Neointimal Smooth Muscle Cells Research Articles

Myocyte enhancer binding factor-2 expression and activity in vascular smooth muscle cells. Association with the activated phenotype.

Proliferation and phenotypic modulation of smooth muscle cells (SMCs) are major components of the vessel's response to injury in experimental models of restenosis. Some of the growth factors involved in restenosis have been identified, but to date little is known about the transcription factors that ultimately regulate this process. We examined the expression of the four members of the myocyte enhancer binding factor-2 (MEF2) family of transcription factors in cultured rat aortic SMCs (RASMCs) and a rat model of restenosis because of their known importance in regulating the differentiated phenotype of skeletal and cardiac muscle. In skeletal and cardiac muscle, the MEF2s are believed to be important for activating the expression of contractile protein and other muscle-specific genes. Therefore, we anticipated that the MEF2s would be expressed at high levels in medial SMCs that are producing contractile proteins and that they would be downregulated along with the contractile protein genes in neointimal SMCs. On the contrary, we observe that MEF2A, MEF2B, and MEF2D mRNAs are upregulated in the neointima, with the highest levels in the layer of cells nearest to the lumen, whereas MEF2C mRNA levels do not appreciably increase. Moreover, few cells in the media are making MEF2 proteins detectable by immunohistochemistry, whereas large numbers of neointimal cells are positive for all four MEF2s. These data suggest that the MEF2s are involved in the activated smooth muscle phenotype and not in the maintenance of contractile protein gene expression.

An essential role for platelet-derived growth factor in neointima formation in human saphenous vein in vitro

The role of platelet-derived growth factor (PDGF), a potent vascular smooth muscle cells (SMC) mitogen and chemoattractant, was investigated during neointima formation in human saphenous vein organ culture. PDGFA and B messenger ribonucleic acid (mRNA) expression was detected by RNase protection assay and in situ hybridisation and PDGF protein by immunocytochemistry. The expression of PDGFA and B mRNA was low in veins before culture while PDGF protein was detected in all cell types. A neointima consisting of densely packed SMC developed after 14 days of culture. The dense packing and high expression of PDGFA and B mRNA in neointimal SMC led to higher PDGF protein concentrations in the neointima, the role of which was examined by culturing with neutralising anti-(human PDGF) antibodies. The anti-PDGF antibodies significantly reduced neointimal thickness by ~ 66% and the number of neointimal cells by ~ 50%, without affecting neointimal or medial proliferation indices or cell viability. These results suggest that PDGF played an essential role in SMC migration into the neointima in human saphenous vein.

Doxazosin blocks the angiotensin II-induced smooth muscle cell DNA synthesis in the media, but not in the neointima of the rat carotid artery after balloon injury

