Targeting trained innate immunity with nanobiologics to treat cardiovascular disease

The innate immune system plays a key role in atherosclerosis progression and the pathogenesis of cardiovascular disease. Trained immunity, an epigenetically regulated hyperresponsive state of myeloid cells, is a driving force underlying chronic inflammation in atherosclerosis. Therapeutically targeting innate trained immunity therefore may mature into a compelling new paradigm for the effective treatment of cardiovascular patients, which would require effective engagement of myeloid cells. For over a decade, we have worked on apolipoprotein A1-based nanomaterials, referred to as nanobiologics, which we have utilized for myeloid cell-directed immunotherapy. Here, we review the application of our nanobiologic immunotherapies in treating vascular disease. The design of nanobiologic therapeutics, as well as their use in targeting myeloid cells and cellular pathways related to trained immunity, is discussed. Furthermore, we show that nanobiologic biocompatibility and in vivo behavior are conserved across species, from mice to larger animals, including rabbits, pigs, and nonhuman primates. Last, we deliberate on the hurdles that currently prevent widespread translation of trained immunity targeting cardiovascular nanotherapies.