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During the proliferative phase of cardiac repair, fibroblasts undergo myofibroblast transdifferentiation expressing contractile proteins and secreting large amounts of matrix proteins. Growth factors, the renin-angiotensin-aldosterone axis, and the mast cell-derived proteases tryptase and chymase are implicated in myofibroblast transformation and proliferation, and stimulate matrix protein synthesis. Specialized matrix proteins contribute to fibroblast activation.
