Vascular injury and time course of smooth muscle cell proliferation after experimental holmium laser angioplasty.

BACKGROUND. In vitro experiments have shown that holmium laser energy can effectively ablate even calcified plaque in human arterial vessels. Because high-energy densities from holmium lasers can easily be transmitted through quartz fibers, this solid-state laser has been suggested as an alternative intraluminal treatment of atherosclerotic plaque. METHODS AND RESULTS. To develop an intimal plaque, 35 New Zealand White rabbits underwent electrical stimulation of their right carotid artery for 28 days. Subsequently, in 25 rabbits, holmium laser angioplasty (wavelength, 2.12 microns; pulse duration, 150 microseconds; energy density, 350 mJ/mm2) was performed. To study the morphological results, the vessels were excised after 7, 14, 28, and 42 days. Cross sections were analyzed in regard to laser-specific injury. Staining of alpha-actin was used to identify smooth muscle cells (SMCs). After bromodeoxyuridine labeling, the extent of proliferation (number of cells undergoing DNA synthesis) was determined by using a monoclonal antibody. Holmium laser ablation resulted in an initial decrease of the numbers of intimal cell layers in the early group (7 days after treatment: 5 +/- 1 cell layers with 76 +/- 39 microns; control: 13 +/- 3 cell layers with 144 +/- 44 microns). Quantification of SMCs undergoing DNA synthesis in the intima (control: 51 +/- 19 cells/mm2) showed a significant increase of labeled cells after 7 (216 +/- 74 cells/mm2, p = 0.003) and 14 days (281 +/- 139 cells/mm2, p = 0.011). Integrity of the internal elastic lamina was disrupted in all animals after intervention. Seven and 14 days after treatment, a considerable reduction of medial cell nuclei was found in 10 of 12 animals. SMC proliferation in the medial layer was increased within the first 2 weeks after laser ablation (168 +/- 113 cells/mm2; control: 8 +/- 4 cells/mm2; p = 0.023). Six weeks after holmium laser angioplasty, SMC proliferation had returned to control levels in the intima and remained increased in the medial layer. This proliferative response resulted in a significant increase of intimal thickening within 6 weeks after laser ablation (30 +/- 6 cell layers, 375 +/- 97 microns resp.; p = 0.001 each). CONCLUSIONS. Holmium laser treatment leads to considerable vessel wall injury and results in SMC proliferation in the intimal and medial layer with a maximum of proliferative activity within the first 2 weeks. Subsequently, this results in considerable intimal and medial hyperplasia within 6 weeks after treatment.     

Restenosis following coronary balloon angioplasty Role of smooth muscle cell proliferation

Restenosis following successful coronary balloon angioplasty remains one of major limitations of this procedure. It is now known that intimal hyperplasia is the primary cause of restenosis. Angioplasty injury of arteries causes activation of platelets, injury and necrosis of smooth muscle and endothelial cells, and leukocyte infiltration. These events result in the production and release of factors that stimulate smooth muscle cell proliferation and subsequently lead to intimal hyperplasia. A number of antiproliferative agents have been found to be effective in inhibiting intimal hyperplasia. It is hoped that an effective pharmacologic approach toward preventing restenosis may be found in the near future.     

Hyperplasia of the arterial intima due to smooth muscle cell proliferation. Current data,experimental treatments and perspectives

Restenosis after vascular surgery using bypasses or endovascular techniques for dilatation or recanalisation remains the major Achilles' heel for these techniques. The progressive decrease of vessel lumen in an anastomose leading to graft failure or after arterial transluminal angioplasty is due to a complex process: intimal hyperplasia. This process can be compared to an hypertrophic healing into the intimal layer, reducing the lumen of the vessel. This process appears shortly after surgery or dilatation, between the 3rd and the 18th month. Mechanisms leading to this process are particularly complex, involving several cells and many regulatory processes still unclear. Smooth muscle cells are the main actor by their ability to proliferate and to secrete matrix into the media layer but stimulation and control of this process appear nevertheless complicated. The present review focuses on the pathophysiology of intimal hyperplasia, on different cells acting and on their regulation. Also, we reviewed the experimental and clinical trials evaluating approaches to the prevention of intimal hyperplasia in arteries.     

