Spatial localization of arachidonic acid in human carotid atherosclerotic plaques reveals a pro-inflammatory metabolic program in macrophages

Background Carotid atherosclerosis is a significant cause of ischemic stroke. It is a chronic inflammatory disease characterized by the progressive accumulation of inflammatory cells and mediators. Specific key metabolites are known to play pivotal roles in the progression of atherosclerosis. By applying spatial omics, we pinpointed the colocalization of arachidonic acid with inflammatory cells in plaques, providing direct spatial evidence for its pro-inflammatory role in atherosclerosis. Methods We employed metabolomics, spatial metabolomics, and single-cell transcriptomics to compare human stable and unstable plaques, aiming to identify key molecules associated with atherosclerotic disease progression. The spatial distribution of key metabolites and lipid components was analyzed using matrix-assisted laser desorption/ionization mass spectrometry imaging, enabling a detailed description of their spatial characteristics within carotid atherosclerotic plaques. Results Collected human carotid artery atherosclerotic plaque tissues via carotid endarterectomy (CEA) for metabolomic analysis, identifying 74 differential metabolites. Notably, the pro-inflammatory lipid arachidonic acid (AA) was involved in 22 of these pathways and was upregulated in unstable plaques. ROC curve analysis further indicated that AA had good predictive capability for the disease. Focused on investigating the metabolic processes of AA. Using spatial metabolomics technology, revealed the dynamic spatial distribution of the “linoleic acid–AA–leukotriene D4” metabolic axis within atherosclerotic plaques. Based on the pro-inflammatory properties of AA, further explored its spatial distribution within plaques and its association with macrophages. Through single-cell sequencing analysis of macrophage subsets, found that ELOVL5 and ALOX5 were highly expressed in macrophages. Conclusion Our study provides direct spatial evidence for the existence of the “linoleic acid-AA-leukotriene D4” metabolic axis. It reveals the association of ELOVL5 and ALOX5 with macrophage phenotypes, demonstrating their potential in regulating atherosclerosis-related inflammation.