Inflammatory processes play a crucial role in the pathogenesis of atherosclerosis and other vascular disorders. We hypothesized that ischemia of the ductus arteriosus might initiate an active inflammatory response that could play a role in ductus remodeling and permanent closure. To test this hypothesis, we studied effects of postnatal ductus construction on inflammatory processes and remodeling in late-gestation fetal and newborn baboons, and preterm newborn baboons. After postnatal ductus constriction, the expression of several genes known to be essential for atherosclerotic remodeling [vascular cell adhesion molecule (VCAM)-1, E-selectin, IL-8, macrophage colony stimulating factor-1, CD154, interferon-␥, IL-6, and tumor necrosis factor-␣] was increased in the ductus wall. We were unable to detect intercellular adhesion molecule (ICAM)-1, ICAM-2, Pselectin, monocyte chemoattractant protein-1, or IL-1 by either real-time PCR or immunohistochemistry. VCAM-1, which is newly expressed by luminal cells of the closed ductus, is an important ligand for the mononuclear cell adhesion receptor VLA4. After postnatal constriction, VLA4 ϩ monocytes/ macrophages (CD68 ϩ and CD14 ϩ ) and, to a lesser extent, T-lymphocytes adhered to the ductus wall. Neutrophils and platelets were not observed. The extent of postnatal neointimal remodeling (both endothelial cell layering and subendothelial space thickening) was associated with the degree of mononuclear cell adhesion. Similarly, the extent of vasa vasorum ingrowth correlated with the invasion of CD68 ϩ cells, from the adventitia into the muscle media. Based on these data, we conclude that the inflammatory response following postnatal ductus constriction may be as necessary for ductus remodeling as it is for atherosclerotic remodeling. Closure of the full-term ductus arteriosus occurs in two phases. First, smooth muscle constriction obstructs the ductus' lumen. Then, anatomic remodeling permanently occludes the lumen. The initial constriction appears to be the required stimulus for anatomic closure. During constriction, loss of luminal and vasa vasorum flow produce a zone of ischemichypoxia in the ductus' muscle media that induces the following anatomic changes: luminal endothelial proliferation, subendothelial thickening, ingrowth of vasa vasorum, and cell death (1). The preterm newborn is capable of remodeling its ductus, just like the full-term newborn, if it can impede its luminal flow and develop the same degree of ischemic-hypoxia as found at term (2).Although the cell death and ingrowth of vasa vasorum in the ductus wall appear to be due to ATP depletion (3,4) and VEGF induction (5), respectively, the mechanism(s) responsible for the neointimal changes are still unknown. It is now clear that inflammatory processes play a crucial role in the pathogenesis of several vascular disorders (6 -9). The most studied model of