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Thus, by promoting intimal hyperplasia, these vascular disorders (which are related to smooth muscle cell proliferation, collagen accumulation, and the extracellular matrix modification that may result from homocysteinylation of the vascular wall structure leading to connective tissue deterioration) might contribute to the atherogenic tendency of hyperhomocysteinemia

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The activation of the costimulatory receptor CD28 induces PDE4, resulting in the hydrolysis of cAMP, the induction of NF-B, activator protein-1 (AP-1) and NFAT, as well as the activation and proliferation of T cells