ADTRP (androgen dependent TFPI regulating protein) is a multifunctional protein that primarily regulates anticoagulant activity and endothelial cell function. ADTRP controls the expression and cell-associated anticoagulant activity of tissue factor pathway inhibitor (TFPI) in endothelial cells, with this regulation being androgen-dependent 1. The protein also functions as a serine hydrolase, hydrolyzing fatty acid esters of hydroxy-fatty acids (FAHFAs), though hepatic overexpression does not significantly influence lipid and glucose metabolism 2. ADTRP plays a critical role in cardiovascular health by forming positive regulatory loops with LDL receptors (LDLR/CD36/LOX-1) through NF-κB and AKT pathways, promoting endothelial cell proliferation and migration while reducing monocyte adhesion and apoptosis 3. The protein regulates cell cycle progression by modulating histone genes, cell cycle genes, and apoptosis genes 4. ADTRP variants are associated with coronary artery disease susceptibility, and reduced plasma ADTRP levels serve as a biomarker for CAD 5. The protein's protective effects against atherosclerosis involve regulation of matrix metalloproteinase-9 through Wnt signaling and interaction with the MIA3/TANGO1 pathway 67.