C-reactive protein (CRP) is an acute-phase reactant and an active regulator of the innate immune system. 1,2 Prospective clinical studies have shown that elevations in baseline CRP levels confer, albeit to varying degrees, additional prognostic value for predicting future cardiovascular events and death across all levels of the Framingham risk score. 3 CRP has been implicated in multiple aspects of atherogenesis and plaque vulnerability; however, a direct pathogenetic role for CRP in these events is presently controversial. 4,5 CRP has at least 2 conformationally distinct forms, native pentameric (p)CRP and monomeric (m)CRP. Native CRP consists of 5 identical subunits arranged in a cyclic pentamer. Loss of pentameric symmetry in pCRP, yielding mCRP, is associated with expression of distinct bioactivities. 6 -9 To date, little is known about the in vivo source(s) of mCRP.Platelets represent an important interface between thrombosis, innate and adaptive immunity, and atherogenesis. 10 Platelet-triggered inflammatory pathways contribute to atherosclerotic lesion formation and atherothrombosis. 10 In this issue of Circulation Research, Eisenhardt et al 11 provide new insights into the relationship of platelets, CRP, and inflammation. They show that activated platelets dissociate pCRP into mCRP and provide evidence, suggesting that mCRP, rather than pCRP, localizes monocyte-mediated inflammation to the atherosclerotic plaque.Native CRP is thought to be very stable and is not expected to dissociate into separate subunits without denaturation. 12 However, calcium-dependent binding of pCRP to liposomes or cell membranes results in separation into subunits. 13 Eisenhardt et al 11 show that binding of pCRP to lysophosphatidylcholine expressed on the surface of activated platelets and apoptotic monocytic THP-1 cells triggers its rapid dissociation into mCRP. Formation of mCRP involves dissociation of the CRP pentameric disk, resulting in a structural change from predominantly -sheet structure to an ␣-helical structure and expression of intersubunit contact residues, in particular residues 197 to 202, the predominant epitope only expressed on mCRP. 14 mCRP-specific antigen has been detected in inflamed tissues. 15 Immunohistological staining of human atherosclerotic lesions consistently places CRP within the lesion, frequently along with the terminal complement complex. 4,5 Because most anti-CRP antibodies, including the widely used antibody clone 8, recognize both pCRP and mCRP, 16 it is uncertain whether lesions express mCRP, pCRP, or both. Eisenhardt et al 11 show that human aortic and coronary artery atherosclerotic plaques stained with the clone 8 antibody and a specific anti-mCRP antibody but not with a specific anti-pCRP antibody, indicating accumulation of mCRP rather than pCRP in atherosclerotic lesions. mCRP-staining correlated with areas that stained for macrophages or platelets, suggesting generation of mCRP by these cells. Formal colocalization studies would lend additional support to this notion. Future stud...