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Venous bypass grafts often fail following arterial implantation due to excessive smooth muscle cells (VSMC) proliferation and consequent intimal hyperplasia (IH). Intercellular communication mediated by Connexins (Cx) regulates differentiation, growth and proliferation in various cell types. Microarray analysis of vein grafts in a model of bilateral rabbit jugular vein graft revealed Cx43 as an early upregulated gene. Additional experiments conducted using an  ex-vivo  human saphenous veins perfusion system (EVPS) confirmed that Cx43 was rapidly increased in human veins subjected  ex-vivo  to arterial hemodynamics. Cx43 knock-down by RNA interference, or adenoviral-mediated overexpression, respectively inhibited or stimulated the proliferation of primary human VSMC  in vitro . Furthermore, Cx blockade with carbenoxolone or the specific Cx43 inhibitory peptide  43 gap26 prevented the burst in myointimal proliferation and IH formation in human saphenous veins. Our data demonstrated that Cx43 controls proliferation and the formation of IH after arterial engraftment.

Connexin43 Inhibition Prevents Human Vein Grafts Intimal Hyperplasia