The project has delivered results that move beyond the current state of the art by repositioning endothelial cells as active regulators of both blood cell production and vascular inflammation, rather than passive bystanders. The work shows that persistent, low‑grade activation of the vessel wall can influence how immune cells are generated in the bone marrow and how they behave within atherosclerotic plaques, unifying two previously separate aspects of cardiovascular disease in one framework.
A major advance is the development of human‑relevant experimental models that more faithfully mimic the bone marrow and arterial wall than traditional flat cultures. These perfused three‑dimensional systems, combined with high‑content analytical techniques, enable detailed mapping of how endothelial activation states associate with immune profiles at both systemic and plaque levels and can be applied to other chronic inflammatory diseases.
Preclinical studies further show that targeted modulation of endothelial metabolic activity can alter plaque characteristics and circulating immune cell distributions, providing early proof‑of‑concept for endothelial‑focused interventions beyond standard lipid‑lowering or broad anti‑inflammatory strategies. Endothelial metabolism thus emerges as a promising, more selective entry point to reduce residual cardiovascular risk and potentially to influence other conditions characterised by low‑grade inflammation.
For further uptake, key needs include additional research to prioritise the most promising endothelial pathways, testing across diverse models and patient groups, and collaboration with industrial partners to develop, characterise and protect potential interventions and to use advanced vascular models as screening tools. Overall, the project provides an integrated view of endothelial control over inflammation, a suite of advanced platforms for studying vascular–immune interactions, and preclinical evidence that endothelial‑focused metabolic modulation is a viable strategy for future translational work.