Role of smooth muscle cell proliferation after balloon angioplasty]

The long-term success of percutaneous transluminal coronary angioplasty (PTCA) is severely limited by the high incidence of restenosis, which occurs in up to 30 to 40% of primary successfully treated patients. Several postmortem and experimental studies have demonstrated that restenosis after balloon angioplasty is caused by intimal proliferation of smooth muscle cells (SMCs). As a result of the vessel wall injury due to the mechanical intervention, endothelial injury and platelet aggregation at the site of dilatation can be observed. SMCs are activated for migration and proliferation in the early phase after angioplasty by subsequent expression of several growth factors, activation of macrophages, and expression of a variety of mitogens (Figure 1). Since several other alternative interventional devices like atherectomy, excimer laser angioplasty and stenting are also limited by the occurrence of SMC proliferation following treatment, there is an obvious need for a pharmacological approach to inhibit SMC proliferation after PTCA. It has been shown in experimental studies that the proliferative response of the vessel wall in the intima occurs within the first seven days after dilatation. A significant increased mitosis rate of SMCs in the media, however, can be observed within three weeks after intervention (Figure 2). As suggested by several authors, macrophages are thought to play an important role in the restenosis process after balloon angioplasty. However, our experimental results demonstrate that no significant accumulation of macrophages occurred prior to seven days following balloon angioplasty (Figure 3).(ABSTRACT TRUNCATED AT 250 WORDS)     

Focal smooth muscle proliferation in the aortic intima produced by an initiation-promotion sequence.

Human atherosclerotic fibrous plaques display a clonal character similar to many benign neoplasms. We report here that chickens treated with an initiation-promotion sequence developed focal intimal smooth muscle lesions in the thoracic aorta that resemble early forms of atherosclerosis. Scanning electron microscopy revealed small mound-like lesions protruding from an intact endothelium in birds treated with an initiating dose of 7,12-dimethylbenz[a]anthracene (Me2BA) followed by twice weekly injections of the alpha 1-selective adrenergic agonist methoxamine for 20 weeks. Intimal lesion foci were composed of densely packed modified smooth muscle cells, abundant extracellular matrix, and occasional mononuclear cells (possibly monocytes). There was no ultrastructural evidence of lipid accumulation or alteration of the underlying media. These intimal lesions appeared in aortic segments of treated chickens in a pattern similar to that observed in classical experiments of multistage tumorigenesis in epidermis and other tissues. The treatment with Me2BA followed by methoxamine produced more focal lesions per thoracic segment and more segments per group with lesions than did treatment with either Me2BA or methoxamine alone. Thoracic intimal foci were absent from untreated and vehicle-treated groups. In contrast, the growth of a spontaneously arising atheroma in the distal abdominal aorta was not demonstrably affected by the initiation-promotion regimen. Likewise, weekly injections of Me2BA for 23 weeks, while greatly enhancing abdominal atheroma growth, produced no thoracic lesions. These results provide evidence that focal proliferation of intimal smooth muscle cells, a critical early event in atherogenesis, can be produced by an initiation-promotion treatment sequence.     

Time course and importance of neoadventitial formation in arterial remodeling following balloon angioplasty of porcine coronary arteries.

OBJECTIVES: Arterial remodeling has been suggested as the predominant factor in restenosis. However, the time course and morphometric factors that determine whether remodeling occurs remain unclear. We hypothesized that arterial remodeling does not occur in all arteries following balloon injury and is dependent on neoadventitial formation. METHODS: Using single (SI) and double (DI) balloon injury of Yorkshire porcine coronary arteries we examined changes in morphometry 3, 7, 14, 28 days following balloon injury. RESULTS: In both SI and DI arteries, the neoadventitia (NAD) area expanded by day 3 and was the first compartment to increase following injury. In SI arteries lumen area (LA) decreased between day 3 and 14 while in DI arteries, there was significantly less loss in LA. In SI arteries, contracture of the area circumscribed by the external elastic lamina (EEL), which occurred predominantly between day 7 and 14, accounted for 67% of the loss of LA. CONCLUSIONS: Accumulation of NAD appears to be the earliest change in the vessel wall following balloon injury of normal or previously injured arteries and precedes the growth of the I + M (intima and media). The predominant mechanism for lumenal narrowing following single balloon injury of a normal artery is remodeling. In contrast, remodeling does not occur in DI arteries, possibly due to differences in the degree of adventitial fibrosis of normal and injured arteries.     

