Apoptosis is a naturally occurring mechanism of cell death that plays
an important role in both normal and pathological remodeling of the ve
ssel wall. Abdominal aortic aneurysms (AAA) represent a unique and dra
matic example of vessel wall remodeling characterized by degeneration
of the elastic media. Although much attention has been focused on the
proteolytic mechanisms that underlie elastin and collagen degradation
in AAA, recent studies suggest that depletion of medial smooth muscle
cells (SMC) makes an important contribution to this disease by elimina
ting a cell population capable of directing connective tissue repair.
As described in this review, these investigations have revealed that S
MC depletion in human aneurysm tissues is accompanied by biochemical,
morphological and molecular changes consistent with SMC apoptosis. The
exact mechanisms responsible for SMC apoptosis in AAA remain to be el
ucidated, but current evidence indicates that elevated cellular produc
tion of p53 and p21 participates in the process. These findings provid
e an important new starting point for further investigations on the ce
llular and molecular mechanisms underlying SMC depletion in AAA and ho
w this process might trigger the accelerated progression of aneurysm d
isease. (C) Rapid Science Publishers. ISSN 0954-6928.