The pathogenesis of cardiac fibrosis

Ping Kong, Panagiota Christia, Nikolaos G. Frangogiannis

Research output: Contribution to journalReview articlepeer-review

1170 Scopus citations


Cardiac fibrosis is characterized by net accumulation of extracellular matrix proteins in the cardiac interstitium, and contributes to both systolic and diastolic dysfunction in many cardiac pathophysiologic conditions. This review discusses the cellular effectors and molecular pathways implicated in the pathogenesis of cardiac fibrosis. Although activated myofibroblasts are the main effector cells in the fibrotic heart, monocytes/macrophages, lymphocytes, mast cells, vascular cells and cardiomyocytes may also contribute to the fibrotic response by secreting key fibrogenic mediators. Inflammatory cytokines and chemokines, reactive oxygen species, mast cell-derived proteases, endothelin-1, the renin/angiotensin/aldosterone system, matricellular proteins, and growth factors (such as TGF-β and PDGF) are some of the best-studied mediators implicated in cardiac fibrosis. Both experimental and clinical evidence suggests that cardiac fibrotic alterations may be reversible. Understanding the mechanisms responsible for initiation, progression, and resolution of cardiac fibrosis is crucial to design anti-fibrotic treatment strategies for patients with heart disease.

Original languageEnglish (US)
Pages (from-to)549-574
Number of pages26
JournalCellular and Molecular Life Sciences
Issue number4
StatePublished - Feb 2014


  • Angiotensin
  • Cardiac remodeling
  • Chemokine
  • Extracellular matrix
  • Macrophage
  • Mast cell
  • Myofibroblast
  • TGF-β

ASJC Scopus subject areas

  • Molecular Medicine
  • Molecular Biology
  • Pharmacology
  • Cellular and Molecular Neuroscience
  • Cell Biology


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