(Circulation. 1999;99:2164-2170.)
© 1999 American Heart Association, Inc.
Basic Science Reports |
Inhibition of Intimal Thickening After Balloon Angioplasty in Porcine Coronary Arteries by Targeting Regulators of the Cell Cycle
From the Cardiovascular Biology Research Laboratory, the Zena and Michael Wiener Cardiovascular Institute (R.G., A.P., M.R., J.C., J.F., V.F., J.J.B.), and the Department of Pathology (J.F.), Mount Sinai School of Medicine, New York, NY; the Molecular Cardiology Program, Columbia University, College of Physicians and Surgeons, New York, NY (T.J., S.M., A.M.); and Wyeth-Ayerst, Princeton, NJ (S.A.).
Correspondence to Juan José Badimon, PhD, Cardiovascular Biology Research Laboratory, Zena and Michael Wiener Cardiovascular Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY-10029. E-mail jjb-laboratory{at}smtplink.mssm.edu
Background—Although percutaneous transluminal coronary angioplasty (PTCA) is a highly effective procedure to reduce the severity of stenotic coronary atherosclerotic disease, its long-term success is significantly limited by the high rate of restenosis. Several cellular and molecular mechanisms have been implicated in the development of restenosis post-PTCA, including vascular smooth muscle cell (VSMC) activation, migration, and proliferation. Recently, our group demonstrated that rapamycin, an immunosuppressant agent with antiproliferative properties, inhibits both rat and human VSMC proliferation and migration in vitro. In the present study, we investigated (1) whether rapamycin administration could reduce neointimal thickening in a porcine model of restenosis post-PTCA and (2) the mechanism by which rapamycin inhibits VSMCs in vivo.
Methods and Results—PTCA was performed on a porcine model at a balloon/vessel ratio of 1.7±0.2. Coronary arteries were analyzed for neointimal formation 4 weeks after PTCA. Intramuscular administration of rapamycin started 3 days before PTCA at a dose of 0.5 mg/kg and continued for 14 days at a dose of 0.25 mg/kg. Cyclin-dependent kinase inhibitor (CDKI) p27kip1 protein levels and pRb phosphorylation within the vessel wall were determined by immunoblot analysis. PTCA in the control group was associated with the development of significant luminal stenosis 4 weeks after the coronary intervention. Luminal narrowing was a consequence of significant neointimal formation in the injured areas. Rapamycin administration was associated with a significant inhibition in coronary stenosis (63±3.4% versus 36±4.5%; P<0.001), resulting in a concomitant increase in luminal area (1.74±0.1 mm2 versus 3.3±0.4 mm2; P<0.001) after PTCA. Inhibition of proliferation was associated with markedly increased concentrations of the p27kip1 levels and inhibition of pRb phosphorylation within the vessel wall.
Conclusions—Rapamycin administration significantly reduced the arterial proliferative response after PTCA in the pig by increasing the level of the CDKI p27kip1 and inhibition of the pRb phosphorylation within the vessel wall. Therefore, pharmacological interventions that elevate CDKI in the vessel wall and target cyclin-dependent kinase activity may have a therapeutic role in the treatment of restenosis after angioplasty in humans.
Key Words: restenosis • cells • angioplasty
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