Endothelin-1 is a potent vasoactive peptide that occurs in chronically high levels in humans with pulmonary hypertension and in animal models of the disease. Recently, the unfolded protein response was implicated in a variety of diseases, including pulmonary hypertension. In addition, evidence is increasing for pathological, persistent inflammation in the pathobiology of this disease. We investigated whether endothelin-1 might engage the unfolded protein response and thus link inflammation and the production of hyaluronic acid by pulmonary artery smooth muscle cells. Using immunoblot, real-time PCR, immunofluorescence, and luciferase assays, we found that endothelin-1 induces both a transcriptional and posttranslational activation of the three major arms of the unfolded protein response. The pharmacologic blockade of endothelin A receptors, but not endothelin B receptors, attenuated the observed release, as did a pharmacologic blockade of extracellular signal-regulated kinases 1 and 2 (ERK-1/2) signaling. Using short hairpin RNA and ELISA, we observed that the release by pulmonary artery smooth muscle cells of inflammatory modulators, including hyaluronic acid, is associated with endothelin-1-induced ERK-1/2 phosphorylation and the unfolded protein response. Furthermore, the synthesis of hyaluronic acid induced by endothelin-1 is permissive for persistent THP-1 monocyte binding. These results suggest that endothelin-1, in part because it induces the unfolded protein response in pulmonary artery smooth muscle cells, triggers proinflammatory processes that likely contribute to vascular remodeling in pulmonary hypertension.Keywords: unfolded protein response; endothelin; pulmonary artery smooth muscle; hyaluronic acid; inflammation Pulmonary hypertension (PH) is a disease characterized by extensive pulmonary vascular remodeling, present along the entire length of the vascular tree (1). Eventually, the increased impedance to flow causes right heart failure and death (2). Evidence is mounting that the recruitment of inflammatory cells and the development of persistent inflammation are key components of the pathological vascular remodeling observed in PH (3). In patients with idiopathic PH, macrophages and lymphocytes are found in bronchovascular locations and in occlusive neointimal lesions, and express a panoply of chemokines including CCL2, CCL5, and CX3CL1 (4-7). Concentrations of proinflammatory cytokines, including IL-1 and IL-6, are elevated in both human idiopathic pulmonary artery hypertension (PAH) (8) and in the monocrotaline (MCT) model of PH (9, 10). Depletion of the circulating pool of macrophages is sufficient to prevent hypoxia-driven PH (11), and dexamethasone treatment reverses MCT PH (12). Taken together, these studies suggest that PH is a syndrome characterized by the complex disturbance of innate and acquired immune cells, and of mediators and effectors of inflammation.Building on studies that pointed to the importance of extracellular matrix metabolism in pulmonary vessel homeostasis (13,14), rec...