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Extensive Proliferation of a Subset of Differentiated, yet Plastic, Medial Vascular Smooth Muscle Cells Contributes to Neointimal Formation in Mouse Injury and Atherosclerosis Models
Open accessAbstract
Rationale: Vascular smooth muscle cell (VSMC) accumulation is a hallmark of atherosclerosis and vascular injury. However, fundamental aspects of proliferation and the phenotypic changes within individual VSMCs, which underlie vascular disease, remain unresolved. In particular, it is not known whether all VSMCs proliferate and display plasticity or whether individual cells can switch to multiple phenotypes. Objective: To assess whether proliferation and plasticity in disease is a general characteristic of VSMCs or a feature of a subset of cells. Methods and Results: Using multicolor lineage labeling, we demonstrate that VSMCs in injury-induced neointimal lesions and in atherosclerotic plaques are oligoclonal, derived from few expanding cells. Lineage tracing also revealed that the progeny of individual VSMCs contributes to both alpha smooth muscle actin (aSma)–positive fibrous cap and Mac3-expressing macrophage-like plaque core cells. Costaining for phenotypic markers further identified a double-positive aSma+ Mac3+ cell population, which is specific to VSMC-derived plaque cells. In contrast, VSMC-derived cells generating the neointima after vascular injury generally retained the expression of VSMC markers and the upregulation of Mac3 was less pronounced. Monochromatic regions in atherosclerotic plaques and injury-induced neointima did not contain VSMC-derived cells expressing a different fluorescent reporter protein, suggesting that proliferation-independent VSMC migration does not make a major contribution to VSMC accumulation in vascular disease. Conclusions: We demonstrate that extensive proliferation of a low proportion of highly plastic VSMCs results in the observed VSMC accumulation after injury and in atherosclerotic plaques. Therapeutic targeting of these hyperproliferating VSMCs might effectively reduce vascular disease without affecting vascular integrity.
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![Figure 1. Efficient and specific multicolor vascular smooth muscle cell (VSMC) labeling in Myh11-CreERt2/Rosa26-Confetti animals. A, Schematic representation of the Myh11-CreERt2 transgene and the Rosa26-Confetti reporter allele. B, Schematic representation illustrating tamoxifen-induced recombination at the Rosa26-Confetti locus, resulting in expression of 1 of 4 fluorescent proteins, which are stably propagated independent of Myh11 expression within progeny. C and D, Carotid artery cross sections from high density–labeled (C; 10× 1 mg tamoxifen) or low density–labeled (D; 1× 0.1 mg tamoxifen) animals; region outlined in (i) is magnified in (ii). Signals for fluorescent proteins are shown with (left) and without (right) nuclear DAPI (4',6-diamidino-2-phenylindole) staining (white). C, VSMCs, indicated by arrows in (ii), are labeled with red fluorescent protein (RFP), yellow fluorescent protein (YFP), nuclear (n) green fluorescent protein (GFP), or membrane-associated (m) cyan fluorescent protein (CFP), whereas cells within the adventitia and endothelium, indicated by arrow heads, are unlabeled. In (D[ii]), arrows point to the few labeled VSMCs, and open arrows point to unlabeled VSMCs within the media. Scale bars are 100 μm in (i) and 50 μm in (ii).](/paper-figures/4d5396293f304d1f922b1a4092734e02/extensive-proliferation-of-a-subset-of-differentiated-yet-plastic-medial-figure-1.jpg)
![Figure 2. Vascular smooth muscle cell (VSMC)–derived cells generate oligoclonal atherosclerotic plaques. A, Experimental protocol for the atherosclerosis studies. B and C, Arterial cryosections from high density–labeled animals (10× 1 mg tamoxifen) presenting plaques containing VSMC-derived cells of a single color (membrane-associated cyan fluorescent protein [CFP]; B) and >1 color (red fluorescent protein [RFP], membrane-associated CFP, and yellow fluorescent protein [YFP]; C). The region outlined in (i) is magnified in (ii). Scale bars are 150 μm (i) and 50 μm (ii). Signals for fluorescent proteins and nuclear DAPI (4',6-diamidino-2-phenylindole; in ii, white) are shown. D, Box plot showing the proportion of the total number of cells (DAPI), which express the Confetti reporter (Confetti+) within each plaque region (in 23 plaques from 6 animals). E, Bar chart showing the proportion of the total number of cells (DAPI), which express the Confetti reporter (Confetti+) within plaques for 6 individual animals (23 plaques from 6 animals). Mean across all animals is indicated by the orange bar, SD±0.16. F, Bar chart showing the number of colors observed per plaque (82 plaques from 16 animals). G, Bar chart showing the theoretical distribution of colors per plaque resulting from proliferation of 1, 2, 3, or 4 VSMCs labeled at the recombination frequency observed in high density–labeled animals. All data are from animals labeled at high density (10× 1 mg tamoxifen).](/paper-figures/075234726326418ea4cdba3305089a64/extensive-proliferation-of-a-subset-of-differentiated-yet-plastic-medial-figure-2.jpg)



