Inhibition of N-cadherin retards smooth muscle cell migration and intimal thickening via induction of apoptosis

Objectives: Inhibition of vascular smooth muscle cell (VSMC) migration is a potential strategy for reducing intimal thickening during in-stent restenosis and vein graft failure. In this study, we examined the effect of disrupting the function of the VSMC adhesion molecule, N-cadherin, using antagonists, neutralizing antibodies, and a dominant negative, on VSMC migration and intimal thickening. Migration was assessed by the scratch-wound assay of human saphenous vein VSMCs and in a human saphenous vein ex vivo organ culture model of intimal thickening. Results: Inhibition of cadherin function using a pan-cadherin antagonist, significantly reduced migration by 53% +/- 8% compared with the control peptide (n = 3; P < .05). Furthermore, inhibition of N-cadherin function with an N-cadherin antagonist, neutralizing antibodies, and adenoviral expression of dominant negative N-cadherin (RAd dn-N-cadherin), significantly reduced migration by 31% +/- 2%, 23% +/- 1% and 32% +/- 7% compared with controls, respectively (n = 3; P < .05). Inhibition of cadherin function significantly increased apoptosis by between 1.5- and 3.3-fold at the wound edge. In an ex vivo model of intimal thickening, inhibition of N-cadherin function by infection of human saphenous vein segments with RAd dn-N-cadherin significantly reduced VSMC migration by 55% and increased VSMC apoptosis by 2.7-fold. As a result, intimal thickening was significantly suppressed by 54% +/- 14%. Importantly, there was no detrimental effect of dn-N-cadherin on endothelial coverage; in fact, it was significantly increased, as was survival of cultured human saphenous vein endothelial cells. Conclusions: Under the condition of this study, cell-cell adhesion mediated by N-cadherin regulates VSMC migration via modulation of viability. Interestingly, inhibition of N-cadherin function significantly retards intimal thickening via inhibition of VSMC migration and promotion of endothelial cell survival. We suggest that disruption of N-cadherin-mediated cell-cell contacts is a potential strategy for reducing VSMC migration and intimal thickening. (J Vase Surg 2010;52:1301-9.) Clinical Relevance: Intimal thickening occurs in a large number of coronary artery vein grafts, lower extremity vein grafts, and stented arteries and is therefore a significant clinical problem. Intimal thickening is caused by migration of vascular smooth muscle cells (VSMC) from the intima to the media where they proliferate. In this study, we have shown that inhibition of the function of N-cadherin (a cell-cell contact protein) significantly retards VSMC migration and intimal thickening, while promoting endothelial coverage, and may therefore be clinically useful for treating intimal thickening.