SUMMARY:Rapamycin, an immunosuppressant and antiproliferative agent, reduces intimal hyperplasia after arterial injury in animal models and in a preliminary study in humans. Rapamycin treatment reportedly increases expression of p27, a cyclin-dependent kinase inhibitor. This mechanism was tested using a p27-deficient (p27 Ϫ/Ϫ) murine model. Aortic smooth muscle cells from wild-type (WT) and p27 Ϫ/Ϫ mice were isolated and cultured. Cell proliferation, assessed by cell count and 3 H-thymidine incorporation, was inhibited significantly by rapamycin in WT and p27 Ϫ/Ϫ cells at concentrations of 1 ng/ml, 10 ng/ml, and 100 ng/ml (p Ͻ 0.05, versus control). The in vivo effect on intimal hyperplasia was studied in p27 Ϫ/Ϫ and WT mice after femoral artery transluminal injury. Rapamycin treatment was started 2 days before injury and maintained for 2 weeks (1 mg/kg per 48 hours, ip). No significant differences in intima-to-media ratio were found between WT (1.1 Ϯ 0.1) and p27 Ϫ/Ϫ mice (1.0 Ϯ 0.1) 4 weeks after injury. Rapamycin significantly (p Ͻ 0.05) reduced intima-to-media ratios in both WT (0.7 Ϯ 0.1) and p27 Ϫ/Ϫ mice (0.5 Ϯ 0.1), compared with untreated mice. p27 deficiency did not alter the arterial wall proliferative response to injury. The inhibitory effect of rapamycin on intimal hyperplasia occurred via a p27-independent mechanism. The in vitro data showed that this effect was mediated through decreased proliferation and enhanced apoptosis. (Lab Invest 2001, 81:895-903).E xcessive vascular smooth muscle cell (SMC) proliferation is a feature of restenosis after percutaneous coronary interventions and is present in spontaneous atherosclerotic lesions (Casscells, 1992;Foegh and Virmani, 1993;Ross, 1999). Control of cell proliferation by targeting cell-cycle regulation has been proposed as a therapeutic strategy to prevent development of intimal hyperplasia (Braun-Dullaeus et al, 1998;Chang et al, 1995;Chen et al, 1997;Li and Brooks, 1999;MacLellan and Majesky, 1997;Mann et al, 1999;Morishita et al, 1994.Cyclin-dependent kinase inhibitors (CDKIs) are critical regulators of cell-cycle progression. These proteins bind to complexes formed by cyclins and cyclindependent kinases (CDKs), inhibiting their enzymatic activity and thereby inducing cell-cycle arrest (Sherr and Roberts, 1995). p27 kip1 is an ubiquitous CDKI with a predominant role in regulating G1/S phase transition, determining cell entry into S phase or withdrawal from the cycle (Koff et al, 1993;Polyak et al, 1994).Mitogenic stimuli, such as platelet-derived growth factor (PDGF) and interleukin-2, down-regulate p27 (Nourse et al, 1994). Low intracellular levels of free p27 enable retinoblastoma protein (pRB) hyperphosphorylation by cyclin-CDK complexes, subsequent release of E2F transcription factor, and cell replication .Rapamycin is a potent growth inhibitor that impairs progression through G1/S transition (Marx et al, 1995). Proposed mechanisms of action include inhibition of p70S6 kinase, impairment of pRB hyperphosphorylation, and prevention of p27 down-r...