Objectives-We performed a detailed kinetic analysis in a rat balloon injury model to clarify the essential roles of ␣v3 integrin and endothelial cell (EC) regeneration in neointima formation. Using this model, we evaluated the antistenotic effect of Dainippon compound BS-1417, a novel ␣v3 integrin antagonist. Methods and Results-Kinetic analysis using RT-PCR showed that ␣v3 integrin-related genes are upregulated before neointima formation. Morphological and functional analyses revealed that EC regeneration requires Ͼ4 weeks after injury, and that recovery of EC normal function coincides with the arrest of neointima formation. Subcutaneous infusion of BS-1417 for 2, 4, 7, or 12 weeks after injury potently inhibited neointima formation without affecting EC regeneration. Although withdrawal of treatment with BS-1417 after short-term administration after injury resulted in catch-up growth of neointima, a long-term study suggested that this catch-up growth can be prevented by continuous administration of BS-1417 until EC regeneration. Conclusion-We clarified that ␣v3 integrin and EC regeneration play an essential role in neointima formation, and that continuous administration of BS-1417 potently and stably inhibits neointima formation without affecting EC regeneration. These findings suggest that BS-1417 might be useful as a novel systemic drug for the treatment of restenosis. 3,4 It is also known that regeneration of endothelial cells (ECs) plays an important role in preventing SMC proliferation. 5,6 Given systemically, numerous single molecule drugs for the prevention of neointima formation in animal models have been reported. 7 However, these drugs have shown only short-term efficacy in animal models 7 and no promising result in clinical trials. 7,8 See page 1309 ␣v3 integrin, also called vitronectin receptor, is expressed on a variety of cell types, 9 including SMCs and ECs, and it is known to mediate migration or proliferation of certain cells in disease states, including SMCs in restenosis after vascular injury, 10 and ECs and SMCs in angiogenesis. 11 Although many cyclic peptide and nonpeptide ␣v3 integrin antagonists have been reported, 12,13 only a few have been shown to potently inhibit neointima formation in rat models.In preliminary in vitro studies aimed at finding selective inhibitors of SMC proliferation, we found a series of ␣v3 integrin antagonists that inhibit SMC proliferation without affecting EC proliferation. Based on this finding and the results of a previous study showing that small-molecule ␣v3 integrin antagonists effectively inhibit neointima formation in rats, 14 we focused our efforts on ␣v3 integrin antagonists and recently found a new series of promising phenylpiperazine-based ␣v3 integrin antagonists. 15 Extensive screening of these novel antagonists using a rat balloon injury model led us to the discovery of BS-1417 ( Figure I, available online at http://atvb.ahajournals.org) as a suitable candidate for further development. 15 In the present study, we first performed a deta...