The Nahrendorf laboratory shares a longstanding interest with the Swirski lab in innate immune cells, especially myeloid cells. We discovered that healing after myocardial infarction involves time-resolved monocyte and macrophage subset dynamics. We identified a splenic monocyte reservoir, which deploys within 24 hours after myocardial infarction. This reservoir contributes half of all monocytes recruited to the infarct. In atherosclerosis and chronic heart failure, macrophages expand by proliferating locally, and there is interaction between local and systemic inflammation, including in the remote myocardium after ischemic injury. In the healthy heart, cardiac resident macrophages connect to myocytes via gap junctions and participate in electric conduction; their depletion leads to conduction abnormalities such as AV block.

We described the mechanisms behind acceleration of atherosclerotic disease after a first infarct in the heart or brain. Infarct-induced sympathetic nervous system signaling in the bone marrow activates hematopoietic stem cells, which begin to proliferate and relocate to the spleen where they over-produce leukocytes. The most upstream point of hematopoiesis activation rests in CCR2+ hematopoietic stem cells. Newly produced leukocytes migrate to the atherosclerotic plaque, rendering it more inflamed and vulnerable to rupture, triggering reinfarction, a frequent clinical event that was previously unexplained. The findings are clinically important as they provide a new therapeutic opportunity to prevent secondary complications of atherosclerosis. We subsequently observed similar pathway activation after ischemic stroke and during exposure to chronic psychosocial stress.

In collaboration with MIT and Alnylam, we pioneered in vivo RNAi to silence the chemokine receptor CCR2, and subsequently other targets, in monocytes, macrophages and endothelial cells. Delivered by nanoparticles, siRNA is incorporated into splenic and circulating monocytes and macrophages, resulting in efficient silencing of gene expression. These cells 'lose their GPS', i.e. they are no longer able to migrate to the site of inflammation. This new class of anti-inflammatory therapy is highly selective, as it only targets certain genes. Subsequently we have targeted other proteins in myeloid cells and their progenitors as well as endothelial cells.