Macrophage cannibalism: efferocytosis in atherosclerosis

Purpose of review This review explores the evolving understanding of efferocytosis – the clearance of dead or dying cells by phagocytes – in the context of atherosclerosis. It highlights recent discovers in cell death modalities, impaired clearance mechanisms and emerging therapeutic strategies aimed at restoring efferocytosis to stabilize plaques and resolve inflammation. Recent findings Recent studies have expanded the scope of efferocytosis beyond apoptotic cells to include other pro-inflammatory cell death modes, including pyroptosis, necroptosis and ferroptosis, revealing context-dependent clearance efficiency and immunological outcomes. Novel mechanisms of impaired efferocytosis have been identified, including CD47- or CD147-mediated inhibition, efferocyte metabolic reprogramming and age-related MerTK cleavage. Therapeutic advances include nanoparticle-mediated delivery of SHP-1 inhibitors, engineered efferocytotic receptors, and treatment with resolvin D1 to enhance efferocytosis and reduce inflammation. Summary Efferocytosis is a critical process in maintaining vascular homeostasis and preventing plaque rupture in atherosclerosis. Its impairment contributes to necrotic core expansion and chronic inflammation. Advances in understanding the molecular regulation of efferocytosis and its therapeutic modulation offer new avenues for intervention. Targeting efferocytosis may complement lipid-lowering and/or anti-inflammatory therapies, representing a promising strategy for cardiovascular disease management.