Transcriptomic landscape identifies C-C motif receptor 2 as a core pro-fibrotic factor in uremic cardiomyopathy

Uremic cardiomyopathy (UC) represents a leading cause of mortality in patients with chronic kidney disease (CKD), characterized by left ventricular hypertrophy (LVH) and fibrosis. The underlying mechanisms of UC pathogenesis remain incompletely understood. This study developed two novel methods to simulate human UC: modified nephrectomy (MNx) and adenine-normal combinational diet, and compared these approaches across several rodent strains. Transcriptomic analysis was performed on left ventricular (LV) tissues from these models. The analysis revealed global changes in UC, including dysregulated cell cycle processes, enhanced extracellular matrix remodeling, and metabolic abnormalities, while also highlighting molecular distinctions between MNx- and adenine-induced UC. Notably, this study identified C-C-motif receptor 2 (CCR-2) as a novel potential antifibrotic target in UC. CCR-2 blockade substantially reversed fibrosis without affecting LVH. The mechanism through which CCR-2 inhibition suppresses cardiac fibrosis development in UC appears to involve the promotion of cardiac residual macrophage expansion. These findings establish CCR-2's central role in cardiac fibrosis and suggest its inhibition as a promising therapeutic target for UC.