Abstract-Thrombin and factor Xa (FXa) are agonists for G protein-coupled receptors (GPRCs) and may contribute to vascular lesion formation by stimulating proliferation of vascular smooth muscle cells (SMCs). Mitogenic signaling of GPCRs requires transactivation of receptor tyrosine kinases (RTKs). In rat SMCs, thrombin transactivates the epidermal growth factor receptor (EGFR) via a pathway that involves heparin-binding EGF-like growth factor (HB-EGF) as ligand for EGFR. The purpose of this study was to investigate in human SMCs the role of receptor transactivation in the mitogenic response to thrombin and FXa. Thrombin (10 nmol/L) and FXa (100 nmol/L) cause a 3.3-and 2.6-fold increase in DNA synthesis, respectively. In human SMCs, neither thrombin nor FXa causes EGFR phosphorylation, and blockade of EGFR kinase does not inhibit DNA synthesis. However, DNA synthesis and phosphorylation of fibroblast growth factor receptor-1 (FGFR-1) induced by thrombin or FXa are inhibited by antibodies neutralizing basic fibroblast growth factor (bFGF) or by heparin. Hirudin inhibits thrombin-, but not FXa-induced mitogenesis, indicating that FXa acts independently of thrombin. We further demonstrate by ELISA that upon thrombin and FXa stimulation, bFGF is released and binds to the extracellular matrix. Our data suggest that in human vascular SMCs, both thrombin and FXa rapidly release bFGF into the pericellular matrix. This is followed by transactivation of the FGFR-1 and increased proliferation. Heparin may inhibit the mitogenic effects of thrombin and Key Words: thrombin Ⅲ factor Xa Ⅲ basic fibroblast growth factor Ⅲ fibroblast growth factor receptor-1 Ⅲ epidermal growth factor receptor V ascular smooth muscle cell (SMC) proliferation and migration are key events in atherosclerosis and restenosis after vascular injury. 1,2 Mitogenic signaling of G proteincoupled receptors (GPCRs) involves transactivation of receptor tyrosine kinases (RTKs). 3 In several cell lines, it has been shown that the GPCR agonist thrombin mediates cell proliferation through transactivating the epidermal growth factor receptor (EGFR) via a metalloproteinase-mediated cleavage and release of pro-heparin binding EGF-like factor (HB-EGF), which then binds to EGFR. 3 We have shown that this mechanism is present in rat SMCs and is required for thrombin-induced migration. 4 Heparin, which inhibits SMC proliferation and migration in vivo and in vitro, 5-7 binds HB-EGF and interferes with this pathway. 4 We have investigated the possible role of receptor transactivation in the proliferation of human SMCs mediated by thrombin and the activated coagulation factor X (FXa). FXa is a serine protease that in addition to cleaving prothrombin activates thrombin receptors (protease-activated receptors, PARs), which are members of the GPCR family. 8 FXa acts as a thrombinindependent mitogen, 9,10 which is also sensitive to heparin inhibition. 11 In this study, we demonstrate that proliferation of human SMCs induced by thrombin and FXa does not involve EGFR transactivati...