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Cardiac macrophages and emerging roles for their metabolism after myocardial infarction
Edward B. Thorp
Edward B. Thorp
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Review

Cardiac macrophages and emerging roles for their metabolism after myocardial infarction

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Abstract

Interest in cardioimmunology has reached new heights as the experimental cardiology field works to tap the unrealized potential of immunotherapy for clinical care. Within this space is the cardiac macrophage, a key modulator of cardiac function in health and disease. After a myocardial infarction, myeloid macrophages both protect and harm the heart. To varying degrees, such outcomes are a function of myeloid ontogeny and heterogeneity, as well as functional cellular plasticity. Diversity is further shaped by the extracellular milieu, which fluctuates considerably after coronary occlusion. Ischemic limitation of nutrients constrains the metabolic potential of immune cells, and accumulating evidence supports a paradigm whereby macrophage metabolism is coupled to divergent inflammatory consequences, although experimental evidence for this in the heart is just emerging. Herein we examine the heterogeneous cardiac macrophage response following ischemic injury, with a focus on integrating putative contributions of immunometabolism and implications for therapeutically relevant cardiac injury versus cardiac repair.

Authors

Edward B. Thorp

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Figure 1

Heterogeneous cardiac macrophages and interacting cell types respond to MI.

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Heterogeneous cardiac macrophages and interacting cell types respond to ...
At steady state, resident CCR2– macrophages, recruited CCR2+ cardiac macrophages, and fibroblasts exhibit non-inflammatory activity. Within 1 week after MI, CCR2– and CCR2+ macrophages show increased macrophage functions related to repair and inflammation. Cardiac macrophages interact with various cell types, including cardiomyocytes, neutrophils (PMNs), fibroblasts, monocytes, B cells, apoptotic cells, regulatory T cells (Tregs), endothelial cells, lymphatic endothelial cells, and myofibroblasts. Related processes include macrophage phagocytic clearance of apoptotic cells (efferocytosis) and released cardiomyocyte-derived exophers. Efferocytosis in the heart may contribute to activation of myofibroblasts and resultant scar formation. Cardiomyocytes may secrete factors that activate endothelial adhesion molecules. Macrophage receptors that interact with the cardiac milieu include the chemokine receptor CCR2, the pattern recognition receptor TLR4, and the phagocytic molecule CD36. Key effector cytokines produced after MI include IL-1β (produced from the inflammasome) and TGF-β. Reparative gene activation involves the vascular endothelial growth factors Vegfa and Vegfc.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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