Infusion of angiotensin II (AngII) during the third and fourth week after balloon injury of the left common carotid artery of the rat induces smooth muscle cell (SMC) DNA synthesis. In this study we wanted to investigate whether alpha 1-adrenoreceptors are involved in AngII-induced SMC DNA synthesis in the neointima. Adult male Wistar Kyoto rats were subcutaneously infused for 2 weeks with AngII and the alpha 1-adrenoreceptor antagonist doxazosin during the 3rd and the 4th week after balloon injury of the left common carotid artery. Control groups received AngII, 0.9% NaCl, AngII + 50% dimethylsulfoxide (DMSO, the solvent of doxazosin), doxazosin or 50% dimethylsulfoxide. Each rat received 5-bromo-2'-deoxyuridine in a separate osmotic minipump to label DNA-synthesizing SMC. Systolic blood pressures were measured in all groups. Angiotensin II caused an increase in systolic blood pressure, whereas addition of doxazosin did not affect the increase in SBP caused by AngII. In the media of the non-injured carotid artery, AngII increased SMC DNA synthesis, as the BrdUrd labeling fraction increased from 0.2 +/- 0.1% (mean +/- s.e.m.) in the NaCl group towards 3.4 +/- 0.6% in the AngII group. Coinfusion with doxazosin reduced the AngII-induced increase in BrdUrd labeling fraction from 3.2 +/- 0.8% in the AngII + DMSO group towards 0.6 +/- 0.2% in the AngII+doxazosin group. A similar effect of doxazosin was found in the media of the injured left carotid artery, in which coinfusion with doxazosin also reduced the BrdUrd labeling fraction from 2.6 +/- 0.8% in the AngII+DMSO group towards 0.3 +/- 0.1% in the AngII+doxazosin group. In the neointima of the injured left carotid artery, AngII increased the BrdUrd labeling fraction from 11.7 +/- 1.6% in the NaCl group towards 28.0 +/- 3.4% in the AngII group. Coinfusion with doxazosin did not influence the AngII-induced SMC DNA synthesis, since the BrdUrd labeling fraction in the neointima of the AngII+doxazosin group was 22.5 +/- 2.9%, whereas the neointimal BrdUrd labeling fraction in the AngII+DMSO group was 22.9 +/- 2.3%. Little effect was found on the medial cross-sectional area. The neointimal cross-sectional area was increased as a result of infusion of AngII (0.12 +/- 0.01 mm2 vs. 0.18 +/- 0.01 mm2), and coinfusion of doxazosin did not reduce the AngII-induced increase in neointimal cross-sectional area (0.18 +/- 0.03 mm2). These data suggest that alpha 1-adrenoreceptors are not involved in AngII-induced neointimal SMC DNA synthesis and cross-sectional area, but only play a role in the media of the carotid artery.

Proliferating Arterial Smooth Muscle Cells After Balloon Injury Express TNF-α but Not Interleukin-1 or Basic Fibroblast Growth Factor

We have recently reported that balloon withdrawal injury to rabbit abdominal aortas induces sustained activation indicated by the expression of certain adhesion molecules such as vascular cell adhesion molecule-1 and intercellular adhesion molecule-1 in regenerating endothelial cells and/or proliferating smooth muscle cells (SMCs). Local cytokine signaling may contribute to ongoing modulation of cellular functions and proliferation of intimal SMCs after acute vascular injury. We therefore studied the expression of tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 beta (IL-1 beta), proinflammatory and SMC growth-promoting cytokines, and basic fibroblast growth factor (bFGF) in SMCs of rabbit aorta at 2 (n = 4), 5 (n = 4), and 10 days (n = 6) after balloon injury. All animals were given bromodeoxyuridine (BrdU, 10 mg/kg per day) continuously to label proliferating SMCs. Frozen cross sections of injured vessels at each time point after balloon injury were examined by immunoperoxidase staining with monoclonal antibodies. As early as 2 days after injury, before intimal thickening begins, foci of medial SMCs expressed TNF-alpha, but not all TNF-alpha-positive medial SMCs had incorporated BrdU, suggesting that TNF-alpha expression by medial SMCs may precede their proliferation. At 5 days, TNF-alpha-bearing and BrdU-labeled medial SMCs increased in number. At 10 days after injury, when uniform intimal thickening occurred, almost all neointimal SMCs and foci of medial SMCs labeled with BrdU. Most of the BrdU-positive (proliferating) SMCs expressed immunoreactive TNF-alpha. Reverse transcription polymerase chain reaction showed increased TNF-alpha mRNA at 10 days after ballooning in the injured portion of the aorta. In contrast, regions of SMC proliferation showed inconsistent IL-1 beta expression, and bFGF, abundant in normal rabbit arteries, was not detected in areas of SMC replication. These data indicate that replication of arterial SMCs after balloon injury occurs in regions of TNF-alpha but not IL-1 beta expression and correlates inversely with the presence of bFGF. These results indicate that SMC-derived TNF-alpha serves as a marker of modulated SMC phenotype after acute vascular injury and may contribute to local cellular activation and proliferation of SMCs at sites of arterial injury.

