During wound healing, contractile fibroblasts called myofibroblasts
regulate the formation and contraction of granulation tissue; however,
pathological and persistent myofibroblast activation, such as occurs in
hypertrophic scars or tissue fibrosis, results in loss of function. Many
outstanding reviews outline cellular and molecular features of myofibroblasts,
and their roles in a variety of diseases. This review will focus on the origins
of myofibroblasts and the factors which control their differentiation and
prolonged survival in fibrotic tissues. Pulmonary fibrosis is used to illustrate
many key points, but examples from other tissues and models are also included.
Myofibroblasts emerge mostly from tissue-resident fibroblasts but also from
epithelial, endothelial cells or other mesenchymal precursors. Their
differentiation is influenced by cytokines, growth factors, extracellular matrix
composition and stiffness, and cell surface molecules such as proteoglycans and
THY1, among other factors. Many of these effects are modulated by cell
contraction. Myofibroblasts resist programmed cell death, promoting their
accumulation in fibrotic tissues. The cause of resistance to apoptosis in
myofibroblasts is under ongoing investigation, but many of the same stimuli that
regulate their differentiation are involved. The contributions of oxidative
stress, the WNT - β-catenin pathway and PPARγ to myofibroblast
differentiation and survival are increasingly appreciated.