Heart failure & cardiomyopathies

Sex-Dependent Fibroblast Signatures in Heart Failure: Toward Stratified Anti-Fibro-Inflammatory Therapies

ESC Heart FailPublished Cardiac fibroblasts isolated from endomyocardial biopsies analyzed in vitro and by single-cell RNA sequencing

Authors' conclusion

Our findings suggest sexual dimorphism in cardiac fibroblast biology with potentially distinct mechanisms. Sex may influence fibroblast activation states that shift in heart failure, underscoring the relevance of considering sex in anti-fibrotic strategies and the use of fibroblasts for individualized disease profiling.

Study context

Population
Heart failure patients with LVEF<50% and age-matched patients with LVEF≥50%each group: n=6, 3 men vs. 3 women
Participants
6 vs 6
Comparison
Female vs male cardiac fibroblasts in patients with LVEF<50% and LVEF≥50%
  • LVEF<50%n = 6
  • LVEF≥50%n = 6
Outcome
Metabolic activity
Methodological detailsage-matched
  • Age-matched

Main finding

As reported in the abstract

  • Higher activity in female compared to male fibroblasts in the LVEF<50% patient group; the reverse in the LVEF≥50% group

Further findings

Collagen deposition and α-SMA expression (LVEF<50%)

Female fibroblasts deposited more collagen despite lower α-SMA expression

Morphology

Female cells more polarized and asymmetric than male cells in LVEF<50%; less pronounced in the LVEF≥50% patient group

Transcriptomic activation programs

Male fibroblasts: broad enrichment of TGF-β-driven extracellular matrix remodeling pathways
Female fibroblasts: IL-1-associated remodeling and selective activation of distinct fibroblast subsets

Original publication

Sex-Dependent Fibroblast Signatures in Heart Failure: Toward Stratified Anti-Fibro-Inflammatory Therapies. ESC Heart Fail. Published 28 May 2026. doi:10.1093/eschf/xvag147

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