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(Circulation. 1995;91:2703-2711.)
© 1995 American Heart Association, Inc.


Articles

Apoptosis in Human Atherosclerosis and Restenosis

Jeffrey M. Isner, MD; Marianne Kearney, BS; Scott Bortman, MD; Jonathan Passeri, BS

From the Departments of Medicine (Cardiology) and Biomedical Research, St Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Mass.

Correspondence to Jeffrey M. Isner, MD, St Elizabeth's Medical Center, 736 Cambridge St, Boston, MA 02135. E-mail jisner@ opal.tufts.edu.

Background Apoptosis has been recognized in normal, including rapidly proliferating, cell populations and is inferred to be potentially responsible for the maintenance of stable cell numbers in tissues with various degrees of proliferative activity. Previous studies performed in rats indicated that despite the persistence of a relatively high level of injury-induced proliferative activity, total arterial smooth muscle content at 12 weeks remained unchanged from that measured at 2 weeks, suggesting that accrual of vascular smooth muscle cells is mitigated by cell death. The extent to which apoptosis may be observed in human atherosclerosis and/or restenosis, however, has not been previously established.

Methods and Results We performed immunohistochemical studies on 56 specimens retrieved from patients undergoing directional atherectomy for primary atherosclerotic lesions or recurrent arterial narrowing after percutaneous revascularization (restenosis). Immunohistochemical staining disclosed evidence of apoptosis in 35 (63%) of the 56 specimens studied. When present, immunohistochemical evidence of apoptosis was typically limited to <2% of cells in the specimen. The finding of apoptosis, however, was not distributed equally among four groups of specimens studied. Specimens retrieved from patients with restenosis were more frequently observed to contain foci of apoptosis than specimens retrieved from patients with primary atherosclerotic lesions. Among 14 peripheral arterial specimens from patients with restenosis, 13 (93%) contained foci of apoptosis; in contrast, apoptosis was observed in only 6 (43%) of 14 peripheral specimens from patients with primary lesions (P=.0046). Among coronary arterial specimens, apoptosis was observed in 12 (86%) of 14 specimens from patients with restenosis versus 6 (29%) of 14 specimens from patients with primary obstructions (P<.0075).

Conclusions Apoptosis is a feature of human vascular pathology, including restenotic lesions and, to a lesser extent, primary atherosclerotic lesions. The findings of the present study suggest that apoptosis may modulate the cellularity of lesions that produce human vascular obstruction, particularly those with evidence of more extensive proliferative activity.


Key Words: apoptosis • programmed cell death • proliferation • BCL-2




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Doxorubicin Induces Apoptosis and CD95 Gene Expression in Human Primary Endothelial Cells through a p53-dependent Mechanism
J. Biol. Chem., March 22, 2002; 277(13): 10883 - 10892.
[Abstract] [Full Text] [PDF]


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Nephrol Dial TransplantHome page
M. Masse, M.-J. Hebert, S. Troyanov, N. Vigneault, I. Sirois, and F. Madore
Soluble Fas is a marker of peripheral arterial occlusive disease in haemodialysis patients
Nephrol. Dial. Transplant., March 1, 2002; 17(3): 485 - 491.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
S. Ling, A. Dai, M. R. I. Williams, K. Myles, R. J. Dilley, P. A. Komesaroff, and K. Sudhir
Testosterone (T) Enhances Apoptosis-Related Damage in Human Vascular Endothelial Cells
Endocrinology, March 1, 2002; 143(3): 1119 - 1125.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
P. Dufourcq, T. Couffinhal, P. Alzieu, D. Daret, C. Moreau, C. Duplaa, and J. Bonnet
Vitronectin is up-regulated after vascular injury and vitronectin blockade prevents neointima formation
Cardiovasc Res, March 1, 2002; 53(4): 952 - 962.
[Abstract] [Full Text] [PDF]


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Cardiovasc ResHome page
A. Matsuda, Y. Suzuki, K. Kondo, Y. Ikeda, and K. Umemura
Hypercholesterolemia induces regression in neointimal thickening due to apoptosis of vascular smooth muscle cells in the hamster endothelial injury model
Cardiovasc Res, February 1, 2002; 53(2): 512 - 523.
[Abstract] [Full Text] [PDF]


