Institutional members access full text with Ovid®

Share this article on:

The walking dead: macrophage inflammation and death in atherosclerosis

Kavurma, Mary M.; Rayner, Katey J.; Karunakaran, Denuja

Current Opinion in Lipidology: April 2017 - Volume 28 - Issue 2 - p 91–98
doi: 10.1097/MOL.0000000000000394
Editor's Choice

Purpose of review To highlight recent studies that describe novel inflammatory and signaling mechanisms that regulate macrophage death in atherosclerosis.

Recent findings Macrophages contribute to all stages of atherosclerosis. The traditional dogma states that in homeostatic conditions, macrophages undergo apoptosis and are efficiently phagocytosed to be cleared by a process called efferocytosis. In advanced atherosclerosis, however, defective efferocytosis results in secondary necrosis of these uncleared apoptotic cells, which ultimately contributes to the formation of the characteristic necrotic core and the vulnerable plaque. Here, we outline the different types of lesional macrophage death: apoptosis, autophagic and the newly defined necroptosis (i.e. a type of programmed necrosis). Recent discoveries demonstrate that macrophage necroptosis directly contributes to necrotic core formation and plaque instability. Further, promoting the resolution of inflammation using preresolving mediators has been shown to enhance efferocytosis and decrease plaque vulnerability. Finally, the canonical ‘don’t eat me’ signal CD47 has recently been described as playing an important role in atherosclerotic lesion progression by impairing efficient efferocytosis. Although we have made significant strides in improving our understanding of cell death and clearance mechanisms in atherosclerosis, there still remains unanswered questions as to how these pathways can be harnessed using therapeutics to promote lesion regression and disease stability.

Summary Improving our understanding of the mechanisms that regulate macrophage death in atherosclerosis, in particular apoptosis, necroptosis and efferocytosis, will provide novel therapeutic opportunities to resolve atherosclerosis and promote plaque stability.

aHeart Research Institute, Sydney, New South Wales, Australia

bCardiometabolic microRNA Laboratory, University of Ottawa Heart Institute, Ottawa, Ontario, Canada

Correspondence to Denuja Karunakaran, PhD, Cardiometabolic microRNA Laboratory, University of Ottawa Heart Institute, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada. E-mail:

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.