The growth of calcium oxalate monohydrate in the presence of Tamm-Horsfall protein (THP), osteopontin, and the 27-residue synthetic peptides (DDDS) 6 DDD and (DDDG) 6 DDD (D = aspartic acid, S = serine, and G = glycine) was investigated via in situ atomic force microscopy. The results show that these four growth modulators create extensive deposits on the crystal faces. Depending on the modulator and crystal face, these deposits can occur as discrete aggregates, filamentary structures, or uniform coatings. These proteinaceous films can lead to either the inhibition of or an increase in the step speeds (with respect to the impurity-free system), depending on a range of factors that include peptide or protein concentration, supersaturation, and ionic strength. While THP and the linear peptides act, respectively, to exclusively increase and inhibit growth on the " 101 ð Þface, both exhibit dual functionality on the (010) face, inhibiting growth at low supersaturation or high modulator concentration and accelerating growth at high supersaturation or low modulator concentration. Based on analyses of growth morphologies and dependencies of step speeds on supersaturation and protein or peptide concentration, we propose a picture of growth modulation that accounts for the observations in terms of the strength of binding to the surfaces and steps and the interplay of electrostatic and solvent-induced forces at the crystal surface.Keywords Biomineralization Á Crystal growth Á Kinetics Á Calcium oxalate monohydrate Á Tamm-Horsfall protein Á Scanning probe microscopy Á Kidney stones Á Osteopontin Although naturally occurring macromolecules in urine [1], such as osteopontin (OPN) and Tamm-Horsfall glycoprotein (THP), are believed to play an important role in controlling stone formation, a mechanistic understanding is missing. Numerous in vitro studies have shown that OPN strongly inhibits the nucleation and growth of calcium oxalate monohydrate-the most abundant mineral phase in urinary stones [2]. Stones are often found attached to epithelial cells and are typically aggregates of smaller crystals containing matrices of proteins, carbohydrates, and lipids [3]. A role for these macromolecular constituents in either promoting or inhibiting aggregation and/or attachment to cell membranes has been proposed [4,5]. Indeed, some in vitro studies have concluded that THP, which is the most common protein found in human urine [6] COM crystal growth [7,8] but acts to inhibit aggregation [9,10] or to limit the attachment of existing crystals to cell surfaces [11][12][13]. Others concluded that THP plays no role in COM growth [8]. A number of studies provide direct evidence that both OPN and THP themselves readily attach to the COM surface [3,14]. For example, using SDS-PAGE and Western blotting, Ryall et al. [15] observed that THP adhered to COM crystals taken from urine, and that ''scrupulous care must be taken to ensure the complete removal of extraneous THP adventitiously associated with CaOx crystals ….'' Using atomic force...