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Mol. Cell. Biol.Home page
T. Suhara, H.-S. Kim, L. A. Kirshenbaum, and K. Walsh
Suppression of Akt Signaling Induces Fas Ligand Expression: Involvement of Caspase and Jun Kinase Activation in Akt-Mediated Fas Ligand Regulation
Mol. Cell. Biol., January 15, 2002; 22(2): 680 - 691.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
A. H. M. Hassan, I. M. Lang, M. Ignatescu, R. Ullrich, D. Bonderman, P. Wexberg, F. Weidinger, and H. D. Glogar
Increased intimal apoptosis in coronary atherosclerotic vessel segments lacking compensatory enlargement
J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1333 - 1339.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Sata, S. Sugiura, M. Yoshizumi, Y. Ouchi, Y. Hirata, and R. Nagai
Acute and Chronic Smooth Muscle Cell Apoptosis After Mechanical Vascular Injury Can Occur Independently of the Fas-Death Pathway
Arterioscler Thromb Vasc Biol, November 1, 2001; 21(11): 1733 - 1737.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
T. Watanabe, M. Yoshizumi, M. Akishita, M. Eto, K. Toba, M. Hashimoto, K. Nagano, Y.-Q. Liang, Y. Ohike, K. Iijima, et al.
Induction of Nuclear Orphan Receptor NGFI-B Gene and Apoptosis in Rat Vascular Smooth Muscle Cells Treated With Pyrrolidinedithiocarbamate
Arterioscler Thromb Vasc Biol, November 1, 2001; 21(11): 1738 - 1744.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
S. Krick, O. Platoshyn, S. S. McDaniel, L. J. Rubin, and J. X.-J. Yuan
Augmented K+ currents and mitochondrial membrane depolarization in pulmonary artery myocyte apoptosis
Am J Physiol Lung Cell Mol Physiol, October 1, 2001; 281(4): L887 - L894.
[Abstract] [Full Text] [PDF]


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EndocrinologyHome page
B. Zhu, G. Zhao, D. P. Witte, D. Y. Hui, and J. A. Fagin
Targeted Overexpression of IGF-I in Smooth Muscle Cells of Transgenic Mice Enhances Neointimal Formation through Increased Proliferation and Cell Migration after Intraarterial Injury
Endocrinology, August 1, 2001; 142(8): 3598 - 3606.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
A. Orlandi, A. Francesconi, D. Cocchia, A. Corsini, and L. G. Spagnoli
Phenotypic Heterogeneity Influences Apoptotic Susceptibility to Retinoic Acid and cis-Platinum of Rat Arterial Smooth Muscle Cells In Vitro : Implications for the Evolution of Experimental Intimal Thickening
Arterioscler Thromb Vasc Biol, July 1, 2001; 21(7): 1118 - 1123.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
E. Sho, M. Sho, T. M. Singh, C. Xu, C. K. Zarins, and H. Masuda
Blood Flow Decrease Induces Apoptosis of Endothelial Cells in Previously Dilated Arteries Resulting From Chronic High Blood Flow
Arterioscler Thromb Vasc Biol, July 1, 2001; 21(7): 1139 - 1145.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Cell Physiol.Home page
D. Ekhterae, O. Platoshyn, S. Krick, Y. Yu, S. S. McDaniel, and J. X.-J. Yuan
Bcl-2 decreases voltage-gated K+ channel activity and enhances survival in vascular smooth muscle cells
Am J Physiol Cell Physiol, July 1, 2001; 281(1): C157 - C165.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
H. Kataoka, N. Kume, S. Miyamoto, M. Minami, M. Morimoto, K. Hayashida, N. Hashimoto, and T. Kita
Oxidized LDL Modulates Bax/Bcl-2 Through the Lectinlike Ox-LDL Receptor-1 in Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, June 1, 2001; 21(6): 955 - 960.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Lung Cell. Mol. Physiol.Home page
A. M. Healy, J. J. Schwartz, X. Zhu, B. E. Herrick, B. Varnum, and H. W. Farber
Gas 6 promotes Axl-mediated survival in pulmonary endothelial cells
Am J Physiol Lung Cell Mol Physiol, June 1, 2001; 280(6): L1273 - L1281.
[Abstract] [Full Text] [PDF]


