Background-Receptor binding of complement C5a leads to proinflammatory activation of many cell types, but the role of receptor-mediated action during arterial remodeling after injury has not been studied. In the present study, we examined the contribution of the C5a receptor (C5aR) to neointima formation in apolipoprotein E-deficient mice employing a C5aR antagonist (C5aRA) and a C5aR-blocking monoclonal antibody. Methods and Results-Mice fed an atherogenic diet were subjected to wire-induced endothelial denudation of the carotid artery and treated with C5aRA and anti-C5aR-blocking monoclonal antibody or vehicle control. Compared with controls, neointima formation was significantly reduced in mice receiving C5aRA or anti-C5aR-blocking monoclonal antibody for 1 week but not for 3 weeks, attributable to an increased content of vascular smooth muscle cells, whereas a marked decrease in monocyte and neutrophil content was associated with reduced vascular cell adhesion molecule-1. As assessed by immunohistochemistry, reverse transcription polymerase chain reaction, and flow cytometry, C5aR was expressed in lesional and cultured vascular smooth muscle cells, upregulated by injury or tumor necrosis factor-␣, and reduced by C5aRA. Plasma levels and neointimal plasminogen activator inhibitor-1 peaked 1 week after injury and were downregulated in C5aRA-treated mice. In vitro, C5a induced plasminogen activator inhibitor-1 expression in endothelial cells and vascular smooth muscle cells in a C5aRA-dependent manner, possibly accounting for higher vascular smooth muscle cell immigration. Conclusions-One-week treatment with C5aRA or anti-C5aR-blocking monoclonal antibody limited neointimal hyperplasia and inflammatory cell content and was associated with reduced vascular cell adhesion molecule-1 expression. 3 and adverse cardiovascular events have been correlated with C5a plasma levels. 4 C5a is a potent soluble anaphylotoxic and chemotactic inflammatory mediator promoting the recruitment and activation of neutrophils and monocytes. 5 C5a specifically binds to its receptor C5aR (also named CD88), a rhodopsin-type receptor expressed in various cell types. In addition to immune cells (neutrophils, eosinophils, basophils, monocytes/macrophages, mast cells, dendritic cells, and T cells), C5aR has also been detected in nonimmune cells, including neuronal and endothelial cells (ECs), and in different tissues (lung, kidney, liver, spleen, intestine, skin, and heart). 6 Binding of C5a to C5aR leads to cellular activation, including adhesion and chemotaxis. 7 Enhanced surface and messenger RNA (mRNA) expression of C5aR was found in microvascular ECs after exposure to lipopolysaccharide, interferon-␥, and interleukin-6, concomitant with an upregulation of macrophage-inflammatory protein-2/ CXCL2 and macrophage chemoattractant protein-1/CCL2. 8 Stimulation of ECs with C5a increases the gene expression of adhesion molecules, 9,10 cytokines, chemokines, and related receptors. 9,11 Clinical Perspective on p 1036In C5aR-deficient mice, IgG...