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Two types of monocytes, Ly6C hi and Ly6C lo , infiltrate the heart in murine experimental autoimmune myocarditis (EAM). We discovered a role for cardiac fibroblasts in facilitating monocyte-to-macrophage differentiation of both Ly6C hi and Ly6C lo cells, allowing these macrophages to perform divergent functions in myocarditis progression. During the acute phase of EAM, IL-17A is highly abundant. It signals through cardiac fibroblasts to attenuate efferocytosis of Ly6C hi monocyte-derived macrophages (MDMs) and simultaneously prevents Ly6C lo monocyte-to-macrophage differentiation. We demonstrated an inverse clinical correlation between heart IL-17A levels and efferocytic receptor expressions in humans with heart failure (HF). In the absence of IL-17A signaling, Ly6C hi MDMs act as robust phagocytes and are less pro-inflammatory, whereas Ly6C lo monocytes resume their differentiation into MHCII + macrophages. We propose that MHCII + Ly6C lo MDMs are associated with the reduction of cardiac fibrosis and prevention of the myocarditis sequalae.

The Cardiac Microenvironment Instructs Divergent Monocyte Fates and Functions in Myocarditis