Challenges and advances in the management of inflammation in atherosclerosis

• Published in: Journal of advanced research
• Main Authors: Xing, Yiming, Lin, Xianhe
• Format: Journal Article
• Language: English
• Published: Egypt Elsevier B.V 21.06.2024
• Subjects: Anti-inflammatory strategies; Atherosclerosis; Cardiovascular diseases; Chronic inflammation; Clonal hematopoiesis of indeterminate potential; Cytokines; Immune cells; CRP; CXCL; MCP-1; CANTOS; LXR; LVEF; SMCs; DAMPs; HDL; NF-κB; CHIP; LDL; MACE; Atherosclerosis; oxLDL; TGF-β; NLRP3; PAMPs; HMOX1; MI; MDS; hs-CRP; ApoB; IFNγ; ABCA1; APCs; VSMCs; Clonal hematopoiesis of indeterminate potential; IL; MMP7; ICAM; Cytokines; JAK-STAT; Treg; Th cells; FOXP3; Anti-inflammatory strategies; VCAM; AIM2; CCR; TNF-α; Chronic inflammation; PCI; NET; Immune cells; Cardiovascular diseases; CHD; ABCG1
• ISSN: 2090-1232; 2090-1224; 2090-1224
• DOI: 10.1016/j.jare.2024.06.016

[Display omitted] •First report on the transition of atherosclerosis perception from lipid-centric to chronic inflammatory, revealing a paradigm shift in understanding this global health concern.•This study elucidates the pivotal roles of specific immune cells in the intricate web of events driving the initiation and progression of atherosclerosis, offering a nuanced perspective on disease mechanisms.•Unveiling the complex array of cytokines released by immune cells provides a detailed picture of the atherosclerotic inflammatory landscape, offering potential targets for therapeutic interventions.•Cutting-edge anti-inflammatory strategies showcased in this review, drawn from recent clinical research, illuminate promising avenues for mitigating atherosclerotic cardiovascular diseases.•By dissecting the mechanisms and therapeutic approaches, this study not only contributes to the understanding of atherosclerosis but also outlines a roadmap for future preventive measures and innovative interventions, fostering advancements in cardiovascular health. Atherosclerosis, traditionally considered a lipid-related disease, is now understood as a chronic inflammatory condition with significant global health implications. This review aims to delve into the complex interactions among immune cells, cytokines, and the inflammatory cascade in atherosclerosis, shedding light on how these elements influence both the initiation and progression of the disease. This review draws on recent clinical research to elucidate the roles of key immune cells, macrophages, T cells, endothelial cells, and clonal hematopoiesis in atherosclerosis development. It focuses on how these cells and process contribute to disease initiation and progression, particularly through inflammation-driven processes that lead to plaque formation and stabilization. Macrophages ingest oxidized low-density lipoprotein (oxLDL), which partially converts to high-density lipoprotein (HDL) or accumulates as lipid droplets, forming foam cells crucial for plaque stability. Additionally, macrophages exhibit diverse phenotypes within plaques, with pro-inflammatory types predominating and others specializing in debris clearance at rupture sites. The involvement of CD4+ T and CD8+ T cells in these processes promotes inflammatory macrophage states, suppresses vascular smooth muscle cell proliferation, and enhances plaque instability. The nuanced roles of macrophages, T cells, and the related immune cells within the atherosclerotic microenvironment are explored, revealing insights into the cellular and molecular pathways that fuel inflammation. This review also addresses recent advancements in imaging and biomarker technology that enhance our understanding of disease progression. Moreover, it points out the limitations of current treatment and highlights the potential of emerging anti-inflammatory strategies, including clinical trials for agents such as p38MAPK, tumor necrosis factor α (TNF-α), and IL-1β, their preliminary outcomes, and the promising effects of canakinumab, colchicine, and IL-6R antagonists. This review explores cutting-edge anti-inflammatory interventions, their potential efficacy in preventing and alleviating atherosclerosis, and the role of nanotechnology in delivering drugs more effectively and safely.