Objective-Previous studies have suggested that neointimal formation, a central cause of vein graft stenosis, has several potential cell sources. It was hypothesized that neointimal cells arise primarily from the cells of the vein graft. Methods and Results-This study investigated vein graft neointimal cell origins using a model of vein-to-artery cross-transplantation between transgenic Rosa26 mice (constitutive expression of bacterial -galactosidase marker gene) and wild-type mice. Vein-originating cells survived and make a major contribution to neointimal formation within the vein graft, mostly adjacent to the lumen/endothelium, suggesting an intimate association with endothelial cells. Key Words: bypass graft Ⅲ neointima Ⅲ Rosa26 Ⅲ thrombomodulin Ⅲ stenosis V ascular bypass surgery using vein grafts has become an established procedure for treating many conditions, most notably myocardial infarction (eg, coronary bypass) and limb claudication (eg, femoral-popliteal bypass grafting). 1,2 Despite high early success rates of these procedures, it is estimated that 20% to 50% of cases undergo stenotic occlusion of the graft within 5 years, 3-5 caused by an inward growth of neointimal cells. 6 Experimental models that mimic clinical vein grafting show a characteristic burst of neointimal cell proliferation early after grafting (3 to 7 days), which leads to a thickened intimal layer by 1 month. 7,8 This neointimal growth appears to stabilize beyond 1 to 2 months in animal models 9,10 and does not create significant graft stenosis at any time, thus differing from the clinical progression of this complication.
See page 1147The source of neointimal cells remains controversial. Studies using arterial injury models (eg, balloon angioplasty) have presented evidence for medial smooth muscle cells, adventitial (myo)fibroblasts, and blood-borne stem cells as major contributors to the neointima. 11-15 Studies using vein graft models have supported adjacent arterial media as a major source for neointimal cells. 7,16 Arterial and organ allotransplantation models have found that circulating progenitor cells and adjacent (recipient) arterial media are the major contributors to transplant-associated neointimal formation. 15,[17][18][19] A recent study using a murine vein graft model demonstrated that the neointimal cells within the graft arise from both the vein graft and the recipient artery. 20 The following study confirms this result using a new murine model that has direct analogy to clinical vein grafting and stenosis. Furthermore, the findings show that neointima cells from the vein graft arise from and proliferate predominantly at the innermost (luminal) aspect, suggesting involvement of vein-derived endothelial cells.
Methods
Vein Graft ModelA new model of vein graft transplantation in mice was developed by the author and is similar to recently described murine vein graft models 20 -22 but uses a smaller-diameter graft, a branch of the jugular vein, interpositioned to the femoral artery. This model has more clinical analogy...