{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:00:47Z","timestamp":1791475247313,"version":"4.3.4"},"reference-count":82,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T00:00:00Z","timestamp":1772668800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:p>Pathological scarring, a fibroproliferative disorder, imposes a substantial burden on affected individuals. This review explores the pivotal role of the local cutaneous renin-angiotensin system (RAS) in the pathogenesis of pathological scarring. We summarize evidence demonstrating how the pro-fibrotic angiotensin II\/angiotensin II type 1 receptor (Ang II\/AT1R) axis drives scar formation by promoting fibroblast proliferation, inflammation, and excessive extracellular matrix (ECM) deposition. Concurrently, we examine the interactions between RAS and other fibrotic pathways, as well as inflammation and reactive oxygen species (ROS). Importantly, the review highlights the significant therapeutic potential of targeting this pathway with RAS inhibitors\u2014specifically angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs)\u2014particularly in topical formulations. We also outline recent advances in next-generation RAS therapies. Finally, we summarize current limitations and challenges in clinical translation, emphasizing the need for advanced clinical trials and precision medicine strategies to facilitate its clinical adoption.<\/jats:p>","DOI":"10.3389\/fphar.2026.1792119","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T06:55:54Z","timestamp":1772693754000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond blood pressure: the renin-angiotensin system as an innovative driver and therapeutic target in pathological scarring"],"prefix":"10.3389","volume":"17","author":[{"given":"Bang-Hui","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin-Ge","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing-Qing","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao-Ling","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei-Qiang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shou-Jie","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, The Fourth Affiliated Hospital of School of Medicine, and International School of Medicine, International Institutes of Medicine, Zhejiang University","place":["Yiwu, Zhejiang, China"]},{"name":"Department of Plastic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University","place":["Hangzhou, Zhejiang, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s10495-018-1490-7","article-title":"TAK1 mediates convergence of cellular signals for death and survival","volume":"24","author":"Aashaq","year":"2019","journal-title":"Apoptosis"},{"key":"B2","first-page":"1442","article-title":"Comparative results in treatment of keloids with intralesional 5-FU\/Kenalog, 5-FU\/Verapamil, enalapril Alone,Verapamil alone, and laser: a case report and review of the literature","volume":"15","author":"Alexandrescu","year":"2016","journal-title":"J. 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