Vascular smooth muscle cell phenotype influences glycosaminoglycan composition and growth effects of extracellular matrix.

Rat neonatal and neointimal vascular smooth muscle cells differ dramatically from adult medical vascular smooth muscle cells in their growth properties, with the neonatal and neointimal cells exhibiting growth in the absence of exogenously added growth factors. Since it has been hypothesized that extra-cellular matrix proteoglycans may influence the growth and differentiation of vascular smooth muscle cells, we examined the ability of matrix derived from these cells to influence vascular smooth muscle cell proliferation. To produce test matrices, cells were grown to confluence and removed by brief alkali treatment. Test cells were seeded onto these matrices and the rates of growth in a growth-factor-deficient medium determined. Compared to plastic wells, matrix from neonatal or neointimal cells stimulated the growth of vascular smooth muscle cells. Interestingly, matrix from adult cells was less efficient at promoting growth. Enzymatic digestion of extracellular matrix heparan sulfate, but not of other glycosaminoglycans, further increased the growth-stimulatory effect of extracellular matrix, suggesting that matrix heparan sulfate acts as a growth inhibitor. Consistent with this, biochemical analysis showed that the adult matrix contained a higher percentage of heparan sulfate compared with neonatal or neointimal matrix. These results suggest that autocrine production of heparan sulfate proteoglycans may play an important role in growth regulation of vascular smooth muscle cells during normal vascular development and differentiation as well as in pathological response to injury.

Elaboration of type-1 plasminogen activator inhibitor from adipocytes. A potential pathogenetic link between obesity and cardiovascular disease.

Obesity is known to predispose to attenuated fibrinolysis attributable to increased concentrations in plasma of type-1 plasminogen activator inhibitor (PAI-1), the primary physiological inhibitor of endogenous fibrinolysis. PAI-1 is present in neointimal vascular smooth muscle cells and lipid-laden macrophages. The present study was designed to determine whether PAI-1 expression occurs in adipose tissue as well, thereby potentially contributing to increased cardiovascular risk associated with obesity. 3T3-L1 preadipocytes were differentiated into adipocytes by exposing them to isobutylxanthine (0.5 mmol/L) and dexamethasone (0.25 mumol/L) over 7 days and incubated for 24 hours with transforming growth factor-beta (TGF-beta), known to augment PAI-1 synthesis in several cell types and to be released from platelets when they are activated. TGF-beta increased PAI-1 activity in the conditioned media of the 3T3-L1-derived cells in a concentration-dependent fashion without significantly affecting cell proliferation. Western blotting and immunoprecipitation of 35S-labeled PAI-1 showed that the increased PAI-1 activity paralleled increased PAI-1 protein. Northern blotting showed that increased PAI-1 mRNA preceded increased accumulation of PAI-1 activity and protein in the conditioned media. Furthermore, TGF-beta (10 ng/g body wt) administered in vivo increased PAI-1 activity in mouse plasma and PAI-1 mRNA expression in mouse adipose tissue. Increased plasma PAI-1 activity in obese human subjects may result from PAI-1 release from an increased mass of adipose tissue, particularly in association with thrombosis and elaboration of TGF-beta from platelet alpha-granules into the circulation. The increased PAI-1 may exacerbate vascular disease by shifting the balance between thrombosis and thrombolysis toward thrombosis and consequently exposing luminal surfaces of vessels to mitogens associated with microthrombi over protracted intervals.

Mitogenic Factors Released from Smooth Muscle Cells Are Responsible for Neointimal Cell Proliferation after Balloon Catheter Deendothelialization

