Abstract-MCAT elements are located in the promoter-enhancer regions of cardiac, smooth, and skeletal muscle-specific genes including cardiac troponin T, -myosin heavy chain, smooth muscle ␣-actin, and skeletal ␣-actin, and play a key role in the regulation of these genes during muscle development and disease. The binding factors of MCAT elements are members of the transcriptional enhancer factor-1 (TEF-1) family. However, it has not been fully understood how these transcription factors confer cell-specific expression in muscle, because their expression patterns are relatively broad. Results of recent studies revealed multiple mechanisms whereby TEF-1 family members control MCAT element-dependent muscle-specific gene expression, including posttranslational modifications of TEF-1 family members, the presence of muscle-selective TEF-1 cofactors, and cell-selective control of TEF-1 accessibility to MCAT elements. In addition, of particular interest, recent studies regarding MCAT element-dependent transcription of the myocardin gene and the smooth muscle ␣-actin gene in muscle provide evidence for the transcriptional diversity among distinct cell types and subtypes. This article summarizes the role of MCAT elements and the TEF-1 family of transcription factors in muscle development and disease, and reviews recent progress in our understanding of the transcriptional regulatory mechanisms involved in MCAT element-dependent muscle-specific gene expression. Key Words: transcriptional enhancer factor-1 Ⅲ MCAT element Ⅲ cardiac muscle Ⅲ smooth muscle Ⅲ skeletal muscle Ⅲ myofibroblasts C ardiovascular disease is the leading cause of mortality in the world according to the World Health Report from the World Health Organization. For the advancement of therapeutic and preventive approaches, it is important to understand the mechanisms whereby the genes specifically expressed in the heart and the vasculature are controlled under physiological and pathological conditions. Identification of signaling pathways and molecules that activate these genes will provide insights regarding the pathophysiology of cardiovascular disease, and elucidation of cell type-specific DNA cis-elements in the cardiovascular system may shed light on therapeutic gene delivery into these tissues.Cardiomyocytes and vascular smooth muscle cells (SMCs) are the major components of the cardiovascular system. Transcription of cell-specific genes in these cell types has been shown to be regulated by multiple cis-elements and their cognate transcription factors, including CArG elements and serum response factor (SRF)/myocardin, E-boxes and the basic Helix-Loop-Helix proteins, AT-rich elements and the myocyte enhancer factor-2 (MEF2) family members, GATA factors, homeodomain proteins, and Krüppel-like factors. 1,2 In addition, MCAT elements and their trans-binding factors, the transcriptional enhancer factor-1 (TEF-1) family of transcription factors, have also been recognized as critical regulators of multiple cardiac and smooth muscle-specific genes during cardi...