Background-Mild oxidation of LDL enhances its atherogenic potential and induces a synergistic interaction with serotonin (5HT) on vascular smooth muscle cell (VSMC) proliferation. Because of its complex chemical nature, the mitogenic components of mildly oxidized LDL (moxLDL) remain unclear. , and 5HT stimulated DNA synthesis in a dose-dependent manner. MoxLDL had a maximal stimulatory effect at a concentration of 5 g/mL (211%), LPC at 15 mol/L (156%), H 2 O 2 at 5 mol/L (179%), and 5HT at 50 mol/L (205%). Added together, moxLDL (50 ng/mL) and 5HT (50 mol/L) synergistically increased DNA synthesis (443%). Coincubation of LPC (1 mol/L) with H 2 O 2 (0.5 mol/L) and 5HT (5 mol/L) resulted in a synergistic increase in DNA synthesis (439%), which was nearly equal to that of moxLDL with 5HT (443%). The combined effects of LPC, H 2 O 2 , and 5HT on DNA synthesis were completely reversed by the combined use of an antioxidant, N-acetylcysteine (400 mol/L) or butylated hydroxytoluene (20 mol/L), with a 5HT 2 receptor antagonist, LY281067 (10 g/mL). Conclusions-Our results suggest that both LPC and reactive oxygen species may contribute to the mitogenic effect of moxLDL on VSMCs and its synergistic effect with 5HT.