In addition to inhibition of the Na-K ATPase, ouabain activates a signal transduction function, triggering growth and proliferation of cultured cells even at nanomolar concentrations. An isomer of ouabain (EO) circulates in mammalians at subnanomolar concentrations, and increased levels are associated with cardiac hypertrophy and hypertension. We present here a study of cardiac and renal hypertrophy induced by ouabain infused into rats for prolonged periods and relate this effect to the recently described ouabain-induced activation of the Src-EGFr-ERK signaling pathway. Ouabain infusion into rats (15 g/kg/day for 18 weeks) doubled plasma ouabain levels from 0.3 to 0.7 nM and increased blood pressure by 20 mm Hg (p < 0.001), cardiac left ventricle (؉11%, p < 0.05), and kidney weight (؉9%, p < 0.01). These effects in vivo are associated with a significant enrichment of ␣1, 1, ␥a Na-K ATPase subunits together with Src and EGFr in isolated renal caveolae membranes and activation of ERK1/2. In caveolae, direct Na-K ATPase/Src interactions can be demonstrated by co-immunoprecipitation. The interaction is amplified by ouabain, at a high affinity binding site, detectable in caveolae but not in total rat renal membranes. The high affinity site for ouabain is associated with Src-dependent tyrosine phosphorylation of rat ␣1 Na-K ATPase. The antihypertensive compound, PST 2238, antagonized all ouabain-induced effects at 10 g/kg/day in vivo or 10 ؊10 -10 ؊8 M in vitro. These findings provide a molecular mechanism for the in vivo pro-hypertrophic and hypertensinogenic activity of ouabain, or by analogy those of EO in humans. They also explain the pharmacological basis for PST 2238 treatment.Until recently, the main, if not unique, function ascribed to the integral membrane protein Na-K ATPase is the maintenance and regulation of the electrochemical gradient across the cell membrane in all tissues (1). Ouabain and other steroidal cardenolides (2) or bufadienolides (3) are considered to be the specific inhibitors of the Na-K ATPase activity. However, in recent years, several studies have indicated that Na-K ATPase can also act as a signal transducer in response to the interaction with its natural ligand ouabain (4). This finding originates mainly from studies carried out on cultured rat cardiomyocytes or renal tubular cells based on effects on cell growth and hypertrophy of ouabain in the micromolar range. At these rather high concentrations, which, however, do not seem to affect the bulk intracellular Na ϩ and Ca 2ϩ concentrations (5), ouabain activates: (a) tyrosine phosphorylation of the epidermal growth factor receptor (EGFr), 1 Src, and p42/44 mitogenactivated protein kinase (MAPKs) in both neonatal rat cardiac myocytes and A7r5 cells (4, 6); (b) the same signaling pathway within the cellular membrane microdomain of caveolae in isolated perfused rat heart (7); and (c) slow intracellular Ca 2ϩ oscillations in rat tubular cells that favor the association of Na-K ATPase with the inositol 1,4,5-trisphosphate receptor (InsP 3 ...