Objective-Apoptosis substantially affects the cellularity and integrity of atherosclerotic plaques. It remains, however, unclear which key regulatory genes are involved. In this study, cDNA expression arrays were used to analyze transcript levels of 205 apoptosis-related genes in human carotid endarterectomy specimens versus nonatherosclerotic mammary arteries. Methods and Results-Seventeen genes with a 2-to 5-fold relative expression difference were identified. One of the most apparent changes in human plaques was the overexpression of death-associated protein (DAP) kinase (Ϸ5-fold), a positive mediator of apoptotic cell death. Differential expression of DAP kinase mRNA in human plaques relative to mammary arteries was confirmed by quantitative reverse-transcription polymerase chain reaction. Western blotting and immunohistochemistry demonstrated enhanced levels of DAP kinase protein in the plaque with negligible expression in non-atherosclerotic vessels. DAP kinase was located predominantly in foam cells of smooth muscle cell (SMC) origin. Uptake of aggregated LDL by cultured aortic SMCs as well as exposure of SMCs to the short-chain acyl ceramide derivative N-hexanoyl-D-sphingosine (C 6 -ceramide) upregulated DAP kinase both at the mRNA and protein level. Conclusions-Our data demonstrate that cDNA array technology can identify novel genes that might participate in cell death pathways underlying atherogenesis. Key Words: atherosclerosis Ⅲ apoptosis Ⅲ cDNA array Ⅲ death-associated protein kinase Ⅲ gene expression A poptosis has been identified as a prominent feature of advanced human atherosclerotic plaques. [1][2][3] The distribution of apoptosis within the plaque as determined by in situ end-labeling techniques (terminal deoxynucleotidyl transferase end labeling [TUNEL] and in situ nick translation [ISNT]) is heterogeneous, being more frequent (1% to 2%) in regions with a high density of macrophages. Early lesions that mainly consist of smooth muscle cells (SMCs) present very little apoptosis (Ͻ0.1%), suggesting that apoptosis in atherosclerotic plaques is strongly related to macrophage infiltration. In recent years, several factors with proapoptotic activity have been identified in human atherosclerotic plaques. SMCs within human fatty streaks or advanced plaques show increased expression of the proapoptotic protein Bax. 3 Furthermore, cytokines with proapoptotic potential, such as interleukin-1, tumor necrosis factor (TNF)-␣, and interferon (IFN)-␥ are secreted by inflammatory cells and contribute to local cell death. 1 Together with macrophages and T lymphocytes, mast cells are present in the inflammatory infiltrate and initiate SMCs apoptosis by releasing chymase in the extracellular matrix. 4 Upregulation of matrix metalloproteinases in human plaques may result in cell detachment from the matrix and apoptotic cell death (anoikis). Macrophages can also induce SMCs apoptosis via Fas/Fas-L interactions. 5 Other substances that are known to induce apoptosis in the plaque include oxidized LDLs, oxysterols, a...