The management of cardiac fibrosis presents significant clinical challenges. Characterized by the aberrant activation of quiescent fibroblasts into myofibroblasts and excessive extracellular matrix (ECM) deposition, it represents an irreversible terminal pathway shared by heart failure, myocardial infarction, and other cardiovascular diseases1,2,3. However, current treatment strategies face significant limitations. Conventional interventions—such as diuretics, β-blockers, and renin–angiotensin–aldosterone system inhibitors—primarily alleviate systemic hemodynamic stress and mitigate neurohumoral activation4,5,6,7. These therapies fail to directly target fibroblast activation or halt ongoing collagen deposition. Furthermore, although signaling cascades such as the transforming growth factor beta (TGF-β)/Smad pathway, oxidative stress, and metabolic reprogramming drive this pathology, translating these insights into direct-acting antifibrotic therapies remains challenging due to systemic toxicities and non-specific delivery mechanisms8,9,10. Thus, there is an urgent need for novel, target-specific antifibrotic therapies. A major translational bottleneck is the lack of functional evaluation systems capable of sensitively and dynamically reporting fibroblast activation. Traditional experimental models exhibit significant limitations that preclude efficient pharmacological screening11,12. While in vivo animal models recapitulate global cardiac remodeling, they suffer from interspecies differences, prolonged experimental timelines, high costs, and low throughput11.
To overcome these hurdles, various in vitro screening platforms have emerged; however, critical methodological flaws remain. High-content immunofluorescence assays require destructive cell fixation and laborious processing, providing only a static snapshot rather than capturing the real-time kinetics of fibroblast activation. Similarly, platforms integrating label-free impedance monitoring with mass spectrometry (MS/MS) suffer from non-specificity and low scalability, as impedance drops caused by general cellular toxicity can be easily confounded with true antifibrotic efficacy. Furthermore, clustered regularly interspaced short palindromic repeats (CRISPR)-engineered reporter systems utilizing induced pluripotent stem cells (iPSCs) to track cytoskeletal markers (e.g., alpha-smooth muscle actin [α-SMA]/ACTA2) present steep translational barriers13. These iPSC-based models are prohibitively expensive, technically demanding, and largely inaccessible for routine high-throughput screening. Moreover, reliance on cytoskeletal markers such as α-SMA may not accurately reflect the pathological endpoint, as their expression does not strictly correlate with the functional secretion and excessive deposition of ECM14. Hence, these systems are insufficient to longitudinally map early-stage cellular responses to pharmacological interventions.
In contrast, this protocol describes a longitudinal functional reporter system driven by the collagen type I alpha 1 (Col1a1) promoter, with the goal of establishing a non-destructive and robust platform to monitor fibroblast activation. Because type I collagen is the predominant ECM component deposited during cardiac remodeling, capturing the transcriptional activation of its encoding gene, Col1a1, serves as a direct and pathologically relevant readout for fibroblast activation. This Col1a1 promoter-based model enables continuous, molecular-level monitoring of fibrotic processes, offering a sensitive, longitudinal, and quantifiable platform optimized for mechanism-based drug screening.