Effect of Saireitoh on rabbit smooth muscle cell proliferation and experimental atherosclerosis

Saireitoh is a traditional Chinese medicine that is often given to patients with nephrotic syndrome or glomerulonephritis. Studies have reported that Saireitoh stimulates intrinsic steroid secretion in rats and suppresses the proliferation of fibroblasts in vitro. We examined the effects of Saireitoh on vascular smooth muscle cell proliferation and migration in vitro and experimental atherosclerosis in vivo. Saireitoh rabbit serum obtained from New Zealand White rabbits which were given a diet containing 2% Saireitoh for 3 days significantly inhibited [3H]-thymidine incorporation by smooth muscle cells, which were isolated from thoracic aorta explants of rabbits. The addition of 10% Saireitoh rabbit serum to a culture medium containing smooth muscle cells inhibited DNA synthesis by 50% as compared with a control culture to which 10% normal rabbit serum was added. We also found that the number of smooth muscle cells in the culture containing Saireitoh rabbit serum was decreased. When PDGF was used as a chemoattractant, we demonstrated that Saireitoh rabbit serum slightly inhibits the migration of smooth muscle cells. In in vivo experiments, Saireitoh did not suppress the development of atherosclerosis but tended to reduce the damage. We concluded that although Saireitoh inhibited the proliferation of smooth muscle cells, the effect of prevention on the development of atherosclerosis is weak in the in vivo condition.     

Morphological changes and smooth muscle cell proliferation after experimental excimer laser treatment

BACKGROUND. Little is known about the mechanism(s) in the development of restenosis after excimer laser angioplasty. Thus, the rationale of this study was to determine the time course of intimal and medial smooth muscle cell (SMC) proliferation and histomorphological changes after experimental excimer laser treatment. METHODS AND RESULTS. Laser ablation was performed in the right carotid artery of 34 New Zealand White rabbits after development of a fibromuscular plaque by repeated weak electrical stimulations. The vessels were excised 3, 7, 14, 21, 28, and 42 days after excimer laser treatment. Staining of alpha-actin was used to identify SMCs. In five rabbits (15%), a stenosis of more than 50% of luminal area was due to intimal proliferation of SMCs, and in four other rabbits, a total occlusion was due to organized thrombi. After the initial ablation of the performed plaque (13 +/- 6 intimal SMC layers) a continuous increase of intimal wall thickness was found from 7 +/- 6 SMC layers at 7 days to 28 +/- 5 intimal SMC layers at 28 days after excimer laser ablation (p less than 0.01). After 42 days, no additional increase of intimal thickening occurred. After bromodeoxyuridine labeling, the extent of cell proliferation (percent of cells undergoing DNA synthesis) in the intima and media was determined using a monoclonal antibody against bromodeoxyuridine. Immunohistological quantification of SMC proliferation in the intima revealed a significant increase of cells undergoing DNA synthesis at 3 (p less than 0.05) and 14 (p less than 0.01) days after laser treatment. Medial proliferation of SMCs was delayed and had a significant increase 7 days (p less than 0.05) after intervention. Twenty-one days after laser treatment, SMC proliferation in the intima as well as in the media was normalized. CONCLUSIONS. The proliferative response of SMCs after experimental excimer laser treatment will occur as a dynamic process with a maximum of SMCs undergoing DNA synthesis during 14 days after laser ablation, resulting in an increase of intimal thickening within 4 weeks after laser treatment. The extent of intimal hyperplasia due to SMC proliferation after excimer laser treatment is comparable with the effect of transluminal balloon angioplasty in this experimental model.     

