Background— Inflammation plays an important role in the response to endoluminal vascular injury. Estrogen (17β-estradiol, E₂) inhibits neointima formation in animal models, and the progestin medroxyprogesterone acetate (MPA) blocks this effect. This study tested the hypothesis that E₂ inhibits the migration of inflammatory cells, particularly granulocytes, into the rat carotid arteries after acute endoluminal injury and that MPA blocks this effect.

Methods and Results— Ovariectomized rats were randomly divided into subgroups and treated with E₂, MPA, E₂+MPA, or vehicle and subjected to balloon injury of the right carotid artery. After 1, 3, or 7 days, rats were euthanized, and carotid arteries (injured and control) were analyzed for inflammatory cells by flow cytometry. At 1 day, granulocytes (HIS48⁺ and CD45⁺), monocyte/macrophages (Mar1⁺ and CD45⁺), and T lymphocytes (CD3⁺ and CD45⁺) were increased 26-fold, 12-fold, and 3-fold, respectively, in injured compared with contralateral control arteries of vehicle-treated rats. Granulocytes and monocyte/macrophages decreased markedly by 3 days. E₂ reduced the granulocyte and monocyte/macrophage populations of injured vessels by ≈50% and increased T lymphocytes. MPA had no independent effect on inflammatory cells but completely blocked the effect of E₂. Immunohistochemical examination verified these findings and localized inflammatory cells to the adventitial and periadventitial domains of injured vessels.

Conclusions— E₂ may limit the neointimal response to endoluminal vascular injury, at least in part, by limiting leukocyte entry from adventitial/periadventitial tissues into injured vessels early in the injury response.