Atherosclerosis results from maladaptive inflammation driven primarily by macrophages, whose recruitment and proliferation drive plaque progression. In advanced plaques, macrophage death contributes centrally to the formation of plaque necrosis, which underlies the instability that promotes plaque rupture and myocardial infarction. Hence, targeting macrophage cell death pathways may offer promise for the stabilization of vulnerable plaques. Necroptosis is a recently discovered pathway of programmed cell necrosis regulated by RIP3 and MLKL kinases that, in contrast to apoptosis, induces a proinflammatory state. We show herein that necroptotic cell death is activated in human advanced atherosclerotic plaques and can be targeted in experimental atherosclerosis for both therapeutic and diagnostic interventions. In humans with unstable carotid atherosclerosis, expression of RIP3 and MLKL is increased, and MLKL phosphorylation, a key step in the commitment to necroptosis, is detected in advanced atheromas. Investigation of the molecular mechanisms underlying necroptosis showed that atherogenic forms of low-density lipoprotein increase RIP3 and MLKL transcription and phosphorylation—two critical steps in the execution of necroptosis. Using a radiotracer developed with the necroptosis inhibitor necrostatin-1 (Nec-1), we show that ¹²³I-Nec-1 localizes specifically to atherosclerotic plaques in Apoe^−/− mice, and its uptake is tightly correlated to lesion areas by ex vivo nuclear imaging. Furthermore, treatment of Apoe^−/− mice with established atherosclerosis with Nec-1 reduced lesion size and markers of plaque instability, including necrotic core formation. Collectively, our findings offer molecular insight into the mechanisms of macrophage cell death that drive necrotic core formation in atherosclerosis and suggest that this pathway can be used as both a diagnostic and therapeutic tool for the treatment of unstable atherosclerosis.

Immunocompetent T lymphocytes in peripheral tissues mainly secrete IL-2 when first stimulated, whereas effector T lymphocytes generated during an immune response secrete different cytokine patterns, such as the Th1, Th2, or other phenotypes displayed by in vitro T cell clones. In this paper, we have examined whether the cell populations that have distinctive cytokine-producing capabilities represent different cell lineages or whether they are derived from the same uncommitted precursor T cell. During allostimulation of CD4+ spleen T cells, TGF-beta inhibited the development of T cells that could produce the Th2 cytokines IL-4 and IL-5. Anti-IFN-gamma inhibited the development of Th1-like IFN-gamma-secreting cells, and the combination of TGF-beta and anti-IFN-gamma resulted in the proliferation of a cell population that produced IL-2, but not IFN-gamma, IL-4, or IL-5, on restimulation. These IL-2-producing T cells expressed low levels of CD45RB and MEL14 and high levels of CD44. Clones of IL-2-producing T cells were isolated, and either bulk culture or clonal IL-2-producing populations acquired the ability to secrete Th1 or Th2 cytokine patterns when restimulated in the presence of TGF-beta or IL-4, respectively. These results demonstrate that both Th1- and Th2-like cells can be derived from a bipotential IL-2-producing precursor CD4+ T cell.