Background-Neointima formation after arterial injury is associated with reduced vascular cyclic guanosine monophosphate (cGMP) and cGMP-dependent protein kinase (PKG), a major cGMP effector in vascular smooth muscle. We tested the effect of PKG overexpression on the neointimal response to vascular injury. Methods and Results-Infection of cultured rat aortic smooth muscle cells (RASMCs) with an adenoviral vector specifying a cGMP-independent, constitutively active PKG mutant (AdPKGcat) reduced serum-induced migration by 33% and increased serum-deprivation-induced apoptosis 2-fold (PϽ0.05 for both). Infection with wild-type PKG (AdPKG), in the absence of cGMP, did not affect migration or apoptosis. Two weeks after balloon-injured rat carotid arteries were infected with 1ϫ10 10 pfu AdPKGcat (nϭ12), AdPKG (nϭ8), or a control adenovirus (nϭ8), intima-to-media ratio was less in AdPKGcat-infected arteries than in AdPKG-or control adenovirus-infected vessels (0.26Ϯ0.06 versus 0.61Ϯ0.12 and 0.70Ϯ0.12, respectively, PϽ0.05 for both). Two weeks after intramural administration of 1.75ϫ10 10 pfu AdPKGcat (nϭ8) or a control adenovirus (nϭ8) into porcine coronary arteries with in-stent restenosis, luminal diameter was greater in AdPKGcat-infected arteries than in control adenovirus-infected vessels (2.32Ϯ0.16 versus 1.81Ϯ0.13 mm, Pϭ0.028), associated with reduced neointimal area (3.30Ϯ0.24 versus 4.15Ϯ0.13 mm 2 , Pϭ0.008), neointima-to-vessel area ratio (0.42Ϯ0.05 versus 0.58Ϯ0.04, PϽ0.05), and percent stenosis (45Ϯ6% versus 70Ϯ4%, PϽ0.05).
Conclusions-Expression of a constitutively active PKG reduces neointima formation after balloon injury in rats andreduces coronary in-stent restenosis in pigs. PKGcat gene transfer may be a promising strategy for vasculoproliferative disorders. Key Words: kinases Ⅲ nitric oxide Ⅲ apoptosis Ⅲ restenosis S trategies designed to increase vascular nitric oxide (NO) levels reduce neointima formation after balloon injury in rat carotid and porcine coronary arteries. [1][2][3] Vascular NO concentrations can be increased by systemic or local administration of NO-donor compounds or the NO synthase substrate L-arginine or by NO synthase gene transfer. The mechanisms whereby NO modulates neointima formation remain unclear but may involve cyclic guanosine monophosphate (cGMP)-dependent or cGMP-independent effects in the vessel wall, as well as the interaction of circulating cells with the injured vascular wall. 4 The cGMP-dependent effects of NO are mediated via a variety of cGMP targets, including the serine/threonine kinase cGMP-dependent protein kinase (PKG). 5,6 PKG activation in vascular smooth muscle cells (VSMCs) can result in relaxation, apoptosis, and reduced proliferation and migration. [7][8][9][10][11][12] Of the 2 PKG genes identified in the mammalian genome, PKG1 is expressed in VSMCs. PKGs have an amino-terminal regulatory domain and a carboxyl-terminal catalytic domain. Binding of cGMP by the regulatory domain leads to activation of the catalytic domain. Two PKG1 isoforms, ␣ and , are ...