Published Online
on March 25, 2002

A more recent version of this article appeared on April 9, 2002

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Submitted on March 22, 2001
Revised on January 29, 2002
Accepted on January 30, 2002

Endothelial Healing in Vein Grafts. Proliferative Burst Unimpaired by Genetic Therapy of Neointimal Disease

Afshin Ehsan MD, Michael J. Mann MD, Giorgio Dell'Acqua PhD, Koichi Tamura PhD, Ruediger Braun-Dullaeus MD, and Victor J. Dzau MD^*

From the Department of Medicine, Harvard Medical School and Brigham and Women's Hospital, Boston, Mass.

^* To whom correspondence should be addressed. E-mail: vdzau{at}partners.org.

Background—Although inhibition of neointimal hyperplasia by cell cycle gene blockade therapy results in improved endothelial cell function in experimental vein grafts, little is known either about endothelial healing immediately after vein grafting or about the effect of this therapy on the healing process.

Methods and Results—Scanning electron microscopy demonstrated an immediate decrease in vein graft endothelial cell density associated with vein graft wall stretch, followed by a return to baseline by postoperative day 3. En face detection of bromodeoxyuridine incorporation confirmed a rapid endothelial proliferation by 48 hours. Despite inhibition of underlying vascular smooth muscle cell proliferation, E2F decoy oligonucleotide did not inhibit either endothelial bromodeoxyuridine incorporation or the return to baseline cell density. This differential response to E2F decoy was also observed in human umbilical vein endothelial cell culture, which resisted the E2F decoy inhibition of cell growth that was observed in human umbilical artery smooth muscle cells, despite evidence for nuclear localized delivery of the oligonucleotide into both cell types. Furthermore, the reduction of E2F binding activity seen in a nuclear gel shift assay of cultured smooth muscle cells was not observed in endothelial cells.

Conclusions—These results suggest a burst of graft endothelial cell proliferation that allows a rapid restoration of cell density in the monolayer. Additionally, there is a selective effect of E2F decoy gene therapy on target smooth muscle cells with sparing of this endothelial healing.

Key words: endothelium • gene therapy • bypass • surgery • veins

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