Immunometabolism and Atherosclerosis

Cellular metabolism is now recognized to impact the function of immune cells. Several immune cells subsets, upon activation, adapt their cellular metabolism to cope with proliferation and/or differentiation. These changes interest the key six cellular metabolic pathways, specifically, glycolysis, the tricarboxylic acid (TCA) cycle, the pentose phosphate pathway, fatty acid oxidation, fatty acid synthesis and amino acid metabolism. In parallel, a global cellular metabolic rewiring occurs which bring in front other metabolic pathways including those related to tryptophan and cholesterol. These processes become are even more peculiar in the context of cardiovascular diseases, where the crosstalk of systemic to cellular metabolism creates the environmental setting to reprogram immune cells in the context of acute heart failure, myocarditis, heart transplant rejection, atherosclerosis and diet induced obesity.

Aim of this position paper by the Working Group on Atherosclerosis and Vascular Biology of the European Society of Cardiology was to present a brief overview of the recent developments in the immunometabolism field, focusing on its role in atherosclerosis.

Metabolites are not just ‘fuels’ in their pathways but they are also effectors and signalling molecules that regulate the immune system. Moreover systemic and microenvironment-induced changes in basic metabolic pathways can skew the balance between pro- and anti-inflammatory responses in atherosclerosis, this paves the way for identyfing key immunometabolic reactions governing plaque development and stability that will give a new understanding of disease processes, and likely lead to novel therapeutic approaches to prevent and treat atherosclerotic CVDs. The position papers also highlights the potential impact of immunometabolic markers and targets in clinical cardiovascular medicine.

This manuscript is part of a spotlight issue of Cardiovascular Research which discusses several aspects connecting immunometabolism in the field of atherosclerosis and cardiovascular diseases.