Imaging and Targeting Coronary Artery Inflammation
Publication: Antioxidants & Redox Signaling
Volume 34, Issue Number 15
Abstract
Significance: Coronary artery disease (CAD) continues to be a leading cause of morbidity and mortality across the world despite significant progress in the prevention, diagnosis, and treatment of atherosclerotic disease.
Recent Advances: The focus of the cardiovascular community has shifted toward seeking a better understanding of the inflammatory mechanisms driving residual CAD risk that is not modulated by current therapies. Significant progress has been achieved in revealing both proinflammatory and anti-inflammatory mechanisms, and how shift of the balance in favor of the former can drive the development of disease.
Critical Issues: Advances in the noninvasive detection of coronary artery inflammation have been forthcoming. These advances include multiple imaging modalities, with novel applications of computed tomography both with and without positron emission tomography, and experimental ultrasound techniques. These advances will enable better selection of patients for anti-inflammatory treatments and assessment of treatment response. The rapid advancement in pharmaceutical design has enabled the production of specific antibodies against inflammatory pathways of atherosclerosis, with modest success to date. The pursuit of demonstrating the efficacy and safety of novel anti-inflammatory and/or proinflammatory resolution therapies for atherosclerotic CAD has become a major focus.
Future Directions: This review seeks to provide an update of the latest evidence of all three of these highly related but disparate areas of inquiry: Our current understanding of the key mechanisms by which inflammation contributes to coronary artery atherosclerosis, the evidence for noninvasive assessment of coronary artery inflammation, and finally, the evidence for targeted therapies to treat coronary inflammation for the reduction of CAD risk. Antioxid. Redox Signal. 34, 1217–1243.
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Published In
Antioxidants & Redox Signaling
Volume 34 • Issue Number 15 • May 20, 2021
Pages: 1217 - 1243
PubMed: 32458744
Copyright
Copyright 2021, Mary Ann Liebert, Inc., publishers.
History
Published in print: May 20, 2021
Published online: 26 April 2021
Published ahead of print: 18 June 2020
Published ahead of production: 27 May 2020
Accepted: 20 May 2020
Received: 7 May 2020
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Author Disclosure Statement
The methods for analysis of the perivascular Fat Attenuation Index described in this article are subject to patents EP3179917 PCT/GB2015/052359 and PCT/GB2017/053262; whereas the methods for AI/radiomic analysis of perivascular space or adipose tissue are subject to patent applications GB2018/1818049.9, GR2018/0100490, and GR2018/0100510. C.A. is a founder and shareholder of Caristo Diagnostics Ltd., a CT image analysis company.
Funding Information
C.A. acknowledges support from the Oxford British Heart Foundation Centre of Research Excellence (Grant nos. FS/16/15/32047, PG/13/56/30383 and RG/13/1/30181). H.W.W. acknowledges support from the Rhodes Trust.
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