Does nitric oxide regulate smooth muscle cell proliferation? A critical appraisal

Smooth muscle proliferation is involved in the pathogenesis of atherosclerosis, restenosis after angioplasty and vein graft failure due to neointimal hyperplasia. Nitric oxide (NO) inhibits smooth muscle cell growth in vitro and experimental neointimal hyperplasia in vivo, suggesting a role for NO as a regulator of smooth muscle cell proliferation. NO is also involved in the control of numerous other vascular functions including platelet and inflammatory cell adhesion, vascular reactivity and endothelial permeability. This review critically examines the experimental and clinical evidence that supports a role for NO as a modulator of smooth muscle cell proliferation, with an emphasis on the multiple mechanisms by which NO acts on vascular lesions.