A rteriogenesis is a process of developing collateral circulation through the remodeling and growth of pre-existing collateral arteries after elevated shear stress induced by occlusion.1-3 Arteriogenesis takes place both during embryogenesis and in adult tissues. In the latter case, arteriogenesis, which usually occurs at sites of occlusion or physical disruption of pre-existing arterial conduits such as coronary artery occlusion or femoral artery ligation, plays a vital role in recovery from ischemic insults. 4,5 Understanding the biological factors that affect arteriogenesis will aid in the development of new treatments for patients with arterial stenosis and occlusions.There are 2 commonly considered mechanisms for arteriogenesis: expansion of pre-existing collaterals and de novo arteriogenesis. 2,6,7 Inflammation caused by mechanical hemodynamic forces, such as shear stress and circumferential wall tension, is considered a pivotal trigger and driver for arteriogenesis. 4,[8][9][10][11] Previous studies have shown that monocytes accumulated in the surrounding tissues of collateral vessels alter arterial occlusion. 7,[11][12][13] These macrophages are potent sources of cytokines and growth factors, which are required for natural adaptive arteriogenesis. In spite of a mounting number of putative arteriogenic factors, the exact mechanisms that regulate collateral remodeling are poorly characterized. Furthermore, the processes responsible for arteriogenesis, and its associated molecular signals are poorly understood.AMP-activated protein kinase (AMPK) is a serine/threonine kinase composed of α, β, and γ subunits. 14,15 The α subunit containing the α1 and α2 isoform is the catalytic subunit, whereas the β and γ are regulatory subunits that maintain the stability of the heterotrimer complex. As an energy sensor, AMPK is activated by various cellular stresses, such as hypoxia, nutrient deprivation, and oxidative stress. [16][17][18] Once activated, AMPK phosphorylates and regulates several downstream kinases that reduce energy demand and increase energy supply to maintain whole-body energy homeostasis. 19 In addition, AMPK also regulates many other cellular processes, including cell polarity, cell growth, and proliferation. [20][21][22] Emerging studies have demonstrated that AMPK is activated in response to shear or ischemic stress. 23,24 AMPK signaling is required for angiogenesis in vivo and in vitro. [25][26][27][28] However, there is no information on the consequences of AMPK deletion in arteriogenesis. In this study, we sought to examine the role © 2016 American Heart Association, Inc. Objective-AMP-activated protein kinase (AMPK), an energy and redox sensor, is activated in response to various cellular stresses, including hypoxia, nutrient deprivation, oxidative stress, and fluid shear stress at the site of vessel blockade. The activation of AMPK is involved in angiogenesis. However, it is unknown whether AMPK can influence arteriogenesis. Here, we demonstrate the contribution of macrophage AMPK to arteriogen...