Nature Reviews. Cardiology | 2021
Immune cell profiling in atherosclerosis: role in research and precision medicine
Abstract
Inflammation is intimately involved at all stages of atherosclerosis and remains a substantial residual cardiovascular risk factor in optimally treated patients. The proof of concept that targeting inflammation reduces cardiovascular events in patients with a history of myocardial infarction has highlighted the urgent need to identify new immunotherapies to treat patients with atherosclerotic cardiovascular disease. Importantly, emerging data from new clinical trials show that successful immunotherapies for atherosclerosis need to be tailored to the specific immune alterations in distinct groups of patients. In this Review, we discuss how single-cell technologies — such as single-cell mass cytometry, single-cell RNA sequencing and cellular indexing of transcriptomes and epitopes by sequencing — are ideal for mapping the cellular and molecular composition of human atherosclerotic plaques and how these data can aid in the discovery of new precise immunotherapies. We also argue that single-cell data from studies in humans need to be rigorously validated in relevant experimental models, including rapidly emerging single-cell CRISPR screening technologies and mouse models of atherosclerosis. Finally, we discuss the importance of implementing single-cell immune monitoring tools in early phases of drug development to aid in the precise selection of the target patient population for data-driven translation into randomized clinical trials and the successful translation of new immunotherapies into the clinic. In this Review, Fernandez and Giannarelli discuss how single-cell technologies can advance our understanding of the cellular and molecular composition of atherosclerotic plaques and how these approaches can guide the design of new, personalized immunotherapies and immune monitoring tools for the management of patients with atherosclerotic cardiovascular disease. Atherosclerosis is initiated by the subendothelial accumulation of lipids that trigger maladaptive, non-resolving, chronic inflammation. Anti-inflammatory interventions have substantially reduced the risk of adverse cardiovascular events in patients with recent acute myocardial infarction. Emerging data from clinical trials published since 2017 show that successful treatments need to be tailored to specific groups of patients. Single-cell technologies are ideal for studying immune system dynamics and can advance our understanding of the cellular and molecular architecture of human atherosclerotic tissue to advance drug discovery. The inclusion of single-cell immune-monitoring tools in early phases of drug testing could advance drug discovery and precision medicine in cardiovascular disease to reduce the risk of adverse cardiovascular outcomes and death in patients. Atherosclerosis is initiated by the subendothelial accumulation of lipids that trigger maladaptive, non-resolving, chronic inflammation. Anti-inflammatory interventions have substantially reduced the risk of adverse cardiovascular events in patients with recent acute myocardial infarction. Emerging data from clinical trials published since 2017 show that successful treatments need to be tailored to specific groups of patients. Single-cell technologies are ideal for studying immune system dynamics and can advance our understanding of the cellular and molecular architecture of human atherosclerotic tissue to advance drug discovery. The inclusion of single-cell immune-monitoring tools in early phases of drug testing could advance drug discovery and precision medicine in cardiovascular disease to reduce the risk of adverse cardiovascular outcomes and death in patients.