Pathways of Proliferation

Abstract

See related article, pages 1155–1163 Excessive proliferation of vascular smooth muscle cells (VSMCs) contributes to the pathogenesis of many cardiovascular diseases, including atherosclerosis and pulmonary arterial hypertension (PAH). VSMC proliferation also underlies the failure of many therapies, notable examples being restenosis following coronary angioplasty, vein graft failure in patients with coronary artery bypass grafts, and transplant vasculopathy. Few therapies directly target excess VSMC proliferation, in part, because the underlying pathways have been unknown. Recently, several pathways of VSMC proliferation have been defined, and new therapeutic targets have emerged. An example of the power of preventing VSMC proliferation in reducing human cardiovascular disease is the rapamycin (sirolimus)-coated coronary stent. After dozens of agents failed to prevent the 30% restenosis rate postangioplasty, this VSMC proliferation inhibitor reduced the number to ≈6%.1 However, rapamycin has toxicities, limiting its systemic use. Moreover, the mechanisms of accelerated VSMC proliferation may vary by disease, and, thus, the efficacy of an antiproliferative drug will likely be contextual (ie, disease dependent). Understanding the pathways controlling proliferation offers hope for identifying drugs that selectively target proliferating cells. The contribution by Gizard et al in this issue of Circulation Research identifies such a pathway and suggests new therapeutic targets.2 Members of this group expand on their previous work showing that peroxisome proliferator-activated receptor (PPAR)α activation suppresses G1→S cell cycle progression by increasing the expression of the cyclin dependent kinase (CDK) inhibitor p16INK4a.3 The present study is built on a solid body of knowledge of the cell cycle. Although growth factors are necessary to initiate proliferation in normal cells, cells become independent of these external stimuli during the G1 phase. This “point of no return” is highly regulated by the interaction among cyclins, CDKs, and CDK inhibitors.4 In nonproliferating cells, the …