Time course of smooth muscle cell proliferation after local drug delivery of low-molecular-weight heparin using a porous balloon catheter

It has been reported previously that systemic application of low-molecular-weight heparin (LMWH) suppresses smooth muscle cell (SMC) proliferation after balloon angioplasty in experimental studies. However, the high concentration of heparin required for a beneficial effect may cause severe bleeding complications. The ideal situation to overcome the systemic side effects would be to administer LMWH locally and deep into the arterial wall, which became possible by the development of porous balloon catheters. The in vivo feasibility of local delivery of LMWH using the porous balloon has been assessed by delivering tritium-marked LMWH into rabbit carotid arteries. The efficacy of the system was investigated by using a second injury animal model. After development of an intimal plaque by electrical stimulation, 61 rabbits were treated with the porous balloon after balloon angioplasty. In 23 rabbits, local drug delivery was accomplished with a porous balloon catheter (35 holes, hole diameter 75 μm, 2.5 mm catheter diameter). LMWH was locally administered with 4 ml (solution 375 anti-Xa-units/ml) and 2 atm. To study the extent of restenosis and morphological changes, these animals were killed 3, 7, 14, 28, or 56 d after intervention. After staining (hematoxylin, van Gieson, BrdU, RAM 11, α-actin) procedures to quantify SMC proliferation, intimal macrophages and morphological analysis were performed. Porous balloon treatment led to an increase in intimal SMC proliferation rate in the early stage after intervention. However, during the following time period, a significant decrease of the proliferation rate as compared with the animals treated with balloon angioplasty alone could be observed, which resulted in an only moderate increase of the intimal layer after local drug delivery compared with balloon angioplasty alone. Cathet. Cardiovasc. Diagn. 41:268–274, 1997. © 1997 Wiley-Liss, Inc.     

Acute cellular damage in medial smooth muscle cells following experimental coronary angioplasty in Dog. Damage of cytoskeleton and apoptosis

Summary The purpose of the present study was to investigate the responses of the cytoskeleton and the presence of apoptosis following acute damage of medial smooth muscle cells after percutaneous transluminal coronary angioplasty (PTCA). We killed 20 dogs, 4h and 4 days after PTCA (n=10 in each group). Ten dogs without PTCA were used as controls. PTCA was achieved by inflating balloon catheters two times, for 60s each time, to 150 PSI, followed by a 60-s deflation. The coronary artery obtained from each dog was fixed in 10% formalin neutral buffer solution. The response of the cytoskeleton was studied immunohistochemically, using monoclonal antibodies against α-smooth muscle actin, vimentin, and β-tubulin. Proliferation was determined by proliferating cell nuclear antigen (PCNA), and DNA fragmentation indicating apoptosis was determined by in situ nick end labeling. Four h after PTCA, endothelial denudation, microscopic mural thrombi, rupture of the internal elastic membrane, medial tear, and stretched smooth muscle cells with nuclei were found at the PTCA site. An immunohistochemical study revealed diffuse reduction or defective immunoreactivity in each cytoskeleton of medial smooth muscle cells, 4h after PTCA. The extent of positive immunoreactivity in the media decreased to 45±11% in α-smooth muscle actin (control value, 80±10%), 9±8% in vimentin (control value, 83±9%), and 10±7% in β-tubulin (control value, 75±8%). The decrease was more significant in vimentin and β-tubulin than in α-smooth muscle actin. Four days after PTCA, the features were diffuse cell death and the focal proliferation of medial cells, as well as macroscopic intramural thrombi. The extent of positive immunoreactivity in the media was 15±9% in α-smooth muscle actin, 13±7% in vimentin, and 14±11% in β-tubulin. There were no smooth muscle cells with positive PCNA (0%) in the control and 4-h groups, but 4 days after PTCA the percentage was 19±4%. In situ nick end labeling showed DNA fragmentation in the nuclei of medial smooth muscle cells at a rate of 15±5% 4h after PTCA and at 8±6% 4 days after PTCA, compared with 0% in the control. We concluded that severe damage of the cytoskeleton and medial smooth muscle cell death were induced immediately after PTCA, followed by proliferation of smooth muscle cells. Apoptosis may be partially involved in the death of smooth muscle cells, in addition to necrosis. Damage to the cytoskeleton and apoptosis may play an important role in the pathogenesis of acute lesions and the proliferation of smooth muscle cells after PTCA.     

Time course of mucosal cell proliferation following acute aspirin injury in rat stomach

The time course of replicating cell proliferation in the gastric fundic mucosa following acute aspirin-induced injury was determined by BrdU labeling. Gastric erosions were produced in adult rats by gastric gavage using aspirin (200 mg/kg) suspended in 0.15 M HCl. Lesion scores indicated significant gross injury in the aspirin-treated rats at all times measured (from 2 to 48 hr). BrdU labeling was not elevated at 2 or 8 hr after gavage. A significant increase in labeling was observed at 15 hr, reached a maximum at 16 hr, and declined with a slight, but significant increase still present at 48 hr. Elevations in BrdU labeling were uniform and seen in areas adjacent to and distant from the gross injury. The BrdU labeling in the fasted control rats decreased during this same time period. The height of the proliferative zone was not altered from control in the aspirin-treated rats despite the marked differences in proliferation activity. This study demonstrates the importance of the time course in the assessment of mucosal cell proliferation following injury.     

