Selective expansion of cardiac macrophage subtypes distinguishes their functional roles in disease and homeostasis.

Cardiac macrophages are broadly studied as 2 subtypes, tissue-resident CX3C chemokine motif receptor 1 positive (CX3CR1+) that are also CC motif chemokine receptor 2 negative (CCR2-) and monocyte-derived CCR2+. Previous systemic loss-of-function approaches suggested unique roles for each subtype in the heart, with CCR2+ being inflammatory and CX3CR1+ being prohealing. Here, we employed a cardiac-specific gain-of-function approach to selectively enhance either macrophage subtype. A robust increase in basal CCR2+ macrophages in the heart by targeted CC chemokine ligand 2 (Ccl2) expression did not induce inflammation, cause fibroblast activation, or impair cardiac function. However, increased CCR2+ macrophages reciprocally diminished self-renewing tissue-resident macrophages and worsened cardiac fibrosis due to pressure overload stimulation. Conversely, augmented expression of colony-stimulating factor-1 (Csf1) in the heart promoted selective expansion of resident CX3CR1+ macrophages, which exerted no pathophysiological consequences at steady state. However, pressure overload in these mice with expanded CX3CR1+ macrophages showed a CCR2+ macrophage-dependent inflammation leading to exacerbated cardiac dysfunction, simultaneously protecting from adverse remodeling and cardiac fibrosis. In conclusion, cardiac-specific selective enrichment of macrophage subtypes shows their intricate interplay and unique functional roles in regulating myocardial inflammation and fibrosis during hypertrophy and at homeostasis.