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Updated: Nov 2, 2025

A Human Ex Vivo Atherosclerotic Plaque Model to Study Lesion Biology
Published on: May 6, 2014
Glucocorticoid induced TNF receptor family-related protein (GITR) - A novel driver of atherosclerosis
Laura A Bosmans1, Annelie Shami2, Dorothee Atzler3
1Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands.
Abstract:
Atherosclerosis is a lipid-driven, chronic inflammatory disease. In spite of efficient lipid lowering treatments, such as statins and PCSK9 inhibitors, patients, especially those with elevated inflammatory biomarkers, still have a significant residual cardiovascular disease risk. Novel drugs targeting inflammatory mediators are needed to further reduce this residual risk. Agonistic immune checkpoint proteins, including CD86, CD40L and CD40, have been shown to be drivers of atherosclerosis. Recently, glucocorticoid-induced tumour necrosis factor receptor family-related protein (GITR), a co-stimulatory immune checkpoint protein, was identified to be pivotal in cardiovascular disease. Cardiovascular patients have elevated soluble GITR plasma levels compared to healthy controls. Furthermore, in human carotid endarterectomy plaques, GITR expression was higher in plaques from symptomatic compared to asymptomatic patients and correlated with features of plaque vulnerability. Moreover, depleting GITR reduced atherosclerotic plaque development in mice. GITR-deficient monocytes and macrophages exhibited less inflammatory potential and reduced migratory capacity. In this review, we discuss GITR's effects on various immune cells, mechanisms, signalling pathways and finally GITR's potential as a novel drug target in atherosclerosis.
Insights
Glucocorticoid-induced tumor necrosis factor receptor (GITR) is a key driver of atherosclerosis. Targeting GITR may reduce cardiovascular disease risk in patients with persistent inflammation despite lipid-lowering therapies.
Area of Science:
- Immunology
- Cardiovascular Medicine
- Inflammation Biology
Background:
- Atherosclerosis is a chronic inflammatory disease with residual cardiovascular risk despite lipid-lowering treatments.
- Immune checkpoint proteins like CD86, CD40L, and CD40 are implicated in atherosclerosis development.
- Elevated soluble glucocorticoid-induced tumor necrosis factor receptor family-related protein (GITR) levels are observed in cardiovascular patients.
Purpose of the Study:
- To review the role of GITR in cardiovascular disease and explore its potential as a therapeutic target.
- To discuss GITR's impact on immune cells, signaling pathways, and atherosclerotic plaque development.
Main Methods:
- Review of existing literature on GITR's involvement in atherosclerosis.
- Analysis of GITR expression in human carotid endarterectomy plaques.
- Examination of GITR's effect on atherosclerotic plaque development in murine models.
Main Results:
- GITR expression is higher in symptomatic human carotid plaques and correlates with plaque vulnerability.
- Depletion of GITR reduces atherosclerotic plaque development in mice.
- GITR-deficient monocytes and macrophages show reduced inflammatory potential and migration.
Conclusions:
- GITR plays a pivotal role in cardiovascular disease pathogenesis.
- GITR represents a promising novel drug target for reducing residual cardiovascular risk in atherosclerosis.
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