytes remain non-fibrogenic in vitro, in vivo, and upon transplantation.
  5. Wound adipocytes do not convert into fibrogenic myofibroblasts
  6. Injury-induced migratory adipocytes remain lineage-restricted.
  7. Migratory adipocytes do not reprogram into a fibrosing phenotype.
  8. These findings have broad implications for regenerative medicine, wound repair, diabetes, and fibrotic pathologies

Sublethal necroptosis signaling promotes inflammation and liver cancer

  1. Concomitant necrosome and NF-κB activation in hepatocytes, with low RIPK3 expression, leads to a prolonged “sublethal” state with leaky membranes, turning them into secretory cells.
  2. The secretory cells release specific chemokines, including CCL20 and MCP-1, triggering hepatic cell proliferation and activation of procarcinogenic monocyte-derived macrophage cell clusters, contributing to hepatocarcinogenesis.
  3. In contrast, necrosome activation in hepatocytes with inactive NF-κB signaling causes an accelerated execution of necroptosis, limiting alarmin release, and preventing inflammation and hepatocarcinogenesis.
  4. Intratumoral NF-κB-necroptosis signatures are associated with poor prognosis in human hepatocarcinogenesis.
  5. Pharmacological reprogramming between these distinct forms of necroptosis may represent a promising strategy against hepatocellular carcinoma.

https://www.cell.com/immunity/fulltext/S1074-7613(23)00234-0?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS1074761323002340%3Fshowall%3Dtrue

  1. The pulmonary vasculature is often overlooked in lung diseases like ARDS, PF, and COPD.
  2. Emphasis on managing parenchymal disorders typically focuses on epithelial cell injury and repair.
  3. Increasing evidence points to the active role of vascular endothelium in lung disease development.
  4. The endothelial cell network exists in capillary beds, arterial, and venous vessels, controlling immune cell migration, vascular tone, and permeability.
  5. Endothelial cells contribute to remodeling processes in acute and chronic lung diseases.
  6. Remodeled vessels and altered endothelial cells are present in lung diseases to varying extents due to disease-specific mechanisms.
  7. Understanding vascular alterations is crucial due to their association with pulmonary hypertension.

Transglutaminases (TGs) are cross-linking enzymes associated with fibrosis, especially, TG2, TG1, and FXIII-A to the progression of fibrosis. TG2 - fibrosis has been reported mainly through transforming growth factor beta (TGF-beta) signaling and matrix cross-linking mechanisms.

Targeted alveolar regeneration with Frizzled-specific agonists

  1. Wnt ligands oligomerize Frizzled (Fzd) and Lrp5/6 receptors to control the specification and activity of stem cells in various species.
  2. The mechanism of selectively activating Wnt signaling in different stem cell populations within the same organ is not well understood.
  3. In lung alveoli, distinct Wnt receptors are expressed by different cell types: epithelial cells express Fzd5/6, endothelial cells express Fzd4, and stromal cells express Fzd1.
  4. Fzd5 is specifically required for alveolar epithelial stem cell activity, while fibroblasts use different Fzd receptors.
  5. Using a range of Fzd-Lrp agonists, it is possible to activate canonical Wnt signaling in alveolar epithelial stem cells through either Fzd5 or non-canonical Fzd6.
  6. Both a Fzd5 agonist (Fzd5ag) and a Fzd6 agonist (Fzd6ag) stimulate alveolar epithelial stem cell activity and enhance survival in mice following lung injury.
  7. However, only Fzd6ag promotes an alveolar fate in airway-derived progenitors.
  8. This research identifies a potential strategy for promoting lung regeneration without exacerbating fibrosis during lung injury.

https://www.cell.com/cell/fulltext/S0092-8674(23)00541-X?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS009286742300541X%3Fshowall%3Dtrue

*Mutations in epigenetic regulators like DNA methyltransferase 3 alpha (DNMT3A) drive clonal hematopoiesis of indeterminate potential (CHIP) and are linked to unfavorable outcomes in heart failure (HF) patients.
*The interactions between CHIP-mutated cells and other cardiac cell types, such as fibroblasts, were previously unknown.
*The study identifies fibroblasts as potential interaction partners with CHIP-mutated monocytes.
*Inactivating DNMT3A in macrophages intensifies interactions with cardiac fibroblasts, leading to increased cardiac fibrosis.
*DNMT3A inactivation amplifies the release of heparin-binding epidermal growth factor-like growth factor, which activates cardiac fibroblasts.
*The findings suggest that DNMT3A CHIP-driver mutations may play a role in the initiation and progression of HF.
*The study provides a basis for developing innovative anti-fibrotic strategies targeting the pathway identified.

DNMT3A clonal hematopoiesis-driver mutations induce cardiac fibrosis by paracrine activation of fibroblasts - PMC (nih.gov)