6. Concluding remarks
It is recently ascertained that fibrosis, excess deposition of ECM components, in metabolically active, insulin-sensitive tissues, including the skeletal muscle, adipose tissue and liver has damaging impact on glucose homoeostasis [6,120,121]. Obesogenic ECM remodelling of white adipose tissues is closely linked with the increased levels of circulating ECM proteins and ECM-derived peptides in parallel with increased levels of adipose-derived cytokines. These white adipose tissue-derived ECM or ECM-related molecules may exert metabolically deleterious effects on metabolic crosstalk between the adipose tissue, liver, and skeletal muscles (Fig. 3). Despite a recent implication of ECM-receptor pathway in determining glucose homoeostasis in the skeletal muscle and liver [6], its role in the adipose tissue has not been fully defined. We postulate that the ECM receptor pathway of adipocytes as well as other cell types found in adipose tissues, i.e. inflammatory monocytes and macrophages and vascular endothelial cells are important in transducing intracellular signalling of adipocyte death, angiogenesis, and the infiltration of inflammatory cells, which culminate in insulin resistance. Tissue-specific mouse models that lack a key ECM, ECM modifier, ECM receptor, or intracellular mediator, will help us decipher the importance of the ECM receptor pathway and its regulators in determining metabolic tissue remodelling, function and glucose homoeostasis. We propose the potential of developing therapeutic strategies that target ECM matrix of metabolically active tissues, including the liver, skeletal muscle and the adipose tissue. Current anti- fibrotic drugs being tested in clinical settings have been focused on cancers (e.g. PEGPH20), heart failure (e.g. FT011) and glaucoma surgery (e.g. CLT-28643). The effectiveness of their use in obesity, insulin resistance and type 2 diabetes is unknown and may worth further investigation.