Abstract-Intima-media thickening (IMT) in response to hemodynamic stress is a physiological process that requires coordinated signaling among endothelial, inflammatory, and vascular smooth muscle cells (VSMC). Axl, a receptor tyrosine kinase, whose ligand is Gas6, is highly induced in VSMC after carotid injury. Because Axl regulates cell migration, phagocytosis and apoptosis, we hypothesized that Axl would play a role in IMT. Vascular remodeling in mice deficient in Axl (Axl Ϫ/Ϫ ) and wild-type littermates (Axl ϩ/ϩ ) was induced by ligation of the left carotid artery (LCA) branches maintaining flow via the left occipital artery. Both genotypes had similar baseline hemodynamic parameters and carotid artery structure. Partial ligation altered blood flow equally in both genotypes: increased by 60% in the right carotid artery (RCA) and decreased by 80% in the LCA. There were no significant differences in RCA remodeling between genotypes. However, in the LCA Axl Ϫ/Ϫ developed significantly smaller intimaϩmedia compared with Axl Key Words: Axl Ⅲ flow Ⅲ carotid artery Ⅲ remodeling Ⅲ mouse Ⅲ apoptosis Ⅲ inflammation T he receptor tyrosine kinase Axl (also known as Ufo and Tyro7) belongs to a family of tyrosine receptors that includes Tyro3 (Sky) and Mer (Tyro12). 1,2 A common ligand for Axl family is Gas6 (Growth arrest-specific protein 6). 2,3 Important cellular functions of Gas6/Axl include cell adhesion, migration, phagocytosis, and inhibition of apoptosis. 4 -7 Gas6 and Axl family receptors are highly regulated in a tissue and disease specific manner. 8 -11 A recent genetic study found a significant association of a Gas6 mutation with stroke in humans. 12 Both Gas6 and Axl-family receptor knockout mice show abnormalities in platelet function, further supporting a vascular role for the Gas6/Axl pathway. 13,14 In human umbilical vein endothelial cells (HUVEC) and pulmonary artery EC, Gas6/Axl signaling promotes cell survival, 8,15 possibly via an autocrine pathway. 16 Gas6/Axlmediated survival signals include activation of Akt, phosphorylation of nuclear factor B (NF-B), increased expression of Bcl-2, and decreased caspase-3 activation. 17 Similarly, in vascular smooth muscle cells (VSMC), Gas6/Axl powerfully stimulates cell migration and cell survival. 18 We reported that Axl was highly regulated after rat carotid balloon injury consistent with a role in intimal VSMC proliferation. 19 Our recent findings showed that the Gas6/Axl/PI3K/Akt pathway inhibited VSMC apoptosis. 20 Moreover, Axl contributes to generation of reactive oxygen species in VSMC. 21 In addition, the Gas6/Axl pathway is important in the mammalian immune system. 7 Recent data suggest that the Axl family is a central regulator of macrophage activation and phagocytosis. 22 We developed a reproducible mouse model of flowdependent vascular remodeling that resembles human intimamedia thickening (IMT). 23 In response to decreased blood flow IMT occurs, which involves critical interactions among cells of the vessel wall. 23,24 Based on the significant rol...