Abstract-We have found that 15-hydroxyeicosatetraenoic acid (15-HETE) induced by hypoxia was an important mediator in the regulation of hypoxic pulmonary hypertension, including the pulmonary vasoconstriction and remodeling. However, the underlying mechanisms of the remodeling induced by 15-HETE are poorly understood. In this study, we performed immunohistochemistry, pulmonary artery endothelial cells migration and tube formation, pulmonary artery smooth muscle cells bromodeoxyuridine incorporation, and cell cycle analysis to determine the role of 15-HETE in hypoxia-induced pulmonary vascular remodeling. We found that hypoxia induced pulmonary vascular medial hypertrophy and intimal endothelial cells migration and angiogenesis, which were mediated by 15-HETE. Moreover, 15-HETE regulated the cell cycle progression and made more smooth muscle cells from the G 0 /G 1 phase to the G 2 /MϩS phase and enhanced the microtubule formation in cell nucleus. In addition, we found that the Rho-kinase pathway was involved in 15-HETE-induced endothelial cells tube formation and migration and smooth muscle cell proliferation. Together, these results show that 15-HETE mediates hypoxia-induced pulmonary vascular remodeling and stimulates angiogenesis via the Rho-kinase pathway. (Hypertension. 2011;58:679-688.) • Online Data Supplement Key Words: pulmonary hypertension Ⅲ pulmonary vascular remodeling Ⅲ angiogenesis Ⅲ 15-hydroxyeicosatetraenoic acid Ⅲ ROCK P ulmonary hypertension (PH) is a refractory disease commonly associated with the high morbidity and mortality of adult and pediatric patients with various lung and heart diseases. 1,2 The mechanisms by which the pulmonary arteries in the pulmonary circulation narrow include pulmonary vasoconstriction, pulmonary vascular remodeling, and thrombosis in situ. 3,4 Vascular remodeling involves all 3 layers of the vascular wall and is complicated by the finding that cellular heterogeneity exists within the compartment of the pulmonary arterial wall. 3,5 However, the specific role and the interaction between each cell are poorly understood. Generally, pulmonary vascular remodeling includes endothelial angiogenesis, smooth muscle cell proliferation and hypertrophy, adventitial fibroblast proliferation, myofibroblast differentiation, and extracellular matrix deposition. Hypoxia is considered as the predominant factor in the pathogenesis of pulmonary hypertension (PH). 1,6 During the early period of hypoxic exposure, angiogenesis in the mature pulmonary circulation is a potentially beneficial adaptation for gas exchange. 6 The lung vascular homeostasis involves maintaining an ideal number of capillaries per unit of lung volume. However, the sustained chronic hypoxia leads to disorder of the process and excess angiogenesis, which would impose more pressure on the proximal pulmonary artery and complicate the course of PH, suggesting that excess angiogenesis is a crucial player in the pathogenesis of PH. 7 Rho-kinase (ROCK), a downstream target of the GTPase RhoA, has been involved in many p...