Arteriosclerosis, Thrombosis, and Vascular Biology

As non-nutritive sweeteners (NNS) increasingly replace sugar in a variety of foods, concerns are growing over about their potential link to cardiometabolic complications, from type 2 diabetes to atherothrombotic diseases¹. Although erythritol is widely deemed safe and commonly used in sugar-free, low-calorie, and “keto” products—often recommended for individuals with obesity, diabetes, or cardiometabolic diseases —recent findings suggest it may exert unanticipated effects beyond glycemic control²˒³. A controlled study by Witkowski et al.⁴ provides critical insights into erythritol’s effects on platelet hyper-reactivity, a key precursor to thrombosis, and raises concerns about its cardiovascular safety.

Single cell studies have considerably increased our understanding of the heterogenous cellular composition of atherosclerotic plaques. During disease development, different cell populations in the plaque become activated or modulate their function, undergoing a process called transdifferentiation. Apart from the major contribution of transdifferentiated vascular smooth muscle cells, macrophages, and endothelial cells, T cells have been identified in human plaques¹.

Atherosclerosis is a chronic inflammatory disease characterized by the accumulation of lipids, inflammatory cells, and fibrous elements in the large arteries (1). The progression of atherosclerosis involves various cell types, including endothelial cells, smooth muscle cells (SMCs), macrophages, and fibroblasts (2). Recent studies leveraging single-cell analysis and fate-mapping experiments further highlighted the heterogeneity and plasticity of atherosclerotic plaque cells, including the emerging concept that SMCs can undergo phenotypic modulation, with specific SMC-derived cell types contributing to plaque instability, while others promoting plaque stabilization. Additional large-scale single-cell analyses of human plaque are still very much needed to understand the overall landscape of various cell types in atherosclerotic lesions.