Objective-Attempts to restore blood flow through atherosclerotic vessels by angioplasty often result in restenosis. Because the role of nerves in this process is unclear, we investigated whether neuropeptide Y (NPY), a sympathetic cotransmitter with vascular mitogenic activities, contributes to postangioplasty restenosis. Methods and Results-Carotid artery balloon angioplasty upregulated vascular expression of NPY and its processing enzyme (DPPIV/cd26) and receptors (Y1, Y2, Y5 mRNA and protein) within 6 to 24 hours and stimulated neointima formation and accumulation of NPY in platelets after 14 days. NPY pellets (1 to 10 g/pellet for 14 days) inserted next to the injured artery elevated platelet and vascular NPY immunoreactivity to stress-like levels and dose-dependently augmented angioplasty-induced neointima. Strikingly, 10 g NPY for 14 days led to vessel occlusion with an atherosclerotic-like lesion, with thrombus and neointima containing neovessels, macrophages, matrix, and lipids. Y1 or Y5 receptor antagonist completely prevented the effect of NPY and reduced angioplasty-induced neointima by 50%.
Conclusions-Angioplasty
See page 1137Multiple growth factors have been implicated in restenosis, 4 most of them thought to derive from mesenchymal cells. Surprisingly, the role of perivascular sympathetic nerves that richly innervate these vessels is less known. Sympathetic activity has been believed to promote atherosclerosis indirectly, either by its vasoconstrictive effects 5 or by stimulating platelet aggregation or insulin resistance. 6 However, these views have been rapidly changing in recent years because both norepinephine 7 and its cotransmitter, ATP, 8 have been found to exert direct trophic actions on vascular smooth muscle cells (VSMCs) both in vivo and in vitro.NPY is also a sympathetic and central cotransmitter, mediating pleiotropic activities such as stimulation of appetite and anxiolysis by activating multiple G i/o -coupled Y1-Y5 receptors. 9 -11 In the cardiovascular system, NPY cooperates with norepinephrine (NE) and causes, via Y1 receptors, a slow-onset, long-lasting vasoconstriction in many arteries, including coronary and cerebral. 9 -12 Plasma NPY levels are elevated by stress, such as cold exposure or treadmill exercise 9,12,13 and, in patients with myocardial ischemia, congestive heart failure and hypertension. 9,12,13 Recently, the vasoconstrictive Y1 receptor has also been identified as mediating proliferation of VSMCs in vitro. 14,15 In addition to neurogenic, extraneuronal NPY synthesis has been identified in endothelial 16 and immune cells 17 and megakaryocytes/platelets. 9,18 -20 Similar to VSMCs, NPY potently promotes growth of endothelial and immune cells, 14,16 but specific receptor subtypes mediating its effects appear to differ. For example, the angiogenic activity of NPY seems to be mediated not by Y1 but by Y2/Y5 receptors. The switch from the Y1-receptor-mediated vasoconstriction and VSMC mitogenesis to non-Y1-receptor-mediated angiogenic actions of NPY is provided by DPP...