Smooth muscle cell (SMC) proliferation results in neointimal formation in response to selective deendothelialization. The neointimal SMC are characteristically different from normal, medial SMC. The major difference is that neointimal SMC have a higher proliferation rate. The high proliferation rate has been observed 15 weeks after endothelial injury. In this study, it is noted that neointimal SMC release some mitogenic factor(s) which is(are) responsible for inducing persistent SMC proliferation in an autocrine manner. The SMC were cultured from the media of normal rabbit aorta as well as the neointimal tissue formed 15 weeks after an endothelial injury. From the culture of the neointimal SMC, the conditioned medium was collected and growth factors, including PDGF-AB, TGF-β 1, TGF-β 2, and bFGF, were assayed. The conditioned medium was used to culture the medial SMC from normal rabbit aorta. The mitogenic effect of the conditioned medium was evaluated by the incorporation of [3H]thymidine into the SMC. Results demonstrated that PDGF-AB and TGF-β 1 were increased in neointimal SMC-conditioned medium. After incubation with the conditioned medium, medial SMC incorporated significantly higher [3H]thymidine, compared to incubation with control medium ( P ≤ 0.01). The data indicate that endothelial injury induces production of some growth factors, including PDGF and TGF-β, by the neointimal SMC. These growth factors may act in an autocrine manner to stimulate SMC proliferation for a long time following a single deendothelialization.

Composite porosity of expanded polytetrafluoroethylene vascular prosthesis

Polytetrafluoroethylene (PTFE) prostheses were modified to produce two types of composite porosity PTFE grafts: type I — inner 60 μm/outer 20 μm and type II — inner 20 μm/outer 60 μm. These composite porosity PTFE designs were investigated for bleed through, graft healing and patency and compared with high porosity PTFE (60 μm) and standard PTFE (20 μm) grafts. The grafts were implanted into the carotid and femoral arteries of dogs and retrieved after 4, 12 and 18 weeks. Both composite porosity grafts showed significantly less bleed through than standard and high porosity grafts after reperfusion. In composite grafts, the 60-μm layer allowed fibrovascular tissue and histiocyte ingrowth from perigraft tissue, but the 20-μm layer did not. Neointima formation occurred earlier and endothelialization was more extensive in high porosity grafts, but seroma formation occurred in 25% of cases. In type I composite porosity grafts, smooth muscle cells of neointima migrated into the pores of the graft, providing a firmly anchored intima. Type II composite porosity grafts allowed better ingrowth of fibrovascular tissue at the outer layer from the perigraft tissue; however, endothelialization was not completed. Composite porosity grafts should be considered for evaluation in specific clinical situations.

Kinetics of smooth muscle cell proliferation and intimal thickening in a pig carotid model of balloon injury

Restenosis as a result of neointimal smooth muscle cell accumulation is an important limitation to the effectiveness of balloon angioplasty as a treatment for end-stage atherosclerosis. Quantitative animal models allow the definition of pathophysiological mechanisms and the evaluation of new therapeutic strategies. In this study we quantified the time course of neointima formation by morphometry, and smooth muscle cell (SMC) proliferation by immunocytochemistry for proliferating cell nuclear antigen (PCNA), in the pig carotid artery 0-28 days following balloon injury. This led to two distinct kinds of injury observed also in clinical studies, namely medial dilatation or deep medial tearing with rupture of the internal elastic lamina. Dilatation injury alone led to medial enlargement and neointima formation by 7 days, which did not increase further up to 28 days. Medial enlargement was similar following rupture of the internal elastic lamina; however the sum of neointima formation plus the area of medial repair (‘neomedia’) increased progressively up to 21 days after balloon injury. Balloon injury increased the PCNA index of smooth muscle cells in the media underlying an intact internal elastic lamina maximally after 3 days. The PCNA index in the neointima and especially in the neomedia was greater and maximal after 7 days. Endothelial regrowth occurred by 21 days in the presence or absence of medial tears. Our results establish a quantitative pig model of balloon injury which will allow the assessment of new therapeutic strategies directed at two clinically relevant types of injury. Medial tearing is associated with an enhanced and localized proliferative response and may therefore be especially important in human restenosis.