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Exp. Biol. Med.Home page
M. Li, P. M. Absher, P. Liang, J. C. Russell, B. E. Sobel, and N. K. Fukagawa
High Glucose Concentrations Induce Oxidative Damage to Mitochondrial DNA in Explanted Vascular Smooth Muscle Cells
Experimental Biology and Medicine, May 1, 2001; 226(5): 450 - 457.
[Abstract] [Full Text]


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Arterioscler. Thromb. Vasc. Bio.Home page
M. Leskinen, Y. Wang, D. Leszczynski, K. A. Lindstedt, and P. T. Kovanen
Mast Cell Chymase Induces Apoptosis of Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, April 1, 2001; 21(4): 516 - 522.
[Abstract] [Full Text] [PDF]


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J. Am. Soc. Nephrol.Home page
K. HEERMEIER, W. LEICHT, A. PALMETSHOFER, M. ULLRICH, C. WANNER, and J. GALLE
Oxidized LDL Suppresses NF-{{kappa}}B and Overcomes Protection from Apoptosis in Activated Endothelial Cells
J. Am. Soc. Nephrol., March 1, 2001; 12(3): 456 - 463.
[Abstract] [Full Text]


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Am. J. Physiol. Cell Physiol.Home page
T.-S. Lee and L.-Y. Chau
Fas/Fas ligand-mediated death pathway is involved in oxLDL-induced apoptosis in vascular smooth muscle cells
Am J Physiol Cell Physiol, March 1, 2001; 280(3): C709 - C718.
[Abstract] [Full Text] [PDF]


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Postgrad. Med. J.Home page
D M Braganza and M R Bennett
New insights into atherosclerotic plaque rupture
Postgrad. Med. J., February 1, 2001; 77(904): 94 - 98.
[Full Text]


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Cardiovasc ResHome page
C.-C. Hsieh, M.-H. Yen, C.-H. Yen, and Y.-T. Lau
Oxidized low density lipoprotein induces apoptosis via generation of reactive oxygen species in vascular smooth muscle cells
Cardiovasc Res, January 1, 2001; 49(1): 135 - 145.
[Abstract] [Full Text] [PDF]


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CirculationHome page
Y. Okura, M. Brink, H. Itabe, K. J. Scheidegger, A. Kalangos, and P. Delafontaine
Oxidized Low-Density Lipoprotein Is Associated With Apoptosis of Vascular Smooth Muscle Cells in Human Atherosclerotic Plaques
Circulation, November 28, 2000; 102(22): 2680 - 2686.
[Abstract] [Full Text] [PDF]


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Physiol. Rev.Home page
V. Hampl and J. Herget
Role of Nitric Oxide in the Pathogenesis of Chronic Pulmonary Hypertension
Physiol Rev, October 1, 2000; 80(4): 1337 - 1372.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
H. Obara, A. Takayanagi, J. Hirahashi, K. Tanaka, G. Wakabayashi, K. Matsumoto, M. Shimazu, N. Shimizu, and M. Kitajima
Overexpression of Truncated I{kappa}B{alpha} Induces TNF-{alpha}-Dependent Apoptosis in Human Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, October 1, 2000; 20(10): 2198 - 2204.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
F. D. Kolodgie, J. Narula, A. P. Burke, N. Haider, A. Farb, Y. Hui-Liang, J. Smialek, and R. Virmani
Localization of Apoptotic Macrophages at the Site of Plaque Rupture in Sudden Coronary Death
Am. J. Pathol., October 1, 2000; 157(4): 1259 - 1268.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J. A. Hamilton, G. Whitty, and W. Jessup
Oxidized LDL Can Promote Human Monocyte Survival
Arterioscler Thromb Vasc Biol, October 1, 2000; 20 (10): 2329 - 2331.
[Full Text] [PDF]


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Cardiovasc ResHome page
F. Jung, J. Haendeler, C. Goebel, A. M. Zeiher, and S. Dimmeler
Growth factor-induced phosphoinositide 3-OH kinase/Akt phosphorylation in smooth muscle cells: induction of cell proliferation and inhibition of cell death
Cardiovasc Res, October 1, 2000; 48(1): 148 - 157.
[Abstract] [Full Text] [PDF]


