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Physiology
Fibrosis is similar to the process of scarring, in that both involve stimulated
fibroblasts laying down connective tissue,
including collagen and glycosaminoglycans. The process is initiated when
immune cells such as macrophages release soluble factors that stimulate
fibroblasts. The most well characterized pro-fibrotic mediator is TGF beta,
which is released by macrophages as well as any damaged tissue between
surfaces called interstitium. Other soluble mediators of fibrosis
include CTGF, platelet-derived growth factor(PDGF), and Interleukin 4 (IL-4).
These initiate signal transduction pathways such as the AKT/mTOR and SMAD
pathways that ultimately lead to the proliferation and activation of fibroblasts,
which deposit extracellular matrix into the surrounding connective tissue. This
process of tissue repair is a complex one, with tight regulation of ECM synthesis
and degradation ensuring maintenance of normal tissue architecture. The entire
process however, although necessary, can lead to a progressive irreversible
fibrotic response if tissue injury is severe or repetitive, or if the wound healing
response itself becomes deregulated.
Examples of fibrosis
Fibrosis can occur in many tissues within the body, typically as a result of
inflammation or damage, and examples include:
Micrograph showing cirrhosis of the liver. The tissue in this example is stained
with a trichrome stain, in which fibrosis is colored blue. The red areas are the
nodular liver tissue
Lungs
Pulmonary fibrosis
Cystic fibrosis
Idiopathic pulmonary fibrosis (idiopathic meaning the cause is unknown)
Liver
Cirrhosis
Heart
Atrial Fibrosis
Endomyocardial fibrosis
Old myocardial infarction
Brain
glial scar
Other