# Clonal expansion, resistance to efferocytosis and innate immunity in atherosclerosis

> **NIH NIH R35** · STANFORD UNIVERSITY · 2020 · $853,390

## Abstract

PROJECT SUMMARY/ABSTRACT
 Recent studies have shown that the vascular smooth muscle cell (SMC) can ‘de-differentiate’ and
undergo substantial ‘phenotypic modulation’ during atherogenesis. Novel lineage-tracing data revealed that a
subset of these cells assume a ‘stem-like’ phenotype and undergo significant clonal expansion, likely
potentiating plaque progression. Unfortunately, we do not yet know the mechanism by which these clonal
populations arise, how they promote disease, or whether they can be targeted for translational purposes.
 The broad, long-term goal of this proposal is to precisely define how clonal expansion occurs and how
to suppress it. In doing so, we will learn how to target the ‘atherosclerosis stem cell’ and develop novel
therapies for heart disease. Using new preliminary data generated via single-cell RNA-seq analysis of
multicolor lineage-tracer models, our team will test the hypothesis that ‘stem-like’ SMCs evade phagocytic
removal (allowing them to undergo clonal expansion) and activate the complement cascade (causing them to
exacerbate vascular inflammation). The project combines unique transgenic animals, highly specialized
human biorepository specimens and new interdisciplinary collaborations. The program is focused on three
broad efforts which will: 1. Determine if pro-phagocytic therapies can specifically prevent clonal expansion; 2.
Determine whether the ‘stem-like’ SMC requires the classical complement cascade to promote disease; and 3.
Determine if clonal SMC expansion also has translational relevance to human atherosclerosis. This proposal
will provide important insights into the root causes of SMC plasticity and determine how programmed cell
removal, or ‘efferocytosis’ (from Greek, meaning to carry the dead to the grave) contributes to atherosclerosis.
Ultimately, discoveries made in this highly flexible R35 project will support the stated mission of the National
Institutes of Health, provide tools for other HLBS investigators, train the next generation of investigators, and
lead to the development of new translational therapies for patients with cardiovascular disease.

## Key facts

- **NIH application ID:** 9849800
- **Project number:** 5R35HL144475-02
- **Recipient organization:** STANFORD UNIVERSITY
- **Principal Investigator:** Nicholas James Leeper
- **Activity code:** R35 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $853,390
- **Award type:** 5
- **Project period:** 2019-01-15 → 2025-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9849800

## Citation

> US National Institutes of Health, RePORTER application 9849800, Clonal expansion, resistance to efferocytosis and innate immunity in atherosclerosis (5R35HL144475-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/9849800. Licensed CC0.

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