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The contribution of distinct subsets of macrophages to atherosclerosis is poorly understood. Here the authors describe a protective subset of vascular macrophages expressing the C-type lectin receptor CLEC4A2, which licenses monocytes to join the resident vascular macrophage pool and ensures vascular homeostasis.

Dib, Koneva et al. generate an scRNA-seq atlas of immune cells from human carotid endarterectomies and report the presence of a subset of pathogenic pro-inflammatory PLIN2^hi/TREM1^hi, derived from TREM2^hi lipid-associated macrophages via TLR signaling, which correlates with an increased risk of cerebrovascular events.

Bacterial symbionts of the Endozoicomonadaceae family are frequently found in marine animals but are poorly understood. Using data from the Tara Pacific expedition, this study of Endozoicomonadaceae ecology at an ocean basin-scale reveals that corals across the Pacific Ocean have different host-symbiont association strategies that are determined at the bacterial lineage level.

The BioID approaches takes advantage of the promiscuous biotinylation enzyme (BirA*) to identify proteins that closely interact. Here the authors improve the resolution of BioID using a protein fragment complementation approach that allows the assignment of protein-protein interactions to specific complexes within a common interactome.

Amadori et al. show that plasma from patients with atherosclerosis triggers unique inflammatory transcriptomic and signaling signatures in peripheral blood mononuclear cells, which were used for selecting drugs that may be repurposed for the treatment of atherosclerosis.

The immune response is not unlike a game of chess, with white and black pieces playing opposing roles and orchestrating an opening, a middle and an endgame of innate immunity, adaptive immunity and resolution, respectively. After decades of research, the study of atheroimmunology has brought the first therapeutics to the clinic. Can we resynchronize the immune system in atherosclerosis and save the king?

The mechanisms underlying atherosclerotic complications in type 2 diabetes are still unknown. Here, the authors provide evidence for an impaired vascular fibrous repair response involving transforming growth factor-ß2-regulated collagen synthesis and cell differentiation as central mechanisms.

Mokry et al. performed bulk RNA sequencing of 654 advanced human carotid plaques from the Athero-Express biobank and 162 coronary samples, and they show that unsupervised clustering defines plaque types corresponding to different cell compositions and clinical presentations. Circulating biomarkers can be potentially used to mark the different transcriptomic-defined plaque phenotypes.

The plasma of individuals with atherosclerosis contains cytokines that induce a pathogenic signaling cascade in immune cells. Saracatinib, a dual kinase inhibitor that targets the tyrosine kinases SRC and BCR-ABL, can prevent activation of this phospho-signaling pathway implicated in the pathogenesis of cardiovascular disease.

Döring, van der Vorst, Yan, Neideck et al. present a non-canonical chemokine pathway involving CCL17 signaling through CCR8, which induces CCL3 expression independent of CCR4 and suppresses the functions of atheroprotective T_reg cells.

Mathematical tools can be used to help identify pathological features from images of diseased lungs. Here, the authors used mathematical tools combined with high resolution multiplex imaging mass cytometry to show an association between immature neutrophils, CD8 T cells and proliferating alveolar epithelial cells in areas of maximal alveolar damage in COVID-19 lungs.

Knight and colleagues report altered granulopoiesis and increased frequency of immature neutrophil subsets with immunosuppressive properties in a subset of patients with sepsis with poor outcome.

Single-cell profiling and fate-mapping experiments in the developing brain of mice and humans show that microglia and meningeal macrophages originate from a common prenatal precursor, but that perivascular macrophages are derived postnatally from meningeal macrophages.

In this Roadmap, Stellos and colleagues discuss the mechanisms of cardiovascular system ageing and how the ageing of blood, vessels and heart relates to the decline in organ function, and highlight potential therapeutic interventions, challenges in ageing research and future directions for preclinical and clinical studies.

A randomized trial in patients hospitalized with COVID-19 showed no benefit and potentially increased harm associated with the use of convalescent plasma, with subgroup analyses suggesting that the antibody profile in donor plasma is critical in determining clinical outcomes.

A systematic review of evidence, across the key pillars of prevention, diagnosis, treatment and prognosis, outlines milestones that need to be met to enable the broad clinical implementation of precision medicine in diabetes care.

Grieger, Takele, Vesco, et al. perform a systematic review and meta-analysis of gestational weight gain interventions. Findings indicate lifestyle interventions that reduce excessive gestational weight gain provide greater benefits for women with a normal BMI and higher HDL cholesterol levels at the initiation of interventions.

In this Review, the authors provide an overview of the immune cells involved in atherosclerosis, discuss preclinical research and published and ongoing clinical trials assessing the therapeutic potential of targeting the immune system in atherosclerosis, highlight emerging therapeutic targets from preclinical studies and identify challenges for successful clinical translation.

Widespread loss of coastal marshes will occur in the Mediterranean by 2100, ranging from 8% to 92% of current extent, and even total loss in specific regions depending on climate mitigation policies, according to a comprehensive modelling approach that includes sea-level rise, sediment accretion and potential for marsh migration.

Nutrient fluxes from rivers and groundwater flowing into the ocean are impacted by climate change impacts such as precipitation changes, cryosphere melt, and sea level rise.

Ahmad, Lim, Morieri, Tam et al perform a systematic review and meta-analysis of biomarkers, genetic markers, and risk scores for prediction of cardiovascular outcomes in Type 2 diabetes. A few prognostic markers are identified that provide incremental predictive utility beyond established cardiovascular risk factors.

Felton et al. conduct a systematic review to determine the utility of islet autoantibodies as biomarkers of type 1 diabetes heterogeneity. They find that islet autoantibodies are most likely to be useful for patient stratification prior to clinical diagnosis.

Felton et al. conducted a systematic review to evaluate studies testing disease-modifying therapies and features linked to treatment response for type 1 diabetes prevention. While the quality of prevention and intervention trials is found to be high, precision analyses on factors associated with treatment response are of poorer quality.

Naylor et al. systematically review the efficacy of treatments for beta-cell monogenic diabetes. Limited evidence from the mostly non-randomized, small studies supports no treatment in glucokinase-related hyperglycemia and sulfonylureas for HNF1A-diabetes; further evidence is needed on the optimum treatments in these and other monogenic subtypes.

Semnani-Azad et al. review the evidence on prognostic factors that predict cardiovascular disease and type 2 diabetes for women, and cardiometabolic profile in offspring subsequent to gestational diabetes. The evidence was of low quality, but some maternal characteristics were predictive of unfavourable outcomes in women and their offspring.