Quantification of Plasminogen Activators and Their Inhibitors in the Aortic Vessel Wall in Relation to the Presence and Severity of Atherosclerotic Disease

Increased expression of plasminogen activator inhibitor-1 (PAI-1) has been demonstrated in the human atherosclerotic vessel wall and may contribute to the impaired plasma fibrinolytic capacity in patients at high risk of atherothrombotic events. In addition, the mural PA/plasmin system may have important pathobiologic functions during atherogenesis. We quantitatively analyzed PAs of the tissue type (TPA) and urokinase type (UPA), PAIs, and plasminogen in protein extracts from different layers of human aorta in relation to the presence and severity of atherosclerotic lesions. In comparison with normal control vessels, intimal and neointimal TPA concentrations were reduced in atherosclerotic aortas except in the necrotic core areas of advanced plaques, where TPA was mainly complexed to PAI-1 in extracellular matrix deposits. In the media, TPA antigen was higher in lesional segments and closely associated with smooth muscle cells. UPA antigen was increased in the intima of atherosclerotic lesions and colocalized with tissue-infiltrating macrophages and neointimal smooth muscle cells. By spectrophotometric assay, neither TPA nor UPA activity could be detected in intimal or medial extracts. PAI-1 concentrations increased significantly in the intima of atherosclerotic segments compared with adjacent uninvolved areas or control aortas. The immunohistochemical distribution of PAI-1 was similar to that observed for TPA. A large excess of PAI-1 over PA concentrations, particularly in the intimal layer, characterizes atherosclerotic lesions of the human aorta and suggests that PA action is locally confined and counterbalanced by enhanced PAI expression and accumulation.

Taxol inhibits neointimal smooth muscle cell accumulation after angioplasty in the rat.

Despite significant improvements in the primary success rate of the medical and surgical treatments for atherosclerotic disease, including angioplasty, bypass grafting, and endarterectomy, secondary failure due to late restenosis continues to occur in 30-50% of individuals. Restenosis and the later stages in atherosclerotic lesions are due to a complex series of fibroproliferative responses to vascular injury involving potent growth-regulatory molecules (such as platelet-derived growth factor and basic fibroblast growth factor) and resulting in vascular smooth muscle cell (VSMC) proliferation, migration, and neointimal accumulation. We show here, based on experiments with both taxol and deuterium oxide, that microtubules are necessary for VSMCs to undergo the multiple transformations contributing to the development of the neointimal fibroproliferative lesion. Taxol was found to interfere both with platelet-derived growth factor-stimulated VSMC migration and with VSMC migration and with VSMC proliferation, at nanomolar levels in vitro. In vivo, taxol prevented medial VSMC proliferation and the neointimal VSMC accumulation in the rat carotid artery after balloon dilatation and endothelial denudation injury. This effect occurred at plasma levels approximately two orders of magnitude lower than that used clinically to treat human malignancy (peak levels achieved in this model were approximately 50-60 nM). Taxol may therefore be of therapeutic value in preventing human restenosis with minimal toxicity.

901-19 Low-dose Radioactive Palmaz-Schatz Stents Prevent Smooth Muscle Cell Proliferation and Neointimal Hyperplasia in Rabbits

The long-term consequences of ionizing irradiation of arteries with doses of more than 10 Gray (Gy) are vascular stenosis. To evaluate anti-proliferative effects of much lower irradiation doses, we implanted radioactive PalmazSchatz stents (RS) emitting doses of 0.002 Gy/h in rabbit arteries (n = 20). The radiation dose absorbed in the arteries after 100 days is lower than a human chest dose after a single cardiac catheterization. Arterial smooth muscle cell (SMC) proliferation and neointimal hyperplasia were compared 1 and 12 weeks after RS and non-radioactive stent (NRS) implantation. SMC proliferation was assessed by immunostaining with antibodies to proliferating cell nuclear antigen (PCNA) and SMC-α-actin and by computer-assisted counting of neointimal cells (NIC)/0.1 mm2neointima. Quantitative morphometry of arterial cross-sections was applied to compare the neointimal areas after implantation of RS and NRS. After 1 week, 30% neointimal SMCs were positive for PCNA in NRS, whereas 0.5% SMCs were PCNA-positive in NRS (p < 0.01). After 12 weeks, 850 ± 50 NIC (mean ± SD) were found in arteries with NRS compared to 237 ± 26 NIC in arteries with RS (p < 0.01). The neointimal area was 0,8 ± 0,2 mm212 weeks following implantation of NRS versus 0.4 ± 0.2 mm2following RS implantation (p < 0.01) A low-dose endovascular irradiation via radioactive stents prevents smooth muscle cell proliferation and stenotic neointimal thickening after angioplasty. The results do not confirm previous reports of vascular stenosis after ionizing irradiation.

