Vascular Smooth Muscle Cells in Atherosclerosis

Abstract

The historical view of vascular smooth muscle cells (VSMCs) in atherosclerosis is that aberrant proliferation of VSMCs promotes plaque formation, but that VSMCs in advanced plaques are entirely beneficial, for example preventing rupture of the fibrous cap. However, this view has been based on ideas that there is a homogenous population of VSMCs within the plaque, that can be identified separate from other plaque cells (particularly macrophages) using standard VSMC and macrophage immunohistochemical markers. More recent genetic lineage tracing studies have shown that VSMC phenotypic switching results in less-differentiated forms that lack VSMC markers including macrophage-like cells, and this switching directly promotes atherosclerosis. In addition, VSMC proliferation may be beneficial throughout atherogenesis, and not just in advanced lesions, whereas VSMC apoptosis, cell senescence, and VSMC-derived macrophage-like cells may promote inflammation. We review the effect of embryological origin on VSMC behavior in atherosclerosis, the role, regulation and consequences of phenotypic switching, the evidence for different origins of VSMCs, and the role of individual processes that VSMCs undergo in atherosclerosis in regard to plaque formation and the structure of advanced lesions. We think there is now compelling evidence that a full understanding of VSMC behavior in atherosclerosis is critical to identify therapeutic targets to both prevent and treat atherosclerosis.

Keywords: atherosclerosis; extracellular matrix; interleukin; platelet-derived growth factor; smooth muscle.

Figure 1

Schematic summarizing the current knowledge of the identity and origins of VSMCs, macrophages, and putative derivatives of these cells within advanced atherosclerotic lesions. The solid lines illustrate known pathways that give rise to lesion cells whereas dotted lines with a “?” indicate putative pathways not yet directly validated in animal models or humans. (Illustration Credit: Ben Smith)

Figure 2

Schematic illustrating a number of processes that VSMCs undergo in advanced atherosclerotic plaques. (Illustration Credit: Ben Smith)