Objective-Atherosclerotic blood vessels overexpress connective tissue growth factor (CTGF) mRNA, but the role of CTGF in atherosclerosis remains controversial. To assess the hypothesis that CTGF is involved in atherosclerotic plaque progression, we investigated CTGF protein expression and distribution in the different types of plaque morphology. Methods and Results-Serial cross-sections of 45 human carotid plaques were immunohistochemically analyzed for the presence of CTGF protein, neovascularization (von Willebrand factor), macrophages (CD68), and T cells (CD3). The lesions were categorized according to American Heart Association (AHA) classification as fibrous (type IV and V) or complicated plaques (type VI). The levels of CTGF were significantly higher in complicated compared with fibrous plaques (Pϭ0.002). CTGF accumulated particularly in the rupture-prone plaque shoulder and in the areas of neovascularization or infiltration with inflammatory cells. Macrophage-like cells stained positive for CTGF protein in plaques. Subsequent in vitro studies showed that although monocyte-derived macrophages do not produce CTGF on stimulation with transforming growth factor-, lipopolysaccharide, or thrombin, they take it up from culture medium. Furthermore, CTGF induces mononuclear cell chemotaxis in a dose-dependent manner. Key Words: connective tissue growth factor Ⅲ atherosclerosis Ⅲ plaque development Ⅲ chemotaxis A therosclerosis is a chronic multifactorial disease characterized by the accumulation of lipids, fibrous tissue, and inflammatory cells in the large arteries. Whereas the earliest type of lesion consists mainly of lipid-laden foam cells and some T cells, the feature of advanced lesions is the accumulation of lipid-rich necrotic debris, encapsulated by a fibrous cap consisting of extracellular matrix produced by smooth muscle cells (SMCs). In the process of plaque development, complex cellular interactions between cells of the vessel wall and the immune system result in thinning of the fibrous cap, growing lipid core, increased inflammatory activity, and neovascularization. These processes lead to plaque instability and may result in plaque rupture, which is a common pathogenetic feature in a majority of acute manifestations of atherosclerosis, such as acute coronary syndrome and stroke. 1 Connective tissue growth factor (CTGF), a potent angiogenic, chemotactic, and extracellular matrix-inducing growth factor, is produced by a wide variety of cells, including endothelial cells (ECs), SMCs, and fibroblasts. At low levels, CTGF supports wound healing by connective tissue formation after tissue injury and plays a role in angiogenesis and skeletal development. 2 However, overexpression of CTGF gene was implicated in progression of many chronic inflammatory-fibroproliferative disorders, such as glomerulosclerosis, pulmonary fibrosis, and cirrhosis. 3 As reported by Oemar et al, 4 CTGF mRNA is expressed at very high levels in atherosclerotic but not in normal human blood vessels. CTGF-producing cells in plaques...