Born to heal: Why babies recover, but adults scar, after heart damage

A new Northwestern Medicine study in experimental animals reveals a critical difference in how macrophages -- a part of the immune system -- help repair the heart in newborns versus adults after a heart attack. The study highlights a fundamental difference in how the immune system drives healing based on age.

The study will be published Feb. 11 in the journal Immunity.

"Understanding why newborns can regenerate their hearts while adults cannot will open the door to developing treatments that could 'reprogram' adult macrophages," said first and co-corresponding author Connor Lantz, lead scientist of the bioinformatics core at the Comprehensive Transplant Center at Northwestern University Feinberg School of Medicine.

In newborns, macrophages perform a process called efferocytosis, which recognizes and eats dying cells. This process triggers the production of a bioactive lipid called thromboxane, signaling nearby heart muscle cells to divide, and allowing the heart to regenerate damaged heart muscle, the study found. In adults, macrophages produce much less thromboxane, leading to a weaker repair signal.

"By mimicking the effects of thromboxane, we might one day improve tissue repair after a heart attack in adults," Lantz said.

How the study worked

The study examined how the immune system responds to heart injury in mice of different ages, including newborn mice (one day old) and adult mice (eight weeks old). The researchers found the ability of macrophages to engulf dying cells was enhanced in newborn mice due to increased expression of MerTK, a receptor that recognizes dying cells. Therefore, when the scientists blocked this key receptor, newborn mice lost their ability to regenerate their hearts, resembling adult hearts after a heart attack.

Engulfment of dying cells by newborn macrophages triggered a chemical chain reaction that produced a molecule called thromboxane A2, which unexpectedly stimulated heart muscle cells to multiply and repair the damage, the study found. Additionally, nearby muscle heart cells in newborns are primed to respond to thromboxane A2, leading them to change their metabolism to support their growth and healing. But in adults, this process did not work the same way -- after an injury, their macrophages did not produce enough thromboxane A2, limiting their ability to regenerate heart tissue.

The paper is titled, "Early Age Efferocytosis Directs Macrophage Arachidonic Acid Metabolism for Tissue Regeneration." Edward B. Thorp, professor of experimental pathology at Feinberg, is a co-corresponding study author.