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已发表论文
TRAIL-DR5 信号轴在心血管疾病中的双重作用：从分子机制到靶向治疗
Authors Cao R , Qi W, Huang X, Zheng Y, Zheng R, Ma Y, Zhang H
Received 5 May 2025
Accepted for publication 1 October 2025
Published 25 October 2025 Volume 2025:19 Pages 613—629
DOI https://doi.org/10.2147/BTT.S538522
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 4
Editor who approved publication: Dr Shein-Chung Chow
Run Cao,* Wenqing Qi,* Xinyu Huang, Yalun Zheng, Rudan Zheng, Yuanfang Ma, Hailong Zhang
Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Hailong Zhang, Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China, Email hailong6891@163.com Yuanfang Ma, Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China, Email mayf@henu.edu.cn
Abstract: The TRAIL-DR5 signaling axis exhibits a pronounced “double-edged sword” nature in cardiovascular diseases, embodying both deleterious and protective roles. On one hand, it contributes to pathology by promoting cardiomyocyte apoptosis and enhancing inflammatory responses, thereby driving the progression of conditions such as myocardial ischemia-reperfusion injury, atherosclerotic plaque destabilization, and heart failure. On the other hand, under specific contexts, TRAIL-DR5 signaling can exert protective effects through mechanisms including the regulation of angiogenesis, suppression of inflammation, and facilitation of tissue repair. This functional dichotomy likely stems from cell-type specificity, dynamic microenvironmental changes, and crosstalk with other signaling pathways—such as NF-κB, MAPK, and autophagy-related processes. This review systematically examines the molecular mechanisms underlying TRAIL-DR5 signaling and its multifaceted involvement in acute myocardial infarction, heart failure, atherosclerosis, and atrial fibrillation. Furthermore, it explores targeted therapeutic strategies, including: DR5 agonists (such as monoclonal antibodies and small molecule compounds) for selective clearance of pathological cells; inhibitors (for instance, soluble DR5-Fc fusion proteins and siRNAs) to block deleterious signaling; and combination therapies (eg, with kinase inhibitors) to achieve synergistic efficacy. We propose that future investigations should prioritize the development of highly specific biomarkers, the refinement of targeted delivery systems, and a deeper mechanistic understanding of cellular and disease-stage heterogeneity. Such advances will be essential to propel the field from broad-spectrum treatments toward precision interventions, offering innovative solutions for complex cardiovascular disorders.
Keywords: TRAIL-DR5 signaling axis, cardiovascular disease, inflammasome response, targeted therapy, molecular mechanisms
Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Hailong Zhang, Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China, Email hailong6891@163.com Yuanfang Ma, Joint National Laboratory for Antibody Drug Engineering, The First Affiliated Hospital, Henan University, Kaifeng, Henan, People’s Republic of China, Email mayf@henu.edu.cn
Abstract: The TRAIL-DR5 signaling axis exhibits a pronounced “double-edged sword” nature in cardiovascular diseases, embodying both deleterious and protective roles. On one hand, it contributes to pathology by promoting cardiomyocyte apoptosis and enhancing inflammatory responses, thereby driving the progression of conditions such as myocardial ischemia-reperfusion injury, atherosclerotic plaque destabilization, and heart failure. On the other hand, under specific contexts, TRAIL-DR5 signaling can exert protective effects through mechanisms including the regulation of angiogenesis, suppression of inflammation, and facilitation of tissue repair. This functional dichotomy likely stems from cell-type specificity, dynamic microenvironmental changes, and crosstalk with other signaling pathways—such as NF-κB, MAPK, and autophagy-related processes. This review systematically examines the molecular mechanisms underlying TRAIL-DR5 signaling and its multifaceted involvement in acute myocardial infarction, heart failure, atherosclerosis, and atrial fibrillation. Furthermore, it explores targeted therapeutic strategies, including: DR5 agonists (such as monoclonal antibodies and small molecule compounds) for selective clearance of pathological cells; inhibitors (for instance, soluble DR5-Fc fusion proteins and siRNAs) to block deleterious signaling; and combination therapies (eg, with kinase inhibitors) to achieve synergistic efficacy. We propose that future investigations should prioritize the development of highly specific biomarkers, the refinement of targeted delivery systems, and a deeper mechanistic understanding of cellular and disease-stage heterogeneity. Such advances will be essential to propel the field from broad-spectrum treatments toward precision interventions, offering innovative solutions for complex cardiovascular disorders.
Keywords: TRAIL-DR5 signaling axis, cardiovascular disease, inflammasome response, targeted therapy, molecular mechanisms