Approaches to the development of selective inhibitors of vascular smooth muscle cell proliferation.

Abnormal proliferation of VSMC is a feature of atheromatous plaques and is responsible for obstructive neointimal lesions at the sites of mechanical or immunological intimal damage. We have discussed approaches to the development of specific inhibitors of VSMC proliferation based firstly on studies of the mechanism of action of known inhibitors and secondly on the identification of genes which are unique to and necessary for VSMC proliferation. The effects of angiotensin converting enzyme inhibitors, heparin and hexamethylene bisacetamide on VSMC proliferation have been discussed. Each of these types of agent has been shown to inhibit VSMC proliferation in vitro and/or in vivo. Examination of the mechanisms by which these agents inhibit VSMC proliferation reveals that transforming growth factor beta is an important mediator of their action and that the processes of de-differentiation and proliferation are independently regulated. Studies aimed at identifying genes involved in VSMC proliferation are at an early stage but have already provided strong evidence to support the hypothesis that VSMC in the vessel wall are heterogeneous and contain a subpopulation of cells with an enhanced proliferative capacity. Identification of the genes expressed by these cells may allow specific inhibitors of VSMC proliferation to be developed and may shed light on the pathogenesis of neointimal lesions.