Thrombin has been implicated in the stimulation of smooth muscle cell (SMC) proliferation that contributes to post angioplasty restenosis. The present studies demonstrated that human a-thrombin was a potent and efficacious mitogen for cultured rat aortic SMC, stimulating an increase in 3H-thymidine incorporation, as well as an increase in cell number at 1 to 10 nM concentration. -Thrombin, which is enzymatically active but lacks fibrinogen clotting activity, stimulated SMC mitogenesis but was -10-fold less potent than a-thrombin. In contrast, D-phenylalanyl-L-propyl-L-arginyl-chloromethyl ketonea-thrombin, which lacked enzymatic activity, had no mitogenic effect. Diisopropylfluorophosphate-a-thrombin failed to stimulate mitogenesis except at concentrations having equivalent enzymatic activity as that of a-thrombin at its threshold for mitogenesis. Thus, thrombin-induced proliferation was dependent on enzymatic activity. A 14-residue peptide (SFLLRNPNDKY-EPF) corresponding to amino acids 42 through 55 of the human thrombin receptor (Vu, T. K., D. T. Hung, V. I. Wheaton, and S. R. Coughlin, 1991. Cell. 64:1057-1068) had full efficacy in stimulating SMC proliferation. Reversing the first two amino acids of this peptide abolished mitogenic activity. Northern analysis demonstrated that SMC expressed a single mRNA species that hybridized to a labeled thrombin receptor cDNA probe. These findings indicate that a-thrombin stimulates SMC proliferation via the proteolytic activation of a receptor very similar or identical to that previously identified. (J. Clin. Invest. 1993. 91:94-98.)