ABSTRACT. Normal pulmonary arterial development in the relatively hypoxic intrauterine environment and pulmonary arterial remodeling in hypoxic infants include extension of the smooth muscle layer into normally nonmuscular arteries and thickening of the arterial media in the muscular arteries. These changes require proliferation of immature smooth muscle cells or differentiation of smooth muscle cell precursors. Because the mechanisms that regulate these processes have not been clearly defined, we asked whether decreased oxygen tensions could promote either hyperplasia or hypertrophy of smooth muscle cell precursors in vitro. We have studied cells that proliferate and migrate out of explants from the media of the pulmonary arteries of near-term bovine fetuses, because these cells are representative of those that are involved in normal arterial development and possibly also in arterial remodeling. Decreases in oxygen tension within and below the physiologic range do not cause hyperplasia or hypertrophy of these cells. Instead, cell proliferation decreased at oxygen tensions below 60 mm Hg. The effects of hypoxia on proliferation of aortic and pulmonary arterial smooth muscle cells were identical, but effects on proliferation of dermal fibroblasts and endothelial cells were smaller in magnitude and evident only at lower oxygen tensions. These findings suggest that hypoxia does not act directly on smooth muscle cells to produce increased quantities of these cells in the pulmonary arteries during normal prenatal development or during remodeling of the pulmonary arteries of the hypoxic neonate, implying that other factors mediate these phenomena. (Pediatr Res 20: 966-972, 1986) man infants (5-7). The proximal muscular arteries are remodeled by thickening of the tunica media, which may be caused by hypertrophy of medial smooth muscle cells (6), increased abundance of extracellular matrix (3), proliferation of SMC, and/or differentiation of their precursors (I). The peripheral nonmuscular and partially muscular arteries are remodeled by appearance of new smooth muscle in those vessels (I, 2, 4), a process that requires proliferation of SMC or their precursors. Proliferation and peripheral extension of the SMC in the media of the pulmonary arteries is also prominent in normal prenatal development (8, 9), and it has been suggested that the relative hypoxia of the intrauterine environment may be an important stimulus for this process (9).The mechanisms that regulate proliferation and differentiation of SMC or their precursors in the fetus and newborn are unknown. Proliferation could be accelerated by hypoxia itself, as has been reported for fibroblasts (10, II), chondrocytes (12), and embryonic myocardial cells (13). We have examined the effects of oxygen tension on proliferation of SMC cultured from the pulmonary arteries of near-term bovine fetuses. At oxygen tensions within and below the physiologic range, lower oxygen tensions were associated with reduced proliferation of these cells, and cellular hypertrophy was ...