Understanding the Role of EC-like Myofibroblasts in COVID-19-Related Pulmonary Fibrosis


Since the emergence of the global COVID-19 pandemic, millions of people have been infected, and a significant number have lost their lives to this devastating disease.

The impact of COVID-19 extends beyond acute illness, as emerging evidence suggests long-term consequences, particularly in the form of pulmonary fibrosis.

Pulmonary fibrosis is a severe lung disease characterized by the excessive accumulation of fibrotic tissue, impairing lung function. Recent studies have highlighted the alarming rise in COVID-19-related pulmonary fibrosis, necessitating a deeper understanding of its underlying mechanisms.

The Role of Myofibroblasts in Pulmonary Fibrosis

Pulmonary fibrosis involves the dysregulated activation and proliferation of myofibroblasts, specialized cells that produce excessive amounts of extracellular matrix components, such as collagen, fibronectin, and other fibrotic proteins. Initially, myofibroblasts were recognized for their role in tissue repair following injury, but their persistent presence in fibrotic conditions leads to the deposition of an unwanted fibrotic matrix. Myofibroblasts exhibit features of both fibroblasts and smooth muscle cells, contributing to the pathological remodeling observed in fibrotic lung tissues.

The Impact of COVID-19 on Pulmonary Endothelial Cells

Pulmonary endothelial cells (ECs) play a crucial role in maintaining lung function and tissue repair. Studies have shown that the absence of ECs results in underdeveloped lungs and endothelial defects that impair lung repair processes. Recent research has identified a novel differentiation pathway in normal lung tissue, where pulmonary ECs can differentiate into EC-like myofibroblasts, eventually progressing to myofibroblasts. This differentiation trajectory was found to significantly contribute to pulmonary fibrosis.

Analyzing scRNA-seq Data of COVID-19 Patients

To investigate the contribution of EC-like myofibroblasts to COVID-19-related pulmonary fibrosis, researchers analyzed publicly available single-cell RNA sequencing (scRNA-seq) data from patients with severe pulmonary fibrosis following COVID-19 infection.

The analysis revealed a significant increase in EC-like myofibroblasts and myofibroblasts in these patients compared to normal lung tissue. Moreover, a clear differentiation trajectory was observed, starting from capillary ECs and progressing towards EC-like myofibroblasts and myofibroblasts.

The Role of COVID-19 Infection in Driving EC Differentiation

COVID-19 infection was found to drive the transition of ECs towards EC-like myofibroblasts and subsequent progression to myofibroblasts.

The upregulation of certain markers, such as ACTA2, CCN2, POSTN, COL1A1, COL3A1, FN1, and PDGFRα, indicated the presence of these cell populations. Interestingly, COVID-19 infection induced excess production of extracellular matrix proteins in ECs, potentially contributing to fibrosis. However, the exact mechanisms connecting EC differentiation to myofibroblast activation require further investigation.

Influence of Cytokine Expression and MGP Activation

Cytokine storm, a known consequence of severe COVID-19 infection, was investigated in the context of ECs and EC-derived myofibroblasts. The expression levels of IL1β, IL6, IL11, and IL33 were found to be low in these cell clusters, suggesting that other cell types, such as immune cells, are primarily responsible for cytokine secretion during COVID-19 infection.

Additionally, the analysis revealed the induction of Matrix Gla Protein (MGP) in ECs, EC-like myofibroblasts, and myofibroblasts. MGP has been associated with regulating the differentiation of EC-like myofibroblasts and may play a role in counteracting the activation of this unwanted pathway.

Discussion and Potential Therapeutic Approaches

COVID-19 infection continues to pose a significant threat, particularly in terms of long-term organ damage, including severe pulmonary fibrosis. The analysis of scRNA-seq data highlighted the importance of understanding the role of EC-like myofibroblasts in driving fibrosis progression.

Excessive TGF-beta production, triggered by COVID-19 infection, was identified as a potential key driver in the transition of ECs and EC-like myofibroblasts towards myofibroblasts. Therapeutic interventions targeting TGF-beta or its downstream signaling pathways may prove beneficial in mitigating pulmonary fibrosis in COVID-19 patients.

Furthermore, the induction of MGP in the differentiation trajectory suggested that regulating BMP-1 activity could be a potential therapeutic strategy. Berbamine, a compound derived from plants, has shown promise in preventing the transition of EC-like myofibroblasts to myofibroblasts and reducing pulmonary fibrosis in animal models. Exploring the effects of berbamine or other similar compounds on COVID-19 patients with pulmonary fibrosis could offer valuable insights into potential therapeutic avenues.


COVID-19-related pulmonary fibrosis has emerged as a significant concern for individuals recovering from the infection. The analysis of scRNA-seq data has shed light on the contribution of EC-like myofibroblasts to the development of pulmonary fibrosis. Understanding the underlying mechanisms driving this differentiation trajectory and identifying potential therapeutic targets will be crucial in developing effective interventions for COVID-19 patients at risk of developing severe pulmonary fibrosis.

Further research is needed to explore the complex interactions between COVID-19 infection, ECs, myofibroblasts, and the molecular pathways involved in pulmonary fibrosis, ultimately providing hope for better clinical outcomes for those affected by this devastating disease.

reference link : https://doi.org/10.3390/ijms241411500


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