Abstract-Lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) is a membrane protein that can support the binding, internalization, and proteolytic degradation of oxidized low-density lipoprotein. The LOX-1 expression increases in the neointima after balloon injury. To develop an efficient compound to inhibit LOX-1, we designed and synthesized a novel gene silencer pyrrole-imidazole (PI) polyamide targeting the rat LOX-1 gene promoter (PI polyamide to LOX-1) to the activator protein-1 binding site. We examined the effects of PI polyamide to LOX-1 on the LOX-1 promoter activity, the expression of LOX-1 mRNA and protein, and neointimal hyperplasia of the rat carotid artery after balloon injury. PI polyamide to LOX-1 significantly inhibited the rat LOX-1 promoter activity and decreased the expression of LOX-1 mRNA and protein. After balloon injury of the arteries, PI polyamide to LOX-1 was incubated for 10 minutes. Fluorescein isothiocyanate-labeled PI polyamide was distributed to almost all of the nuclei in the injured artery. PI polyamide to LOX-1 (100 g) significantly inhibited the neointimal thickening by 58%. PI polyamide preserved the re-endothelialization in the injured artery. PI polyamide significantly inhibited the expression of LOX-1, monocyte chemoattractant protein-1, intercellular adhesion molecule-1, and matrix metalloproteinase-9 mRNAs in the injured artery. The synthetic PI polyamide to LOX-1 decreased the expression of LOX-1 and inhibited neointimal hyperplasia after arterial injury. This novel gene silencer PI polyamide to LOX-1 is, therefore, considered to be a feasible agent for the treatment of in-stent restenosis. Key Words: basic science Ⅲ endothelium Ⅲ gene therapy Ⅲ cytokines Ⅲ polyamide Ⅲ LOX-1 Ⅲ restenosis C oronary artery restenosis after angioplasty occurs in Ϸ30% of all patients. 1,2 Despite the widespread use of intracoronary stents, in-stent restenosis remains a major clinical problem, occurring in Յ50% of high-risk patients. 3 The development of neointimal hyperplasia after arterial injury contributes to the pathogenesis of restenosis. Several factors are involved in the initiation and progression of neointimal hyperplasia. Coronary arterial diseases are known to be associated with several risks, such as dyslipidemia, hypertension, smoking, and diabetes. A pivotal common factor in these risks is oxidative stress, which also induces restenosis of the coronary artery. 4 The oxidized low-density lipoprotein (ox-LDL) is recognized to be a major cause of endothelial dysfunction in atherogenesis. 5 Lectin-like ox-LDL receptor-1 (LOX-1), a receptor for ox-LDL, is a membrane protein that is expressed in both the vascular endothelium and vascular-rich organs. LOX-1 can support the binding, internalization, and proteolytic degradation of ox-LDL. 6 The LOX-1 expression has been reported to significantly increase in the neointima after balloon injury in various animal models of neointimal hyperplasia, such as rats and rabbits. Hinagata et al 7 reported neointimal hyperplasia after ba...