A fresh angle on myocardial fibrosis processes: cold and hot phenotypes. Pathogenesis features and potential therapeutic strategies

Fibrosis is a process characterized by excessive accumulation of extracellular matrix components in response to injury, ischemia, and chronic metabolic and immune inflammation. Normally, extracellular matrix homeostasis is regulated by maintaining a balance between the intensity of fibrogenesis and fibrolysis. In this review, for the first time in the Russian literature, a new concept of "cold" and "hot" fibrosis is highlighted, based on the peculiarities of the interaction of the extracellular matrix and the immune system. The role of biologically active substances acting as candidate biomarkers for fibrosis and antifibrotic response is discussed. The development of such a biomarker concept can be considered as a basis for the creation of antifibrotic therapy strategies relevant for the treatment of various cardiac diseases.