Macrophage and fibro-adipogenic progenitor communication in skeletal muscle regeneration: tissue homeostasis and pathogenic remodeling.

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Skeletal muscle regeneration depends on coordinated interactions between macrophages, fibro-adipogenic progenitors, and muscle stem cells. Following injury, macrophages transition from proinflammatory to anti-inflammatory phenotypes, regulating debris clearance, cytokine secretion, and the activity of fibro-adipogenic progenitors and muscle stem cells. Fibro-adipogenic progenitors transiently support muscle stem cell-mediated regeneration but, if not cleared appropriately, differentiate into fibroblasts or adipocytes, contributing to fibrosis and fatty infiltration. Dysregulated macrophage-fibro-adipogenic progenitor crosstalk drives pathological conditions, including Duchenne muscular dystrophy and age-related sarcopenia, where imbalances in cytokines and growth factors exacerbate maladaptive remodeling. Fibro-adipogenic progenitor-derived colony-stimulating factor 1 sustains macrophage survival while macrophage-derived signals, including tumor necrosis factor alpha and transforming growth factor beta, regulate fibro-adipogenic progenitor apoptosis, proliferation, and differentiation, shaping the regenerative niche. Single-cell and spatial transcriptomic approaches have revealed extensive heterogeneity among resident and infiltrating macrophages and fibro-adipogenic progenitor subsets, uncovering the molecular circuits underlying intercellular communication. Therapeutic strate

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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