407-6 Intraarterial Beta Irradiation Prevents Neointimal Hyperplasia in a Hypercholesterolemic Rabbit Restenosis Model

Intraarterial gamma irradiation reduces restenosis following balloon angioplasty. Beta irradiation has the advantages of a markedly steeper dose decrease in tissue and less radioprotection problems, permitting its use in the setting of an ordinary catheterization laboratory. Flexible yttrium coils (diameter 0.016”, length 24 mm) were activated in a nuclear reactor. Use of a segmented balloon consisting of four interconnected compartments ( * Schneider, Europe, AG) allowed for intraarterial centering of the 90Y source and homogeneous intramural dose delivery. Under fluoroscopic guidance, one carotid and one iliac artery of 21 hypercholesterolemic rabbits were deendothelialized and then simultaneously dilated and irradiated. Four dose schedules were studied: 1) control (dilated, non irradiated); 2) 6 Gray (Gy); 3) 12 Gy and 4) 18 Gy. Arterial specimens were histologicaly evaluated at 8 days and at 6 weeks. A minimum of 5 arteries were studied in each group at each study end-point. There was a significant decrease (p < 0.001–0.05) in bromodeoxyuridine incorporation and in total neointimal cell number per cm of inner arterial circumference for all radiation doses at 8 days compared to control. At 6 weeks, histological computer derived % area stenosis and mean number of neointimal cell layers were significantly reduced (p < 0.01, P < 0.005 respectively) in the group of arteries that had received 18 Gy compared to the control group, but not in the 6 or 12 Gy groups (Graph). (1) lntraarterial beta irradiation is feasible; (2) Radiation doses between 6 and 18 Gy effectively inhibit neointimal smooth muscle cell proliferation at 8 days; (3) This inhibitory effect is lost during the following post treatment weeks in arteries having received radiation doses of 6 or 12 Gy; (4) A radiation dose of 18 Gy effectively induces long-term inhibition of neointimal hyperplasia in a hypercholesterolemic rabbit model of postangioplasty restenosis.

Neointima formation is promoted by surgical preparation and inhibited by cyclic nucleotides in human saphenous vein organ cultures

Intimal thickening is an important cause of late coronary vein graft occlusion, which no variation of surgical technique or pharmacologic intervention has been shown to reduce. We used a recently developed quantitative organ culture of human saphenous vein to investigate whether surgical preparative injury promotes neointima formation. We also investigated the effects on neointima formation of the lipid-soluble cyclic nucleotide analogs, 8-Br-cyclic adenosine monophosphate and 8-Br-cyclic guanosine monophosphate, and the phosphodiesterase inhibitor, isobutylmethylxanthine. These agents are pharmacologic mimetics of endothelium-derived prostacyclin and nitric oxide, which elevate vascular smooth muscle cyclic adenosine monophosphate and cyclic guanosine monophosphate concentrations, respectively, and may normally suppress neointima formation. Surgical preparation was found to promote intimal thickening and neointimal smooth muscle cell proliferation by 42% and 48%, respectively. 8-Br-cyclic adenosine monophosphate, 8-Br-cyclic guanosine monophosphate, or isobutylmethylxanthine (which elevated endogenous cyclic adenosine monophosphate concentrations) inhibited intimal thickening by 80%, 40%, and 72%, respectively, at a concentration of 0.1 mmol/L. The results imply that surgical techniques that avoid preparative injury and vasodilator drugs that act by elevating cyclic adenosine monophosphate or cyclic guanosine monophosphate concentrations may reduce neointima formation in vein grafts. (J T horacic C ardiovasc S urg 1995;109:2-12)

