Objective-We have previously shown that human macrophages induce human plaque vascular smooth muscle cell (VSMC) apoptosis by cell-cell proximity, Fas-L, and nitric oxide (NO), thereby predisposing to plaque rupture. This study sought to analyze whether tumor necrosis factor-␣ (TNF-␣) contributes additionally to macrophage-induced VSMC apoptosis. Methods and Results-Macrophage-induced VSMC apoptosis was examined in direct coculture. Antagonistic antibodies to TNF-receptor (R1) inhibited VSMC apoptosis, and preincubation of monocytes and VSMCs indicated that TNF-R1 on both cell types contributed to macrophage-induced VSMC apoptosis. Correspondingly, both monocytes and VSMCs expressed TNF-R1, and macrophages expressed cell surface TNF-␣. Two NO donors upregulated VSMC surface TNF-R1, and exogenous TNF-␣ induced VSMC apoptosis synergistically with the NO donor diethylenetriamine/NO, indicating that NO sensitizes VSMCs to TNF-␣. Neutralizing anti-TNF-R1 antibodies inhibited macrophage activation assessed by Fas-L expression and NO secretion. Key Words: macrophages Ⅲ plaque rupture Ⅲ vascular smooth muscle cells Ⅲ apoptosis Ⅲ tumor necrosis factor A therosclerotic plaque rupture causes myocardial infarction. 1,2 Plaque ruptures are associated with increased fibrous cap macrophages, reduced fibrous cap vascular smooth muscle cells (VSMCs), and increased VSMC apoptosis. [3][4][5] Because VSMCs are the only cells within plaques capable of synthesizing structurally important collagen isoforms, VSMC apoptosis might promote plaque rupture. 4,5 We have shown previously that cultured, human blood monocyte-derived macrophages induce human VSMC apoptosis by direct cell-cell contact, Fas-L/Fas, and nitric oxide (NO). 6,7 Macrophages produce other proapoptotic factors, including the Fas-L homologue tumor necrosis-factor-␣ (TNF-␣). 6 TNF-␣, like Fas-L, has a bioactive, membrane-bound pro-form that mediates cell-cell contact-dependent apoptosis both in vitro 8,9 and in vivo. 10 Although the mechanism by which TNF-␣ acts in cytotoxicity is less clear, there is evidence that it induces VSMC apoptosis synergistically, with the inflammatory cytokines interleukin-1 and interferon-␥. 11 TNF-␣ acts through 2 receptors, TNF-R1 and TNF-R2. 12 Both TNF-R1 and TNF-R2 are homologous to Fas. 13,14 Like Fas, TNF-R1 has a death domain that initiates assembly of a death-induced signaling complex, thus activating caspases. 13 TNF-R2 is homologous to TNF-R1 and Fas but lacks a death domain. 13 The mechanism for the proapoptotic effect of TNF-R2 is uncertain. TNF-R2 might, like TNF-R1, by way of tumor necrosis factor receptor-associated factor (TRAF) adaptor molecules, 13 produce proapoptotic effects. Indeed, TNF-R1 and TNF-R2 cooperatively interact to induce apoptosis through TRAFs. 15 Alternatively, Grell et al 12 have postulated that TNF-R2 might mediate the proapoptotic effects of TNF by ligand passing to TNF-R1. Furthermore, macrophage-derived TNF-␣ might activate macrophages in an autocrine loop. 16 -18 Although this could promote cytotoxic...