Kallistatin is a plasma protein that exhibits pleiotropic effects in vasodilation, anti-angiogenesis, and anti-inflammation. To isolate a kallistatin-binding protein that mediates the vascular actions of kallistatin, we screened and identified a positive clone from a human heart cDNA expression library by using an alkaline phosphatase-kallistatin fusion protein binding assay. Sequence analysis revealed that kallistatin-binding protein is human Kruppel-like factor 4 (KLF4). KLF4 was localized on the plasma membrane of HEK-293 cells and endothelial cells overexpressing KLF4. KLF4 and kallistatin complex formation was identified in endothelial cells by immunoprecipitation followed by immunoblotting. We showed that kallistatin inhibits tumor necrosis factor-␣-induced NF-B activation, as well as vascular cell adhesion molecule-1 and monocyte chemoattractant protein-1 expression in endothelial cells, whereas knockdown of KLF4 by small interfering RNA oligonucleotide abolished the effect of kallistatin. Kallistatin increased endothelial nitric-oxide synthase (eNOS) expression and nitric oxide levels, and these effects were also blocked by KLF4 small interfering RNA oligonucleotide. Moreover, inhibition of eNOS by RNA interference or by NOS inhibitor abolished the blocking effect of kallistatin on vascular cell adhesion molecule-1 and monocyte chemoattractant protein-1 expression. In summary, we identified KLF4 as a kallistatin-binding protein, which has a novel role in mediating the anti-inflammatory actions of kallistatin via increasing eNOS expression in endothelial cells. This study provides a new target for modulating endothelial function in vascular disease.Kallistatin was discovered as a tissue kallikrein inhibitor from human plasma (1, 2). Recent studies indicate that kallistatin exerts pleiotropic effects such as vasodilation and inhibition of angiogenesis, tumor growth, inflammation, and oxidative stress, independent of tissue kallikrein (3-7). We showed that an intravenous bolus injection of human kallistatin caused a rapid and transient reduction of mean arterial blood pressure in anesthetized rats and that kallistatin induced relaxation in isolated aorta rings (3). Moreover, a high affinity binding site for kallistatin was identified in the aortic membrane using 125 Ilabeled kallistatin (3). Furthermore, kallistatin directly stimulated the proliferation and migration of cultured vascular smooth muscle cells by activating mitogen-activated protein kinases (8). These findings suggest the presence of kallistatin receptors or binding proteins that mediate its effects in the vasculature. However, the identity of the kallistatin receptor/ binding protein has not been determined.Kallistatin is a negative acute-phase protein, which is reduced after acute lipopolysaccharide-induced inflammation and in chronic inflammatory disease (9). Transgenic mice overexpressing kallistatin are more resistant to lipopolysaccharideinduced lethality (10). Kallistatin administration via gene delivery significantly decreased neutroph...