['Human atherosclerotic lesions overexpress elastolytic and collagenolytic cathepsins with unclear pathological implications. The aim of this study was to investigate the relationship among expression of cathepsin L, macrophage apoptosis in coronary artery disease (CAD) patients, clinical symptoms and plaque severity of human carotid atheroma.', 'Quantitative immunohistochemical analysis of human carotid atherosclerotic lesions (n=49) showed that expression of lysosomal cathepsin L was significantly increased in atherosclerotic plaques with formation of the necrotic core and rupture of the cap. In those plaques, cathepsin L was associated mainly with CD68-positive macrophages, whereas significant lower levels of smooth muscle cell actin were detected. The expression of cathepsin L in these plaques was also correlated with apoptosis and the stress protein ferritin. Plaques from symptomatic patients showed greater increased levels of cathepsin L than those from asymptomatic patients. Human monocyte-derived macrophages from CAD patients (n=7) showed significantly higher levels of cathepsin L, cellular lipids and apoptosis versus cells from matched healthy donors (n=7). 7Beta-hydroxycholesterol significantly enhanced cathepsin L in cells from healthy donors but not in cells from CAD patients. Moreover, macrophage apoptosis was significantly correlated with expression of cathepsin L in cell nuclei and membranes.'] Is cathepsin L significantly associated with apoptosis and plaque destabilization in human atherosclerosis?