Diabetic nephropathy is the leading cause of end-stage renal disease. It is pathologically characterized by the accumulation of extracellular matrix in the mesangium, of which the main component is a1/a2 type IV collagen (Col4a1/a2). Recently, we identified Smad1 as a direct regulator of Col4a1/a2 under diabetic conditions in vitro. Here, we demonstrate that Smad1 plays a key role in diabetic nephropathy through bone morphogenetic protein 4 (BMP4) in vivo. Smad1-overexpressing mice (Smad1-Tg) were established, and diabetes was induced by streptozotocin. Nondiabetic Smad1-Tg did not exhibit histological changes in the kidney; however, the induction of diabetes resulted in an ∼1.5-fold greater mesangial expansion, consistent with an increase in glomerular phosphorylated Smad1. To address regulatory factors of Smad1, we determined that BMP4 and its receptor are increased in diabetic glomeruli and that diabetic Smad1-Tg and wild-type mice treated with a BMP4-neutralizing antibody exhibit decreased Smad1 phosphorylation and ∼40% less mesangial expansion than those treated with control IgG. Furthermore, heterozygous Smad1 knockout mice exhibit attenuated mesangial expansion in the diabetic condition. The data indicate that BMP4/Smad1 signaling is a critical cascade for the progression of mesangial expansion and that blocking this signal could be a novel therapeutic strategy for diabetic nephropathy.Diabetic nephropathy is a life-threatening complication of diabetes and the leading cause of end-stage renal disease (1). The structural features of diabetic nephropathy include thickening of the glomerular basement membrane (GBM) and mesangial matrix expansion (2,3). Mesangial matrix expansion is pathologically important because it leads to glomerulosclerosis accompanied by various tubulointerstitial damages and subsequent nephron loss (4,5). In addition, the severity of mesangial matrix expansion is clinically important because it is closely associated with the decline of the glomerular filtration rate (6).Mesangial matrix expansion is characterized by increased amounts of extracellular matrix (7), particularly a1/a2 type IV collagen (Col4a1/a2) (8). Although various peptides or growth factors are shown to mediate the regulation of this key component, the protein responsible for its direct regulation remains to be determined.Because various injuries of epithelial, endothelial, and mesangial cells converge on the accumulation of Col4a1/a2 in the mesangium, mesangial cells presumably play a central role for the regulation of Col4a1/a2, even if they are not the primary target of injury (9). Therefore, we attempted to elucidate the direct regulation of Col4a1/a2 under diabetic conditions and demonstrate that Smad1 can transcriptionally regulate Col4a1/a2 in the presence of advanced glycation end products in mesangial cells (10).Smad1 is an intracellular molecule originally cloned as a signal transducer of the transforming growth factor (TGF)-b superfamily (11). In response to these stimuli, Smad1 is phosphorylated at the COOH...