Effect of controlled adventitial heparin delivery on smooth muscle cell proliferation following endothelial injury.

Continuous intravenous infusion of heparin suppresses smooth muscle cell proliferation in rats after endothelial injury but may lead to hemorrhage and other complications. The anticoagulant property has been removed from chemically modified heparin without loss of antiproliferative effect but use of such compounds is still limited. In this study ethylene-vinyl acetate copolymer matrices containing standard and modified heparin were placed adjacent to rat carotid arteries at the time of balloon dendothelialization. After 14 days arterial occlusion by smooth muscle cell proliferation was defined. Matrix delivery of both heparin compounds effectively diminished this proliferation in comparison to controls without producing systemic anticoagulation or side effects. In addition, this mode of therapy appeared more effective than the administration of the same agents by either intravenous pumps or heparin/polymer matrices placed in a subcutaneous site distant from the injured carotid artery. Thus, heparin's inhibition of smooth muscle cell proliferation after vascular injury might be most effective within the microenvironment of the injured vessel wall, and the accelerated atherosclerosis or restenosis that often follows angioplasty and other vascular interventions might best be treated with site-specific therapy.     

东菱克栓酶对球囊损伤后大鼠主动脉血管细胞增殖的影响

本文在大鼠胸主动脉球囊内皮剥脱术后血管平滑肌细胞增殖模型上,用东菱克栓酶治疗,可有效地降低血浆纤维蛋白原的浓度,抑制损伤血管壁的细胞计数增加和内膜增殖,降低血管壁组织(3)~H-胸腺嘧啶的参入增加程度.实验结果提示东菱克栓酶对于防治球囊成形术后血管再狭窄的发生可能具有潜在临床应用前景.     

雌激素对卵巢切除雌兔血管内膜损伤后血小板聚集与血管平滑肌增殖的影响

目的探讨不同剂量雌激素对切除卵巢的雌兔血管内膜损伤后血小板聚集与血管平滑肌增殖的影响。方法切除卵巢的成年雌性大白兔５０只，行主动脉球囊扩张术，造成血管内膜损伤实验模型，采用氚标记胸腺嘧啶脱氧核苷（３Ｈ－ＴｄＲ）掺入测定雌激素对血管平滑肌细胞（ＶＳＭＣ）增生的影响，采用图像分析仪测定新生内膜增生面积及Ｂｏｒｎ比浊法测定雌激素对血小板聚集的影响。结果单纯切除卵巢的雌兔，未给予苯甲酸雌二醇（Ｅ２）者，其血小板聚集率显著高于其它各组（Ｐ＜０．０１），血管平滑肌细胞增生程度虽有增加，但与对照组比较差异无显著性（Ｐ＞０．０５）；每天肌肉注射Ｅ２μｇ／ｋｇ不能抑制血小板聚集与血管平滑肌增殖；而每天２０μｇ／ｋｇ即可显现明显的抑制平滑肌增生作用，其血小板聚集率明显下降；但每天２０及１００μｇ／ｋｇ其抑制作用差异无显著性（Ｐ＞０．０５）。结论一定剂量的雌激素能有效的抑制血小板聚集和血管平滑肌增殖     

Serotonin potentiates angiotensin II--induced vascular smooth muscle cell proliferation.