![Figure 6. A subset of vascular smooth muscle cells (VSMCs) proliferate to form the injury-induced neointima. A, Experimental protocol for carotid artery ligation studies. B and C, Whole-mounted control right carotid artery (B) or ligated left carotid artery (C) from a high density–labeled animal (10× 1 mg tamoxifen) 28 days post surgery. Maximal projection of confocal Z-stack covering the entire artery is shown in (B) and (C[i]), whereas (C[ii] and C[iii]) show magnified longitudinal cross section of the regions outlined in (C[i]). D, Box plot showing the size of individual monochromatic patches. The patch sizes of low (blue circles) and medium density–labeled animals (orange crosses) largely fall within the interquartile range observed in high density–labeled animals (green crosses), strongly suggesting that patches result from clonal expansion of a single cell. Large patches (>1500 cells) might arise from merging of same colored clones. Fifty-two patches from 12 high density–labeled (10× 1 mg), 15 patches from 4 medium density–labeled (1× 1 mg), and 8 patches from 4 low density–labeled animals (1× 0.1 mg) were analyzed. E, Maximal confocal Z-stack projection of whole-mounted ligated left carotid artery from a low density–labeled animal (1× 0.1 mg tamoxifen), analyzed 28 days post ligation. Signals for fluorescent proteins are shown. All scale bars are 150 μm. CFP indicates cyan fluorescent protein; GFP, green fluorescent protein; RFP, red fluorescent protein; and YFP, yellow fluorescent protein.](/paper-figures/ced80622ebab434bb3aecce50a5a5afe/extensive-proliferation-of-a-subset-of-differentiated-yet-plastic-medial-figure-6.jpg)

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“Lineage tracing studies have unambiguously demonstrated that VSMCs contribute substantially to plaque formation in murine models of atherosclerosis, generating 30-70% of all plaque cells 11,18-20,22,23 .”
From Vascular smooth muscle cells in atherosclerosis (2019) · cites this paper as [20]
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“Within plaques a large proportion of reporter-expressing VSMC-derived cells do not have detectable levels of the contractile smooth muscle cell marker α SMA 11,20 .”
From Vascular smooth muscle cells in atherosclerosis (2019) · cites this paper as [20]
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“Instead, some plaque reporter-expressing cells were positive for Mac-3 20 , Lgals3 11 and CD68 17 - markers that have been previously used to study macrophages in atherosclerosis.”
From Vascular smooth muscle cells in atherosclerosis (2019) · cites this paper as [20]
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Metadata
- Authors
- Chappell, J., Harman, J. L., Narasimhan, V. M., Yu, H., Foote, K., Simons, B. D., Bennett, M. R., & Jørgensen, H. F.
- Affiliations
- Wellcome/MRC Cambridge Stem Cell Institute (GB)
- From the Cardiovascular Medicine Division, Department of Medicine (J.C., J.L.H., H.Y., K.F., M.R.B., H.F.J.), Cavendish Laboratory, Department of Physics (B.D.S.), The Wellcome Trust/Cancer Research UK Gurdon Institute (B.D.S.), and Wellcome Trust-Medical Research Council Stem Cell Institute (B.D.S.), University of Cambridge, United Kingdom; and The Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom (V.M.N.).
- Corresponding author
- Jørgensen, Helle F.
- ORCID
- Venue
- Circulation Research
- Published
- 2016-12-09
- Volume
- 119
- Issue
- 12
- Pages
- 1313-1323
- ISSN
- 0009-7330 (ISSN-L)
- 1524-4571
- PMC
- PMC5149073
- OpenAlex
- W2525459565
- Cited by
- 437
- References
- 32
- Citations by year
- 2026: 39 · 2025: 38 · 2024: 45 · 2023: 56 · 2022: 62 · 2021: 62 · 2020: 39 · 2019: 45 · 2018: 29 · 2017: 17 · 2016: 3
- FWCI
- 18.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- Circulation Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (cc-by)
- Funders
- Wellcome Trust (098357/Z/12/Z, 100574/Z/12/Z)
- British Heart Foundation (PG/13/25/30014, PG/16/11/32021, PG/12/86/29930, RM/13/3/30159, RG/13/14/30314, FS/15/38/31516, RE/13/6/30180)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Cardiovascular, Neuropeptides, and Oxidative Stress Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cerebrovascular and Carotid Artery Diseases
- Keywords
- vascular smooth muscle cells, vascular smooth muscle cell proliferation, phenotypic plasticity, intimal hyperplasia, atherosclerosis, atherosclerotic plaque, lineage tracing, alpha-smooth muscle actin, VSMC migration, vascular injury
- MeSH terms
- Animals, Disease Models, Animal, Mice, Inbred BALB C, Mice, Inbred C57BL, Mice, Transgenic, Muscle, Smooth, Vascular, Mice, Knockout, Myocytes, Smooth Muscle, Cell Proliferation, Atherosclerosis, Mice, Vascular System Injuries, Neointima
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