Abstract-To study the role of vascular cell adhesion molecule-1 (VCAM-1) in monocyte recruitment and atherogenesis, we constructed a recombinant adenovirus, AdRSVrVCAM-1, carrying the rabbit VCAM-1 cDNA. We have previously shown that AdRSVrVCAM-1-transduced human umbilical vein endothelial cells (HUVECs) support the adhesion of CD4 ϩ CD45RO ϩ memory T lymphocytes under laminar flow conditions. We now demonstrate that AdRSVrVCAM-1-transduced HUVECs support the adhesion of peripheral blood monocytes at a shear stress of Յ1.5 dyne/cm 2 . Although VCAM-1 supported only firm adhesion of lymphocytes, it was able to mediate monocyte rolling, firm adhesion, and transmigration when expressed in the context of otherwise unactivated vascular endothelium. VCAM-1-transduced HUVECs supported the adhesion of as many as 4-fold more monocytes than T cells under laminar flow. The greater monocyte adhesion was explained at least in part by leukocyte-leukocyte interactions (secondary adhesions), which were not seen with T cells. These secondary monocyte interactions were specifically blocked by monoclonal antibodies to L-selectin and P-selectin glycoprotein ligand-1. These data demonstrate that VCAM-1 expressed in the context of unactivated vascular endothelium supports the adhesion of the leukocyte populations present in atherosclerotic plaque and may contribute to the predominance of monocytes over lymphocytes. (Circ Res. 1998;82:871-878.) Key Words: adenovirus Ⅲ adhesion Ⅲ atherosclerosis Ⅲ mononuclear leukocyte T he association between monocytes and atherosclerotic lesions, both in animal models and in humans, has long been recognized.1 Monocytes constitute Ϸ80% of the leukocytes in atherosclerotic plaque. Lymphocytes constitute 5% to 20% of this cell population and are predominantly CD4 ϩ CD45RO ϩ (memory) T cells. 2 Monocytes may contribute both to the development of atherosclerotic lesions and to events, such as acute plaque rupture, underlying acute coronary syndromes.3 VCAM-1 supports the adhesion of mononuclear leukocytes, including monocytes and lymphocytes, in simple in vitro assays. 4 It is expressed on the surface of endothelial cells during atherogenesis in animal models and is also detectable in human atherosclerotic lesions. 4,5 The expression of VCAM-1 in human atherosclerotic plaques appears to be correlated with increased accumulation of mononuclear cells.