Atherosclerosis treatment options
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Lipid-Lowering Therapies for Atherosclerosis
A key approach in treating atherosclerosis is targeting lipid metabolism, especially lowering low-density lipoprotein cholesterol (LDL-C). Therapies that inhibit PCSK9, a protein that leads to LDL receptor degradation and increased LDL-C, have shown promise. These include monoclonal antibodies and RNA-based drugs like antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs), which have been successful in clinical trials for reducing cholesterol and other atherogenic lipoproteins such as Lp(a), ApoCIII, and ANGPTL3 13.
Anti-Inflammatory and Immune-Modulating Treatments
Atherosclerosis is now recognized as a chronic inflammatory disease. Anti-inflammatory therapies, including classic drugs like colchicine, methotrexate, and allopurinol, as well as biologics targeting cytokines such as IL-1, IL-6, TNF-α, and IFN-γ, are being explored. These treatments aim to reduce immune activation and inflammation within plaques. While animal studies show efficacy, more large-scale clinical trials are needed to confirm benefits in humans 268. Modulating immune responses through regulatory T cells (Tregs), TREM-1, and CD47 blockade are also emerging strategies to slow disease progression 15.
Novel Nucleic Acid–Based Therapies
Nucleic acid–based therapies, including ASOs and siRNAs, are being developed to target genes involved in cholesterol and lipoprotein metabolism. These therapies have shown promising results in clinical trials, particularly for patients who do not respond well to traditional lipid-lowering drugs. Research is ongoing to evaluate their long-term safety and effectiveness 3.
Photodynamic and Sonodynamic Therapies
Photodynamic therapy (PDT) uses light-activated drugs to selectively target and stabilize atherosclerotic plaques, reducing inflammation and sparing healthy tissue. Preclinical studies are encouraging, and ongoing research aims to optimize protocols for clinical use 47. Sonodynamic therapy (SDT) is a similar approach that uses ultrasound and sonosensitizers, offering deeper tissue penetration and focused effects. SDT has been shown to suppress plaque formation and increase stability in both laboratory and animal studies, with early clinical trials underway 910.
Nanomedicine and Energy Conversion–Based Approaches
Nanomedicine is introducing new materials that, when activated by light or ultrasound, can promote the removal of cholesterol and induce the death of foam cells within plaques. These energy conversion–based therapies are being actively researched for their potential to target vulnerable plaques and improve outcomes in a minimally invasive way 7.
Future and Experimental Treatments
Emerging strategies include targeting the extracellular matrix, modulating vascular smooth muscle cell behavior, and using vaccines or senolytic drugs to address underlying disease mechanisms. Herbal medicines and dietary interventions are also being studied for their potential to reduce inflammation and slow plaque progression, though more evidence is needed before widespread clinical use 158.
Conclusion
Atherosclerosis treatment is evolving beyond traditional lipid-lowering drugs to include anti-inflammatory, immune-modulating, nucleic acid–based, and energy conversion–based therapies. While many of these approaches show promise in preclinical and early clinical studies, further research and large-scale trials are needed to confirm their safety and effectiveness in reducing cardiovascular events. The future of atherosclerosis management will likely involve a combination of these innovative therapies tailored to individual patient needs.
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