Mechanisms of monocyte recruitment in vascular repair after injury

The inflammatory response to acute vessel wall injury has been increasingly recognized to play a decisive role in neointima formation. In particular, the exuberant infiltration with monocytes aggravates neointimal growth and can thereby promote restenosis. The adhesion of circulating monocytes to the site of mechanical injury represents the key event in monocyte recruitment, and this review highlights recent insights into the molecular mechanisms of monocyte adhesion throughout the course of neointimal growth. An acute and a chronic phase of monocyte recruitment after vascular injury can be discerned. The adhesion of platelets to the denuded subendothelial matrix is the hallmark of the acute phase providing an adhesive substrate for monocytes, whereas chronic monocyte recruitment is regulated by the interaction with neointimal smooth muscle cells and recovering endothelial cells. Clearly, the mechanisms of monocyte rolling and adhesion differ considerably between these diverse substrates. This review is particularly focused on the contribution of chemokines and adhesion molecules to monocyte recruitment to injured vessels according to the different stages of neointimal growth, and on closely related functions of the chemokine-like molecule macrophage migration inhibitory factor. Understanding the complex molecular interactions of the injured vessel wall with circulating monocytes may enable therapeutic targeting to prevent the development of restenosis.