A few years ago, I was asked to give a series of lectures to our second-year medical students on basic inflammatory mechanisms. I was taking the place of the late Russell Ross, who had given these lectures for many years. Among the teaching materials Russ had collected was a videotape generated from a 16-mm movie made in the 1940s. The movie showed leukocytes rolling, adhering, and migrating through capillaries in response to an inflammatory stimulus in a rabbit ear chamber. I used this videotape to illustrate the basic steps in a classical inflammatory response but also to introduce to the students the remarkable complexity of the molecular interactions underlying each step in leukocyte recruitment into inflamed tissues. We have come a long way in delineating the nature of these molecular interactions since the 1940s. We now use in vitro adhesion assays and microscopic techniques such as intravital microscopy, coupled with antibodies and receptor antagonists designed to specify which candidate adhesion molecules, counter receptors, and chemokines mediate leukocyte recruitment 1-7 These have provided a basic molecular paradigm for the rolling, activation, arrest, adhesion, and transmigration of leukocytes. L and P selectins appear to be primarily responsible for the initial capture of cells from the flowing blood, E and P selectins for mediating rolling, and 2 integrins, ICAM-1, and PECAM-1 for adhesion and transmigration. 8 -10 In addition, products of the arachidonate and complement cascades and chemokines, a large family of small peptides that activate leukocytes via binding to G protein-coupled receptors, also seem to play fundamental roles in the recruitment process. [11][12][13] See page 443Most of our current knowledge of the molecular mediators of leukocyte recruitment has been derived from adhesion assays and studies of the microvasculature. Determining whether the same molecules are involved in recruiting leukocytes into atherosclerotic lesions in the muscular arteries has been more problematic. There is extensive evidence that many of these molecules are expressed by cells in human and experimental atherosclerotic lesions 14 -23 and that expression of adhesion molecules such as VCAM-1 is temporally related to lesion initiation and progression in animal models. 22,24 Furthermore, studies of transgenic mice or mice with targeted mutations have provided some insights into which of these molecules play roles in the atherogenic process. In particular, these studies have so far shown that E and P selectins, ICAM-1, MCP-1, and its receptor CCR2, as well as the IL-8 receptor CXCR2, seem to mediate recruitment of leukocytes into atherosclerotic lesions in hyperlipidemic mice. [25][26][27][28][29][30][31][32][33][34] However, the in vivo studies have also clearly demonstrated the presence of redundant mechanisms, as in no case has there been a complete ablation of lesion development in the absence of any one of these molecules. A look at the increasing list of known chemokines and the lack of specificity wit...