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Updated: May 18, 2026

Quantification of Monocyte Chemotactic Activity In Vivo and Characterization of Blood Monocyte Derived Macrophages
Published on: August 12, 2019
Molecular and cellular mechanisms of macrophage survival in atherosclerosis
Wim Martinet1, Dorien M Schrijvers, Guido R Y De Meyer
1Laboratory of Physiopharmacology, University of Antwerp, Belgium. wim.martinet@ua.ac.be
Abstract:
Macrophages play a key role in the initiation and progression of atherosclerotic plaques. Although a significant number of macrophages undergoes cell death during plaque development as a result of atherogenic stressors, advanced plaques are characterized by a large macrophage content. Macrophage accumulation is mediated by continuous recruitment of monocytes, reduced emigration of macrophages and poor phagocytosis of dead cells which may trigger secondary necrosis and amplification of plaque inflammation. Moreover, an increasing body of evidence indicates that macrophages have developed several strategies to survive and to proliferate in the adverse environment of an advanced atherosclerotic plaque. Macrophages contain organic molecules or enzymes that provide enhanced antioxidant protection. In addition, synthesis of anti-apoptotic proteins is upregulated and several cellular protection mechanisms such as the unfolded protein response and autophagy are activated in macrophages to promote cellular survival. In this review, we discuss these macrophage survival mechanisms that allow growth and destabilization of advanced atherosclerotic plaques.
Insights
Macrophages in atherosclerosis survive and proliferate via antioxidant protection, anti-apoptotic proteins, and cellular mechanisms like autophagy. These survival strategies contribute to plaque growth and destabilization.
Area of Science:
- Cardiovascular Biology
- Immunology
- Cellular Pathology
Background:
- Macrophages are central to atherosclerotic plaque development and progression.
- Despite cell death from atherogenic stressors, advanced plaques exhibit high macrophage content.
- Macrophage accumulation results from monocyte recruitment, reduced emigration, and impaired efferocytosis.
Purpose of the Study:
- To review macrophage survival mechanisms within advanced atherosclerotic plaques.
- To elucidate how these mechanisms contribute to plaque growth and destabilization.
Main Methods:
- Literature review of cellular and molecular mechanisms.
- Analysis of macrophage responses to atherogenic stressors.
- Examination of survival pathways including antioxidant defenses, anti-apoptotic signaling, unfolded protein response, and autophagy.
Main Results:
- Macrophages employ enhanced antioxidant protection via organic molecules and enzymes.
- Upregulation of anti-apoptotic protein synthesis supports macrophage survival.
- Activation of cellular protection mechanisms like unfolded protein response and autophagy promotes macrophage persistence.
Conclusions:
- Macrophage survival strategies are critical for the growth of advanced atherosclerotic plaques.
- These survival mechanisms contribute to plaque destabilization and progression.
- Understanding these pathways is key to developing novel therapeutic interventions for atherosclerosis.
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