REVIEW article
Front. Immunol.
Sec. Inflammation
The role of macrophages in vascular calcification: strategies for diagnosis and treatment
Provisionally accepted
Weiling Hong1
Yue Qiu1Xiao Wang1Jingyi Shi1Ziyan Yin1Zile Zhang1Jian Zhang2Xiaoxiao Hu1*
Yingkun Sheng1*- 1Xingzhi College of Xi'an University of Finance and Economics, Xi'An, China
- 2Westlake University, Hangzhou, China
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Vascular calcification (VC) is an actively regulated pathological process that significantly increases the risk of cardiovascular events. As key cells of the innate immune system, macrophages play a dual role in VC through polarization into different phenotypes: Pro-inflammatory macrophages promote calcification by secreting pro-inflammatory factors, releasing apoptotic bodies, and producing extracellular vesicles (EVs); conversely, Anti-inflammatory macrophages inhibit calcification through anti-inflammatory factors, exosomes, plaque stabilization, and ATP/pyrophosphate (PPi) metabolism. However, under metabolic diseases such as diabetes, anti-inflammatory macrophages may exhibit pro-calcific properties. This review systematically summarizes the mechanisms of macrophage polarization in VC, discusses the application of macrophage-related biomarkers and imaging techniques in diagnosis, and highlights therapeutic strategies targeting macrophage polarization, recruitment, and activation. Finally, current challenges in dynamically monitoring macrophage polarization and context-dependent functional heterogeneity are outlined, and future research directions focusing on immunomodulation-based multi-target drug design and engineered cell therapies are proposed.
Keywords: diagnosis, Immunomodulation, Macrophage polarization, Treatment, Vascular Calcification
Received: 14 Oct 2025; Accepted: 12 Dec 2025.
Copyright: © 2025 Hong, Qiu, Wang, Shi, Yin, Zhang, Zhang, Hu and Sheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Xiaoxiao Hu
Yingkun Sheng
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