Augmented Urokinase Receptor Expression in Atheroma

Smooth muscle cell proliferation and migration into neointima are hallmarks of atherogenesis. However, mechanisms responsible have not yet been fully elucidated. One potential mediator of both smooth muscle cell proliferation and migration is activation of plasminogen by activators bound to receptors on cells within the vessel wall. To determine whether vascular smooth muscle cells within atheroma express the receptor for urokinase-type plasminogen activator (uPA-R), we characterized atheroma in cholesterol-fed New Zealand White rabbits and human subjects by immunostaining. Intense immunostaining of uPA-R was observed throughout the neointima in both rabbit and human atherosclerotic lesions with the use of a monoclonal antibody to uPA-R. uPA-R was not detectable in normal arterial tissues. uPA-R was localized to macrophages and neointimal smooth muscle cells identified by immunostaining in serial sections. Furthermore, uPA-R protein in extracts from atheroma was present in at least a ninefold greater quantity compared with extracts from normal vessels, as shown by Western blotting. Expression of uPA-R mRNA in migrating vascular smooth muscle cells did not increase significantly. Thus, altered posttranscriptional regulation may be contributing to the increased uPA-R. In vitro, antibodies to uPA-R delayed the migration of cultured vascular smooth muscle cells. Our results suggest that increased cell-surface uPA-R contributes to pericellular proteolysis and consequently increased neointimalization secondary to increased vascular smooth muscle cell migration in atheroma.

Increased intramural expression of plasminogen activator inhibitor type 1 after balloon injury: A potential progenitor of restenosis

Objectives. This study was performed to determine whether altered gene expression of plasminogen activator inhibitor type I (PAI-1) occurs within the arterial wall after experimentally induced balloon injury.Background. PAI-1, known to inhibit fibrinolysis in the circulation and to be present within atherosclerotic vessels, may influence proteolysis in the arterial wall and neointimal formation after angioplasty.Methods. In rabbit carotid arteries subjected to balloon injury, both PAI-1 gene and protein expression were assayed sequentially with the use of Northern blotting, in situ hybridization and immunohistochemical studies.Results. In uninjured, normal vessels PAI-1 messenger ribonucleic acid (mRNA) was not detectable by Northern blotting or in situ hybridization. However, injury was followed within 3 h by increases in PAI-1 mRNA (3.2 kb) of 5.9-fold compared with that in contralateral control carotid arteries (Northern blots). PAI-1 mRNA was detectable by in situ hybridization early after injury first in adventitia; after 24 h it was particularly prominent in the media. From 1 to 4 weeks after injury it was consistently detectable and was localized in neointimal vascular smooth muscle and endothelial cells at a time when neointimal thickening was marked. Cells of both types exhibited PAI-1 protein detected immunohistochemically. In vessels maintained in organ culture after balloon injury in vivo, sustained increases in PAI-1 activity appeared in conditioned media as well.Conclusions. Our results indicate that balloon injury simulating angioplasty in patients induces intramural expression of PAI-1 in vascular smooth muscle and endothelial cells. The decreased cell surface fibrinolytic activity likely to result from the increased PAI-1 expression may initiate or exacerbate mural thrombosis. Accordingly, excessive stimulation with clot-associated mitogens may stimulate vascular smooth muscle cell proliferation, which, coupled with increased accumulation of extracellular matrix attributable to decreased plasmin-mediated degradation, may contribute to restenosis.

Sudden death in the young. Is acute coronary thrombosis the major precipitating factor?

