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[Preprint]. 2025 Nov 30:2025.11.26.689708. [Version 1] doi: 10.1101/2025.11.26.689708

HDL-associated phosphatidylserine blunts myeloid activation and protects from atherosclerosis

Aurora Bernal, Arslan Hamid, Cristina Grao-Roldán, Alice Scarpa, Iria Sánchez, José Ángel Nicolás-Ávila, Laura Pena-Couso, Mohamed H Yaghmour, Alberto Benguría, Aránzazu Rosado, Lucía Sánchez-García, Carlos Torroja, Ana Dopazo, Fátima Sánchez-Cabo, Andrés Hidalgo, Max L Senders, Mandy MT van Leent, Lea Seep, Jan Hasenauer, Katarzyna Placek, Christoph Thiele, Mihai G Netea, Willem JM Mulder, Niels P Riksen, Carlos Pérez-Medina
PMCID: PMC12699573  PMID: 41394657

ABSTRACT

Background and aims

Lipids play a critical role in atherosclerosis. Low-density lipoprotein (LDL)-cholesterol and certain lipid classes like sphingomyelins are associated with inflammation and poor cardiovascular outcomes. Phosphatidylserine (PS), on the other hand, is a negatively charged anti-inflammatory phospholipid class involved in efferocytosis. In this study, we sought to investigate its anti-atherosclerotic properties through a combination of complementary human lipidomics analyses, in vitro assays and in vivo experiments in Apoe -/- mice.

Methods

Human lipidomics studies were performed on the 300OB cohort comprising 300 obese and overweight individuals at risk of cardiovascular disease. In vitro assays were carried out using human monocytes and macrophages, and in vivo experiments included histopathological, immunophenotyping and single-cell transcriptomic analyses.

Results

In humans, we identified PS as an anti-inflammatory and atheroprotective biomarker. Hence, we developed a high-density lipoprotein (HDL)-like formulation enriched in PS to exploit its properties in a targeted fashion in mice. In vitro , this formulation potently inhibited inflammatory cytokine production on human myeloid cells. Our in-depth in vivo experiments provided evidence of the formulation’s potent plaque-stabilizing and anti-inflammatory actions. These effects were mediated by a shift in the monocyte/macrophage compartment toward homeostatic/repairing phenotypes.

Conclusions

Collectively, our results demonstrate that HDL-associated PS potently suppresses inflammation and atheroprogression, and holds promise as a viable approach to improve immunomodulatory therapies.

Full Text Availability

The license terms selected by the author(s) for this preprint version do not permit archiving in PMC. The full text is available from the preprint server.


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