Chronic hypoxia induces smooth muscle cell proliferation and vessel wall remodeling in the vasculature of the lung. One well-characterized component of the hypoxic response is transcriptional activation of genes encoding vascular smooth muscle cell (VSMC) mitogens. We report here that chronic hypoxia can also prolong the growth of human VSMC by inducing telomerase activity and telomere stabilization. We demonstrate that hypoxia induced phosphorylation of the telomerase catalytic component (TERT) and sustained high levels of TERT protein expression in VSMC compared to normoxia. Furthermore, inhibition of telomerase shortened cell life span in hypoxic cultures, whereas constitutive expression of TERT extended the life span of cells under normoxic conditions. Our data indicate that hypoxic induction of telomerase activity could be involved in long-term growth of VSMC and may thus contribute to human vascular disorders.Hypoxia is an important regulator of physiologic processes, including erythropoiesis, angiogenesis, and glycolysis (6). In the vasculature, chronic hypoxia has been shown to cause proliferation of vascular smooth muscle cells (VSMC), leading to vessel wall remodeling, a key pathophysiologic component of pulmonary hypertension (11). The mechanisms by which hypoxia regulates VSMC growth include direct cell cycle-specific effects, as well as indirect effects, via the regulation of VSMC mitogen production by endothelial cells (10). Hypoxia triggers a cellular adaptive response that is primarily mediated by the transcription factor hypoxia-inducible factor 1 (HIF-1) (20). Expression of HIF-1 target genes serves to maintain cellular homeostasis. Transcriptional activation of hypoxia-responsive genes represents one major component of the vascular cell hypoxic response; however, the mechanisms regulating longterm VSMC proliferation in the vessel wall under chronic hypoxia remain to be elucidated.Telomere integrity is essential for chromosome stability (5) and therefore plays a crucial role in long-term cell proliferation. Telomere length is maintained by telomerase, a ribonucleoprotein that uses its associated RNA moiety as a template to add telomeric repeats onto chromosome ends. High levels of telomerase activity are readily detected in cancer cells but not in most normal somatic cells, indicating that telomerase function is required for tumor growth (9). Recent studies indicate that telomerase activity is also present in highly proliferative somatic cell types, such as activated lymphocytes (7). Moreover, in later generations of mice lacking telomerase RNA, there is decreased cell proliferation in highly proliferative organs (12), suggesting that telomerase activity may also be required for proliferation and long-term viability in these cells.The mammalian telomerase RNA component (TERC) has been identified, and its expression was shown to correlate with cell proliferation as well as with telomerase activity in cancer cells (3). Recently, two protein components have been isolated, the mammalian homologue o...