Atherosclerotic coronary artery disease, complicated by acute thrombosis, is the usual cause of sudden death in adults. This study addresses the pathology of coronary arteries in sudden death in the young (< or = 35 years old). Among 200 consecutive cases of sudden death in youth in the Veneto region of Italy, 37 (33 men and 4 women, age 18 to 35 years; mean, 29.4 years) showed obstructive atherosclerotic coronary artery disease in the absence of other cardiac pathological conditions and causes of death. No patient had previous angina pectoris or myocardial infarction. Cardiac arrest occurred at rest in 30 subjects and was related to effort in 7. A histological study was carried out on the obstructive coronary plaques. Degree of lumen stenosis and extension of lipid core and intimal fibrocellular hyperplasia facing the lumen were calculated morphometrically. Immunohistochemistry and electron microscopy were used to further characterize the plaque cell population. Single-vessel disease was found in 33 patients and triple-vessel disease in 4, with an overall total of 45 obstructive plaques, 34 of which were located in the proximal left anterior descending coronary artery. At histological study, only 10 plaques from 10 patients showed acute thrombosis (occlusive in 5 and subocclusive in 5); the remaining 35 were uncomplicated. Thirty-one plaques were fibrous in nature, while the other 14 were atheromatous. Compared with the atheromatous lesions, the fibrous plaques were rarely complicated by thrombosis (3% versus 64%; P < .001) and distinctly exhibited a fairly well-preserved tunica media (81% versus 21%; P < .001) as well as a stratum of neointimal fibrocellular hyperplasia (68% versus 7%; P < .001), which on immunohistochemistry and electron microscopy appeared to be proliferating smooth muscle cells. In our study population, sudden death was precipitated by acute coronary thrombosis in only 27% of patients with obstructive coronary atherosclerotic plaque. Most of the young victims of sudden death with obstructive coronary atherosclerosis showed single-vessel disease that affected the left anterior descending coronary artery and was due to fibrous plaques with neointimal smooth muscle cell hyperplasia and a preserved tunica media in the absence of acute thrombosis.

Suppression of cycline-dependent kinase activation and neointimal smooth muscle cell proliferation in vivo by antisense CDC2 and CDK2 oligonucleotides in balloon-injured rat carotid artery

Suppression of cycline-dependent kinase activation and neointimal smooth muscle cell proliferation in vivo by antisense CDC2 and CDK2 oligonucleotides in balloon-injured rat carotid artery

Neointimal smooth muscle cells express increased mRNA for syndecan in culture

Neointimal smooth muscle cells express increased mRNA for syndecan in culture

Active cytomegalovirus infection of arterial smooth muscle cells in immunocompromised rats. A clue to herpesvirus-associated atherogenesis?

The susceptibility of medial and neointimal arterial smooth muscle cells (SMCs) to acute cytomegalovirus (CMV) infection was investigated in immunocompetent and immunocompromised rats. The left common carotid artery of all the rats was injured by balloon catheterization. On days 14 and 17 after injury, rats were either intravenously infected with a rat CMV (RCMV) or mock-infected. Active RCMV infection was shown in the neointima of the injured arteries of immunosuppressed rats, characterized by specific cytopathological changes in hematoxylin-eosin-stained sections and by the presence of early viral antigens and the presence of the virus at different stages of maturation at the electron-microscopic level. Viral genome was shown as well by use of in situ hybridization procedures. However, medial cells were hardly ever infected, and RCMV did not infect neointimal parts that were recovered by endothelial cells. No infection was seen in control right carotid arteries or in the injured arteries of immunocompetent rats. Acute intimal RCMV infection was accompanied by infiltration of inflammatory cells, predominantly mononuclear cells that stained positive with an ED-1 monoclonal antibody. The majority of infected neointimal cells were SMCs containing smooth muscle actin. No changes were found in medial or neointimal cross-sectional areas of the infected arteries. In the present study, an active RCMV infection of arterial SMCs was established in vivo, and it was concluded that neointimal SMCs are far more susceptible than are medial SMCs and that the absence of endothelium and immunosuppression are necessary conditions for arterial RCMV infection.