Apoptosis or proliferation of vascular smooth muscle cells (VSMCs) within atherosclerotic plaques is either beneficial or detrimental to lesion development and depends on the stage and localisation of lesions.Tumour necrosis factor (TNF)-related apoptosis inducing ligand (TRAIL) is expressed by a variety of cells, whose major role has traditionally been the induction of apoptosis.Recently we showed that failed aortocoronary saphenous vein bypass grafts express TRAIL in VSMCs, co-localising to regions of proliferation and increased insulin-like growth factor receptor-1 (IGF 1 R) expression-a potent anti-apoptotic growth factor receptor for VSMC.We also demonstrated that TRAIL plays a pro survival and pro-proliferative role in VSMCs (J Biol Chem 2008.283(12):7754-62) via an NFκB-dependent manner.