Targeting metabolic dysregulation for fibrosis therapy

Nat Rev Drug Discov. 2020 Jan;19(1):57-75. doi: 10.1038/s41573-019-0040-5. Epub 2019 Sep 23.


Fibrosis is the abnormal deposition of extracellular matrix, which can lead to organ dysfunction, morbidity, and death. The disease burden caused by fibrosis is substantial, and there are currently no therapies that can prevent or reverse fibrosis. Metabolic alterations are increasingly recognized as an important pathogenic process that underlies fibrosis across many organ types. As a result, metabolically targeted therapies could become important strategies for fibrosis reduction. Indeed, some of the pathways targeted by antifibrotic drugs in development - such as the activation of transforming growth factor-β and the deposition of extracellular matrix - have metabolic implications. This Review summarizes the evidence to date and describes novel opportunities for the discovery and development of drugs for metabolic reprogramming, their associated challenges, and their utility in reducing fibrosis. Fibrotic therapies are potentially relevant to numerous common diseases such as cirrhosis, non-alcoholic steatohepatitis, chronic renal disease, heart failure, diabetes, idiopathic pulmonary fibrosis, and scleroderma.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cellular Reprogramming*
  • Extracellular Matrix Proteins / metabolism*
  • Fibrosis / drug therapy*
  • Fibrosis / metabolism
  • Fibrosis / pathology
  • Humans
  • Metabolic Diseases / drug therapy*
  • Metabolic Diseases / metabolism
  • Metabolic Diseases / pathology
  • Molecular Targeted Therapy*
  • Signal Transduction / drug effects*
  • Transforming Growth Factor beta


  • Extracellular Matrix Proteins
  • Transforming Growth Factor beta