Abstract-Heparin has growth inhibitory effects on pulmonary artery smooth muscle cell (PASMC) in vitro and in vivo.However, the mechanism has not been fully defined. In this study, we investigated the role of cyclin-dependent kinase inhibitors, p21 WAF1/cip1 (p21) and p27 Kip1 (p27), in the inhibitory effect of heparin on PASMC proliferation in vitro and on hypoxia-induced pulmonary hypertension in vivo using p21 and p27-null mice. In vitro, loss of the p27 gene negated the inhibitory effect of heparin on PASMC proliferation, but p21 was not critical for this inhibition. In vivo, heparin significantly inhibited the development of hypoxia-induced pulmonary hypertension and remodeling, as evidenced by decreased right ventricular systolic pressure, ratio of right ventricular weight to left ventricle plus septum weight, and percent wall thickness of pulmonary artery, in p21 ϩ/ϩ , p21 Ϫ/Ϫ , p27 ϩ/ϩ , and p27 ϩ/Ϫ , but not in p27 Ϫ/Ϫ mice. We also observed that hypoxia decreased p27 expression significantly in mouse lung, which was restored by heparin. Heparin inhibited Ki67 proliferative index in terminal bronchial vessel walls in p27 ϩ/ϩ and p27 ϩ/Ϫ , but not in p27 Ϫ/Ϫ mice exposed to hypoxia. Therefore, we conclude that the cyclin-dependent kinase inhibitor p27, but not p21, is required for the inhibition of hypoxic pulmonary vascular remodeling by heparin. Kip1 Ⅲ p21 WAF1/cip1 Ⅲ heparin Ⅲ pulmonary hypertension Ⅲ hypoxia Ⅲ mouse H eparin, a glycosaminoglycan, has been used as an anticoagulant for more than 50 years. 1 Besides anticoagulation, heparin has a variety of other biological activities, such as regulation of lipid metabolism, control of cell attachment to various proteins in the extracellular matrix, binding with acid and basic fibroblast growth factors, and inhibition of vascular smooth muscle cell (SMC) proliferation. 2 An important pathological feature of pulmonary hypertension is increased medial thickening of the pulmonary artery attributable to hypertrophy and hyperplasia of pulmonary artery SMC (PASMC). 3,4 Our previous studies have shown that antiproliferative heparins significantly inhibit pulmonary vascular remodeling induced by hypoxia in rodents 5-7 and PASMC proliferation in culture. 8 -10 Other investigators also have reported that heparin inhibits PASMC proliferation in vitro and in vivo. 8,11 To date, however, the mechanism by which heparin inhibits PASMC proliferation has not been elucidated.The balance between cell proliferation and cell quiescence is regulated by a variety of cell cycle modulators. Cyclindependent kinase (CDK) is a major regulator of the transition between the phases of the cell cycle. 12 Cyclin/CDK complexes are composed of a regulatory subunit, cyclin, and an active kinase subunit, CDK. The cyclin/CDK complexes are controlled by both positive and negative regulators. 13 p21 WAF1/cip1