The TREM Receptor Family in Cardiovascular Diseases: Functions, Mechanisms and Therapeutic Perspectives

The global burden of cardiovascular diseases (CVDs) persists, necessitating novel therapeutic targets. the Triggering Receptor Expressed on Myeloid cells (TREM) family, key regulators of innate immunity and inflammation, has emerged as a critical mediator in cardiovascular pathophysiology, and its integrated role in CVDs requires systematic clarification.

This review synthesizes current knowledge on the functions of TREM family members (TREM1, TREM2, TREML1, TREML2, TREML4) in CVD. We delineate a central paradigm where these receptors exert divergent, often opposing, roles by modulating macrophage polarization and function. TREM1 acts as a potent inflammatory amplifier, exacerbating tissue injury in myocardial infarction (MI), ischemic stroke, atherosclerosis, and sepsis-induced cardiomyopathy by enhancing pro-inflammatory macrophages responses and synergizing with Toll-like receptor signaling. Conversely, TREM2 promotes an anti-inflammatory, reparative phenotype, facilitating cardiac repair post-MI, enhancing atherosclerotic plaque stability via efferocytosis and cholesterol metabolism, and protecting against septic cardiomyopathy by clearing damaged mitochondria. Other members, including TREML1 (in platelet aggregation and thrombosis), TREML2 (in neuroinflammation and thoracic aortic disease), and TREML4 (in coronary artery disease), contribute to specific cardiovascular pathologies. Consequently, therapeutic strategies inhibiting TREM1 (e.g., with the peptide decoy LR12 or small molecules) or agonizing TREM2 (e.g., with antibody AL002 or the brain-penetrant agonist VG-3927) show compelling efficacy in preclinical models.

The TREM family constitutes a pivotal immunoregulatory axis in CVD, with the TREM1/TREM2 balance critically determining inflammatory burden and tissue outcomes. Targeting this family, particularly through dual strategies of TREM1 inhibition and TREM2 activation, represents a promising frontier for immunomodulatory therapy in CVD. Overcoming challenges related to ligand identification, cellular specificity, and species divergence will be crucial for successful clinical translation.