Abstract. HLA class I ligation on graft endothelial cells (EC) has been shown to promote graft arteriosclerosis and chronic allograft nephropathy. This study investigated transcriptional and functional changes mediated by anti-HLA antibodies (Ab), developed by transplant recipient, on vascular renal EC. For mimicking interactions that occur between alloantibodies and graft endothelium, HLA-typed primary cultures of human EC were incubated in vitro in the presence of monomorphic or polymorphic anti-HLA class I Ab. Gene expression analysis identified the upregulation of several molecules involved in cell signaling and proliferation, including the GTP-binding protein RhoA. It was demonstrated further that HLA class I ligation on EC induced a rapid translocation of RhoA to the cell membrane associated with F-actin stress fiber formation and cytoskeleton reorganization. Western blot analysis showed that anti-HLA class I Ab induced, in addition to RhoA, the activation of phosphatidylinositol 3-kinase, reflected by the phosphorylation of Akt (Ser473) and GSK3 (Ser9), in EC. C3 exoenzyme, an inhibitor of RhoA, inhibited RhoA translocation in response to HLA class I ligation and reduced phosphatidylinositol 3-kinase activation. EC proliferation and cell cycle progression, examined by 5,6-carboxyfluorescein diacetate succinimidyl ester staining, demonstrated that anti-HLA-induced EC proliferation was efficiently prevented by the 3-hydroxy-3-methylglutaryl CoA reductase inhibitor simvastatin (0.1 mol/L) through inhibition of RhoA geranylgeranylation. Taken together, these findings support the conclusion that RhoA is a key mediator of signaling pathways that lead to cytoskeletal reorganization and EC proliferation in response to alloantibodies that bind to HLA class I and demonstrate the specific and potent inhibitory effect of simvastatin on allostimulated EC growth.Chronic allograft nephropathy is the major factor limiting long-term survival of renal allografts (1,2). The hallmark of chronic allograft nephropathy is transplant arteriosclerosis, which is characterized by the intimal proliferation of endothelial cells (EC), smooth muscle cells (SMC), and fibroblasts, leading to vessel obstruction and ischemia that causes late graft failure (3). Several risk factors have been identified, including both immune injury to transplant vessels and nonimmunological factors (e.g., ischemia/reperfusion, hypertension, hyperlipidemia). The immunologic mechanisms that induce chronic allograft nephropathy are poorly understood, but it is suspected that the associated vascular changes are a result of early injury to the endothelium of the graft mediated by allogeneic T cells and anti-HLA alloantibodies (2). The incidence of transplant arteriosclerosis is increased in transplant recipients who produce anti-donor HLA antibodies (Ab) after transplantation, suggesting that anti-HLA Ab play a role in the pathogenesis of the disease (4,5). In previous studies, it has been shown that anti-HLA Ab, developed by transplant recipients after trans...