Can Nuclear Imaging Detect Trained Immunity in Cardiovascular Disease?

Inflammation is a major driver of atherosclerotic cardiovascular disease, and the key roles of trained immunity in initiating and driving this condition are increasingly recognized. However, monitoring trained immunity in patients, particularly inside the atherosclerotic plaque, remains challenging due to a lack of noninvasive readouts. Here, we discuss the potential of nuclear imaging in studying trained immunity in atherosclerotic cardiovascular disease. We show that many trained immunity–relevant radiotracers exist, including ones targeting innate immune cells, metabolic processes, and epigenetic enzymes. However, their use remains limited, and distinguishing trained immunity from other immune processes remains challenging, highlighting the need for more specific trained immunity biomarkers.