Abstract
Chronic pancreatitis (CP) is a progressive inflammatory disease characterized by pancreatic fibrosis and functional decline. Here, we identify macrophage-to-myofibroblast transition (MMT) as a novel feature of CP and investigate the role of mitochondrial uncoupling protein 2 (UCP2) in this process. Using mouse models, human pancreatic specimens, and cell lines, we show that UCP2 is markedly upregulated in CP, primarily in acinar cells. UCP2 knockout reduces MMT and alleviates fibrosis, whereas macrophage depletion reverses this protective effect, confirming the central role of MMT. Metabolomic profiling reveals that UCP2 knockout alters lipid metabolism by downregulating acyl-CoA synthetase long-chain family member 3 (ACSL3) and reducing lipid droplet (LD) release in acinar cells. Mechanistically, UCP2 upregulation increases silent information regulator 1 (Sirt1) expression, enhances Smad3 phosphorylation and nuclear translocation, and activates transforming growth factor-β (TGF-β)/Smad3 signaling to promote macrophage MMT. Macrophage-specific Sirt1 knockout suppresses both fibrosis and MMT. In conclusion, UCP2 drives CP progression by regulating ACSL3-mediated LD release in acinar cells and modulating macrophage function through the Sirt1/Smad3 pathway. Targeting UCP2 may represent a promising therapeutic strategy for CP.