Translational Perspectives

The extracellular matrix (ECM) provides structural support and organization for cardiomyocytes and the vasculature of the heart. Under normal conditions, the ECM scaffold facilitates efficient force transduction for mechanical work, while mediating intercellular communication and metabolic exchange. This follows the unique 3-dimensional disposition of myocyte bundles and fibrillar collagens within the myocardium (Figure 1). With stress, injury, or disease, the ECM undergoes changes that potentiate inflammatory processes, myocardial protein turnover, tissue repair, and regeneration, which leads to organ remodeling and functional adaptation. However, sustained ECM remodeling can compromise proper diastolic and contractile functions as seen with fibrosis. This review will discuss the complex dynamics of the ECM in the setting of cardiovascular conditions of myocardial infarction (MI), pressure overload (PO), and volume overload (VO) as both participant and contributor to the disease pathophysiology. Subsequent sections will focus on the translational aspects of identifying biomarkers that can prognosticate or identify disease progression in patients and the current status of ECM-focused antifibrotic therapies. Review