It has been shown that ultrasound (US) stimulation accelerates fracture healing in the animal models and clinical studies. Nitric oxide (NO) is a crucial early mediator in mechanically induced bone formation. Here we found that US stimulation increased NO formation and the protein level of inducible nitric-oxide synthase (iNOS). US-mediated iNOS expression was attenuated by anti-integrinFracture healing is a complex physiological process comprising the coordinated participation of several cell types. Among all the means to influence fracture healing, ultrasound (US) 3 distinguishes itself by being non-invasive and easy to apply. Low intensity levels are used to accelerate fracture healing and are considered neither thermal nor destructive. It has been shown that low intensity US accelerates fracture healing in animal models (1, 2) and clinical studies (3, 4). It has been demonstrated that low intensity-pulsed US exposure increases nitric oxide (NO) and prostaglandin release (5, 6), stimulates collagen synthesis, and promotes bone formation (7). However, the mechanisms involved in osteoblasts to detect US stress and transduce the signal across the membrane for activating signaling pathways in metabolism, such as the induction of inducible nitric-oxide synthase (iNOS) and release of NO, remain poorly understood.Integrins are cell-surface adhesion receptors that regulate cell viability in response to cues derived from the extracellular matrix (8, 9). In the case of mesenchymal cells, encompassed by the extracellular matrix, matrix-derived mechanical stimuli can regulate their viability. In this latter scenario, integrins function as mechanoreceptors that detect mechanical stimuli originating from the extracellular matrix and convert them to chemical signaling pathways that regulate cell viability (10, 11). Mechanical stimuli can be transmitted through the direct or indirect interaction of integrins with associated lipid or protein-signaling molecules in the focal adhesion complex (12, 13). Integrinlinked kinase (ILK), a potential candidate signaling molecule, has been shown to be capable of regulating integrin-mediated signaling (14). ILK can interact with the cytoplasmic domain of -integrin subunits and is activated by both integrin activation as well as growth factors and is an upstream regulator of Akt (15).Hypoxia-inducible factor-1 (HIF-1) is a heterodimeric transcription factor composed of the basic helix-loop-helix-PerArnt-Sim-domain, containing the proteins HIF-1␣ and arylhydrocarbon receptor nuclear translocator (HIF-1) (16). The availability of HIF-1 is determined primarily by HIF-1␣, which is regulated at the protein level in an oxygen-sensitive manner, in contrast to HIF-1, which is stably expressed (17,18). During normoxia, HIF-1␣ is efficiently degraded through the von HippelLindau-dependent ubiquitin-proteasome pathway (18). Under * This work was supported by the National Science Council of Taiwan (Grant NSC 95-2314-B-039-045) and China Medical University . The costs of publication of this arti...