Vascular smooth muscle cell (VSMC) proliferation is a key feature in the development of atherosclerosis and restenosis after angioplasty, which can occur in response to many different humoral and mechanical stimuli. We investigated the growth promoting activities of two potent vasoactive substances, angiotensin II (Ang II) and serotonin (5-HT), on cultured rabbit VSMCs. Growth-arrested VSMCs were incubated with serum-free medium containing different concentrations of Ang II in the presence or absence of 5-HT. [3H]thymidine incorporation into VSMC DNA was measured as an index of cell proliferation. Ang II and 5-HT stimulated DNA synthesis in a dose-dependent manner with a maximal effect at 1.75 microM for Ang II (202%) and 50 microM for 5-HT (205%). When added together, low concentrations of Ang II (1 microM) and 5-HT (5 microM) synergistically induced DNA synthesis (363%). Candesartan (1 microM), an AT(1) receptor antagonist, but not PD 123319 (1 microM), an AT(2) receptor antagonist, inhibited the mitogenic effect on Ang II and its interaction with 5-HT. Sarpogrelate (10 microM), a 5-HT(2A) receptor antagonist, and pertussis toxin (10 ng/ml) inhibited the mitogenic effect of 5-HT and its interaction with Ang II. The protein kinase C inhibitor Ro 31-8220 (0.1 microM), the Raf-1 inhibitor radicicol (10 microM), and the MAPK kinase inhibitor PD 098059 (10 microM) abolished mitogenic effects of Ang II and 5-HT, and also their synergistic interaction. The JAK2 inhibitor AG 490 (10 microM) had only a minimal inhibitory effect of Ang II-induced DNA synthesis but significantly inhibited the interaction of Ang II with 5-HT. The synergistic effect on Ang II (1 microM) with 5-HT (5 microM) on DNA synthesis was completely reversed by the combined use of both candesartan (1 microM) and sarpogrelate (10 microM). Our results suggest that Ang II and 5-HT exert a synergistic interaction on VSMC proliferation via AT(1) and 5-HT(2A) receptors. The activation of MAPK and JAK/STAT pathways may explain the synergistic interaction between Ang II and 5-HT.     

Angiostatin binds to smooth muscle cells in the coronary artery and inhibits smooth muscle cell proliferation and migration In vitro.

Angiostatin is an inhibitor of angiogenesis that is known to reduce endothelial cell proliferation and consequently prevent the progression of tumor metastases. However, the modest effect of angiostatin on endothelial cell proliferation raises the possibility that angiostatin might exert its effects on other cells. To determine the cellular distribution of angiostatin binding in tissues with neovasculature (atherosclerotic coronary arteries), we developed a fusion protein consisting of placental alkaline phosphatase and the first 3 kringles of plasminogen. Angiostatin binding colocalized with smooth muscle cells and could be inhibited by a 50-fold molar excess of plasminogen and 10 mmol/L epsilon-amino-n-caproic acid. The fusion protein also bound to smooth muscle cells in culture. Angiostatin inhibited hepatocyte growth factor-induced proliferation and migration of smooth muscle cells, suggesting that they are a target for the antiangiogenic effect of angiostatin.     

Inhibition of vascular smooth muscle cell proliferation by endothelium-dependent vasodilators.

This review considers the hypothesis that the endothelium-derived vasodilator agents, prostacyclin and nitric oxide, also function physiologically to inhibit vascular smooth muscle cell (VSMC) proliferation. The underlying biochemical mechanisms are also discussed. Prostacyclin and other agents that increase intracellular cAMP concentration are potent and effective inhibitors of the proliferation of isolated VSMC in culture. Such agents inhibit the initiation of proliferation in quiescent cells and the proliferation of logarithmically growing cells from a variety of sources, including man. The data implicate prostacyclin as an important regulator of VSMC proliferation, although there is little direct in vivo evidence. Nitric oxide-releasing drugs (and atriopeptins which increase intracellular cGMP concentration by a different mechanism) also inhibit proliferation of cultured VSMC. The effects are, however, partial and obtained at higher concentrations than those required for vasodilatation. Even allowing for the instability of the agents under tissue culture conditions, cGMP-elevating agents appear to be poorer at inhibiting proliferation than cAMP-elevating agents, despite similar or greater vasodilator potency. These data imply that nitric oxide is less likely than prostacyclin to be a physiological regulator of VSMC proliferation, although definitive experiments in vivo are again lacking. It also follows that nitrovasodilators are less attractive as therapy for VSMC proliferation than prostacyclin analogues or other cAMP-elevating agents, such as phosphodiesterase inhibitors. By analogy with the mechanisms of vasodilatation, inhibition of calcium mobilization and the subsequent activation of protein kinase C are considered as possible mechanisms underlying inhibition of proliferation.(ABSTRACT TRUNCATED AT 250 WORDS)