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CirculationHome page
D. Hou, P. I. Rogers, P. M. Toleikis, W. Hunter, and K. L. March
Intrapericardial Paclitaxel Delivery Inhibits Neointimal Proliferation and Promotes Arterial Enlargement After Porcine Coronary Overstretch
Circulation, September 26, 2000; 102(13): 1575 - 1581.
[Abstract] [Full Text] [PDF]


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Journal of Renin-Angiotensin-Aldosterone SystemHome page
Jianhua Zhu and Danchen Gao
Losartan reduces collagen content and intimal thickening of iliac arteries after balloon injury in rabbits
Journal of Renin-Angiotensin-Aldosterone System, September 1, 2000; 1(3): 278 - 282.
[Abstract] [PDF]


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Circ. Res.Home page
K. Walsh, R. C. Smith, and H.-S. Kim
Vascular Cell Apoptosis in Remodeling, Restenosis, and Plaque Rupture
Circ. Res., August 4, 2000; 87(3): 184 - 188.
[Full Text] [PDF]


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J Am Coll CardiolHome page
N. Latif, M. A. Khan, E. Birks, A. O'Farrell, J. Westbrook, M. J. Dunn, and M. H. Yacoub
Upregulation of the Bcl-2 family of proteins in end stage heart failure
J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1769 - 1777.
[Abstract] [Full Text] [PDF]


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Am. J. Pathol.Home page
B. Metzler, Y. Hu, H. Dietrich, and Q. Xu
Increased Expression and Activation of Stress-Activated Protein Kinases/c-Jun NH2-Terminal Protein Kinases in Atherosclerotic Lesions Coincide with p53
Am. J. Pathol., June 1, 2000; 156(6): 1875 - 1886.
[Abstract] [Full Text] [PDF]


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CirculationHome page
S. Yasuda, T. Noguchi, M. Gohda, T. Arai, N. Tsutsui, T. Matsuda, and H. Nonogi
Single Low-Dose Administration of Human Recombinant Hepatocyte Growth Factor Attenuates Intimal Hyperplasia in a Balloon-Injured Rabbit Iliac Artery Model
Circulation, May 30, 2000; 101(21): 2546 - 2549.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. Klouche, S. Rose-John, W. Schmiedt, and S. Bhakdi
Enzymatically Degraded, Nonoxidized LDL Induces Human Vascular Smooth Muscle Cell Activation, Foam Cell Transformation, and Proliferation
Circulation, April 18, 2000; 101(15): 1799 - 1805.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
H.-S. Kim, K.-K. Hwang, J.-W. Seo, S.-Y. Kim, B.-H. Oh, M.-M. Lee, and Y.-B. Park
Apoptosis and Regulation of Bax and Bcl-X Proteins During Human Neonatal Vascular Remodeling
Arterioscler Thromb Vasc Biol, April 1, 2000; 20(4): 957 - 963.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J.-K. Hsieh, D. Kletsas, G. Clunn, A. D. Hughes, M. Schachter, and C. Demoliou-Mason
p53, p21WAF1/CIP1, and MDM2 Involvement in the Proliferation and Apoptosis in an In Vitro Model of Conditionally Immortalized Human Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, April 1, 2000; 20(4): 973 - 981.
[Abstract] [Full Text] [PDF]


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Arterioscler. Thromb. Vasc. Bio.Home page
J.-K. Hsieh, D. Kletsas, G. Clunn, A. D. Hughes, M. Schachter, and C. Demoliou-Mason
p53, p21WAF1/CIP1, and MDM2 Involvement in Proliferation and Apoptosis in an In Vitro Model of Conditionally Immortalized Human Vascular Smooth Muscle Cells
Arterioscler Thromb Vasc Biol, March 1, 2000; 20(3): 636 - 644.
[Abstract] [Full Text] [PDF]


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FASEB J.Home page
M. MAYR, C. LI, Y. ZOU, U. HUEMER, Y. HU, and Q. XU
Biomechanical stress-induced apoptosis in vein grafts involves p38 mitogen-activated protein kinases
FASEB J, February 1, 2000; 14(2): 261 - 270.
[Abstract] [Full Text]