Atherosclerosis is one of the most prevalent fatal diseases in Western societies, and results from an intricate interplay between diverse factors such as lipid metabolism, blood coagulation elements, cytokines, hemodynamic stress, and behavioral risk factors. Atherosclerotic lesions are characterized by the infiltration of immune competent cells such as macrophages and T-lymphocytes, the proliferation of intimal cells of the arterial wall, the accumulation of lipids and the deposition of extracellular matrix components. For some years, endothelial cells, smooth muscle cells, and macrophages have been accorded crucial roles in the process of atherosclerosis. The mechanisms by which these cells contribute to atherosclerosis include augmented expression of adhesion molecules, as well as secretion of proinflammatory cytokines, matrix metalloproteinases, and tissue factor within human and experimental atheroma. Much evidence supports the role of tissue factor in inciting the thrombosis that causes most acute coronary syndromes. Macrophage content and expression of tissue factor correlate with rupture and instability of the atherosclerotic plaque. Matrix metalloproteinases can digest the plaque's extracellular matrix, and thus impair its stability. Plaque rupture exposes circulating blood components to the tissue factor-rich lipid-core, inciting thrombosis. Despite the increasing appreciation that atherogenesis involves participation of inflammatory pathways within cellular interactions, mediators of local communication between the major cell types within atherosclerotic plaques remain incompletely defined. By early appearance, activated T-cells may act as the orchestrator of atherogenesis. Both soluble and contact-dependent mediators from T-cells may be crucial in the development of this prevalent disease. Recent reports have helped explain some of these questions by pointing to a role of contact dependent interaction between CD40 and CD40 ligand (CD40L, renamed CD154) as a stimulus for atheroma-associated cells. We and others have recently showed that activated T-lymphocytes within the atherosclerotic vessel wall express the CD40 ligand surface molecule, known to play a major role in several immunological pathways. In addition to activated T-lymphocytes, functional CD40 and CD40L are coexpressed by human vascular endothelial cells, smooth muscle cells and human macrophages in vitro as well as in situ in human atherosclerotic lesions. Recent studies indicate that CD40L activates atheroma-associated cells by promoting the expression of molecules thought to be involved in atherosclerosis, such as adhesion molecules, cytokines, matrix metalloproteinases, and tissue factor. Thus, CD40 ligation on these vascular wall cells may promote mononuclear cell recruitment, participate in the weakening of the plaque and set the stage for thrombosis, mechanisms of crucial importance in the process of atherosclerosis. The involvement of the CD40 signaling pathway may play major roles during atherogenesis by regulating antigen-specific T-cell responses to yield activation instead of tolerance, and the presence of functional CD40L on non-leukocytic cells associated with atherosclerotic lesion indicates a novel T-cell-independent route of inflammatory activation, a now well recognized component of atherogenesis. These findings establish a possible crucial role for CD40-CD40L interactions in a prevalent human disease. (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.
