The multifaceted process of immune cell recruitment to sites of tissue injury is key to the development of an inflammatory response and involved in the pathogenesis of numerous cardiovascular disorders. We recently identified C-type natriuretic peptide (CNP) as an important endothelium-derived mediator that regulates vascular tone and protects against myocardial ischemia͞ reperfusion injury. Herein, we investigated whether CNP inhibits leukocyte recruitment and platelet aggregation and thereby exerts a potential antiinflammatory influence on the blood vessel wall. We assessed the effects of CNP on leukocyte-endothelial cell interactions in mouse mesenteric postcapillary venules in vivo in animals with high basal leukocyte activation (endothelial nitric oxide synthase knockout mice, eNOS ؊/؊ ) or under acute inflammatory conditions (induced by interleukin-1 or histamine). CNP suppressed basal leukocyte rolling in eNOS ؊/؊ mice in a rapid, reversible, and concentration-dependent manner. These effects of CNP were mimicked by the selective natriuretic peptide receptor-C agonist cANF 4 -23 . CNP also suppressed leukocyte rolling induced by IL-1 or histamine, inhibited platelet-leukocyte interactions, and prevented thrombin-induced platelet aggregation of human blood. Furthermore, analysis of human umbilical vein endothelial cells, leukocytes, and platelets revealed that CNP selectively attenuates expression of P-selectin. Thus, CNP is a modulator of acute inflammation in the blood vessel wall characterized by leukocyte and platelet activation. These antiinflammatory effects appear to be mediated, at least in part, via suppression of P-selectin expression. These observations suggest that endothelial CNP might maintain an anti-atherogenic influence on the blood vessel wall and represent a target for therapeutic intervention in inflammatory cardiovascular disorders.endothelium ͉ natriuretic peptide receptor type C ͉ atherosclerosis ͉ thrombosis L eukocyte recruitment and platelet activation at sites of tissue injury are important facets of an inflammatory response and are pivotal in the pathogenesis of a number of cardiovascular disorders including atherosclerosis and sepsis. These processes are triggered by specific inflammatory stimuli and are critically dependent on the expression of a series of adhesion molecules on the surface of leukocytes, platelets, and the vascular endothelium (1). However, this is a dynamic process; under basal (physiological) conditions, leukocyte and platelet activation is held in check by specific endothelium-derived mediators. Perhaps the most influential of these is nitric oxide (NO), which, in concert with analogous autacoids such as prostacyclin, maintains an active suppression of leukocyte and platelet activation under physiological conditions that is paramount for maintenance of blood vessel integrity and patency (2-4).The importance of NO in the prevention of leukocyte recruitment has been established by studies demonstrating increased leukocyte-endothelial interactions in animals ...