Review Article
Volume 73, Issue 13, 9 April 2019, Pages 1691-1706
JOURNAL:J Am Coll Cardiol.
Article Link

Targeting the Immune System in Atherosclerosis: JACC State-of-the-Art Review
TX Zhao, Z Mallat.

KEYWORDS
atherosclerosis; clinical trials; immune system; inflammation; therapy and outcome


Atherosclerosis has long been known as an inflammatory disease. However, whether targeting inflammation improves outcomes was unproven until the recent results of CANTOS (Canakinumab Anti-InflammatoryThrombosis Outcomes Study). In this review, we reflect on why it has taken a long time to prove the inflammatory hypothesis of atherosclerosis and derive important lessons for the future. In particular, we discuss the off-target immune-modulatory effects of approved cardiovascular therapies, review the attempted anti-inflammatory therapies including the recently published CIRT (Cardiovascular Inflammation Reduction Trial), and discuss the likely reasons for their failures. We further build on CANTOS to review the immune-modulatory therapies for atherosclerosis currently in trials, and discuss the likelihood of their added value as well as the potential hazard associated with their use. We finally argue for a critical approach to the use of animal models, coupled with the use of humans as model organisms to accelerate the identification of the most appropriate targets.

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