As an analog to the endothelium situated next to the vascular smooth muscle, the epithelium is emerging as an important regulator of smooth muscle contraction in many vital organs/tissues by interacting with other cell types and releasing epithelium-derived factors, among which prostaglandins have been demonstrated to play a versatile role in governing smooth muscle contraction essential to the physiological and pathophysiological processes in a wide range of organ systems. As widely distributed throughout the body, including the blood vessels, airways, gastrointestinal, urinary, and reproductive tracts, smooth muscles have a variety of critical functions such as controlling blood pressure, respiration, and gastrointestinal peristalsis. Abnormality in smooth muscle contractility results in various disorders and diseases including hypertension, asthma, and dyspepsia (89, 95,179). Therefore, smooth muscle contraction is tightly regulated. Apart from the long-recognized regulation by neurotransmitters released from the innervating nerve endings or hormones from the blood stream nearby (66), smooth muscle contraction has been known, for over three decades, to be regulated by the endothelium lining the blood vessels with nitric oxide (NO) as the most important endothelial-derived factor (51, 121). Over recent decades, evidence has also been accumulated indicating an important role of the epithelium, the cell layer lining the luminal surface of many organs or tracts, such as the trachea/bronchus, stomach, intestine, bladder, and reproductive organs, in the regulation of smooth muscle contraction, with a number of epithelium-derived factors identified. However, the importance of the epithelium in regulating smooth muscle tones has not been adequately appreciated. In this review, we will examine the evidence collected from a number of organ systems and hope to provide a clearer picture as to how the epithelium acts as an indispensable regulator of smooth muscle contraction, with epithelium-derived prostaglandins (PGs) as the key mediators, participating in many vital physiological processes as well as the pathogenesis of many diseases.