The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Original Article Aim: Myostatin (Mstn) has been described as a trigger for the progression of atherosclerosis. In this study, we evaluated the role of Mstn in arterial remodeling in patients with end-stage renal disease (ESRD). Methods: Vascular specimens were collected from 16 ESRD patients (56.4 7.9 years) undergoing renal transplant (recipients) and 15 deceased kidney non-uremic donors (55.4 12.1 years). We studied gene and protein expression of Mstn, ubiquitin ligases, Atrogin-1, and muscle ring finger protein-1 (MuRF-1), inflammatory marker CCL2, cytoskeleton components, and Klotho by reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. Moreover, we assessed vascular calcification and collagen deposition. Finally, we studied the effects of recombinant Mstn on rat vascular smooth muscle cells (VSMCs, A7r5) and evaluated the effects of uremic serum (US) on primary human VSMCs. Results: Myostatin mRNA was upregulated in the arterial vascular wall of recipients compared with donors (~15folds, p 0.05). This response was accompanied by the upregulation of gene expression of Atrogin-1 and MuRF-1 (2.5-and 10-fold) and CCL2 (3-fold). Conversely, we found downregulation of protein expression of Smoothelin,-smooth muscle actin (-SMA), vimentin, and Klotho (-85%,-50%,-70%, and-80%, respectively; p 0.05) and gene expression of vimentin and Klotho. Exposition of A7r5 to Mstn induced a time-dependent SMAD 2/SMAD 3 phosphorylation and expression of collagen-1 and transforming growth factor (TGF) mRNA, while US induced overexpression of Mstn and Atrogin-1 and downregulation of Smoothelin and Klotho. Conclusions: Our data suggest that uremia might induce vascular Mstn gene expression together with a complex pathway of molecular and structural changes in the vascular wall. Myostatin, in turn, can translate the metabolic alterations of uremia into profibrotic and stiffness inducing signals. ing 2, 3) , endothelial dysfunction, arterial stiffness, and vascular calci fication 4, 5). The development of vascular disease involves the response to a number of insults and a complex interplay between cells resident in the vascular wall, including vascular smooth muscle cells (VSMCs), endothelial cells, and infiltrating cells of the innate and adaptive immune system 6). In particular, in atherosclerosis, VSMCs undergo a shift from a contractile to a synthetic phenotype, accompanied by Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.