CD163⁺/Dab2⁺ Macrophages Alleviate Cardiac Hypertrophy via Nrg2/ErbB4-Mediated Mitochondrial Reprogramming

ABSTRACT Background Pathological cardiac hypertrophy is a hallmark of numerous cardiovascular diseases, yet effective targeted therapies remain elusive in current clinical practice. Cardiac macrophages contribute to disease progression, but the underlying mechanisms have not been fully elucidated. Methods Single-nucleus RNA-sequencing, bulk RNA-sequencing, proteomics, metabolomics, and a mouse model of pressure overload were employed to investigate cardiac remodeling. We identified a macrophage subset co-expressing CD163 and Dab2 and examined its role using immunofluorescence, flow cytometry, and functional assays. We further assessed the Nrg2/ErbB4 signaling axis through genetic and pharmacological modulation. Results CD163⁺/Dab2⁺ macrophages were reduced in hypertrophic hearts and positively correlated with Nrg2 expression. These macrophages alleviated cardiomyocyte hypertrophy in vitro, an effect abolished by Nrg2 knockdown. In vivo, recombinant Nrg2 treatment mitigated cardiac hypertrophy, preserved mitochondrial structure, and restored bioenergetics via the ErbB4 receptor. Transcriptomic analyses confirmed enhanced expression of genes involved in mitochondrial oxidative phosphorylation. Furthermore, CD163 + /Dab2 + macrophages improved mitochondrial dysfunction by the Nrg2/ErbB4 pathway in vitro. Conclusions We identified a CD163⁺/Dab2⁺ macrophage subset that protects against pathological cardiac hypertrophy by promoting mitochondrial function through Nrg2/ErbB4 signaling. This axis may offer a promising therapeutic target for interventions in pathological cardiac hypertrophy.