This review will focus on the role of cytokines in the behavior of macrophages, a prominent cell type of atherosclerotic lesions. Once these macrophages have immigrated into the vessel wall, they propagate the development of atherosclerosis by modifying lipoproteins, accumulating intracellular lipids, remodeling the extracellular environment, and promoting local coagulation. The numerous cytokines that have been detected in atherosclerosis, combined with the expression of large numbers of cytokine receptors on macrophages, are consistent with this axis being an important contributor to lesion development. Given the vast literature on cytokine-macrophage interactions, this review will be selective, with an emphasis on the major cytokines that have been detected in atherosclerotic lesions and their effects on properties that are relevant to lesion formation and maturation. There will be an emphasis on the role of cytokines in regulating lipid metabolism by macrophages. We will provide an overview of the major findings in cell culture and then put these in the context of in vivo studies. As noted in Getz's overview (1), lesions contain large numbers of cytokines that can be derived from several cell types. These cytokines may affect the function of many cell types in atherogenesis. The effects of cytokines on endothelial and smooth muscle cells are discussed in Raines and Ferri's contribution to this series (2). The purpose of this review is to focus on the effects of cytokines on macrophages in the evolution of atherosclerotic lesions. This is a vast literature that has necessitated some selectivity in the areas that can be covered. Given the subject area of this journal, we have elected to focus particular attention on the effect of cytokines on lipid metabolism in macrophages.
MACROPHAGE FUNCTIONS IN ATHEROSCLEROTIC LESIONSMacrophages are hypothesized to be attracted to the subendothelial space to remove noxious materials deposited at atherosclerosis-prone regions of arteries. The precise chemical identity of the substance that attracts macrophages has not been unequivocally defined, although many candidate molecules are components of modified lipoproteins (3, 4). However, the function of infiltrating cells becomes subverted and leads to their retention within the subendothelial space. In this region, it is proposed that macrophages modify adjacent lipoproteins while also providing major mechanisms of removal for modified materials from the extracellular environment. The combination of lipoprotein modification and uptake leads to macrophages becoming engorged with lipids and resulting in a morphology that is given the descriptive name of "foam cells." Lipid engorgement causes pronounced cellular hypertrophy, with the cell diameter being Ͼ 10 times that of the originating monocyte. Probably as a result of the immense size increase, lipid-laden macrophages are chronically entrapped in the subendothelial space. Trapped macrophages can then invoke processes that perpetuate the continual recruitment of monoc...