. Exogenous heat shock protein-70 inhibits cigarette smoke-induced intimal thickening. Am J Physiol Regul Integr Comp Physiol 295: R1320 -R1327, 2008. First published August 13, 2008; doi:10.1152/ajpregu.00624.2007.-Cigarette smoke is associated with increased carotid intimal thickening or stroke. Preliminary work showed that exposure to smoke resulted in a 4.5-fold reduction of heat shock protein-70 (HSP70) expression in spleens of mice using gene microarray analysis. In the current study, we investigated the role of extracellular HSP70 in carotid intimal thickening of mice exposed to cigarette smoke. Intimal thickening was induced by placement of a cuff around the right carotid artery of mice. Cuff injury resulted in increased HSP70 mRNA expression in carotid arteries that persisted for 21 days. Cigarette smoke exposure decreased arterial HSP70 expression and significantly increased intimal thickening compared with mice exposed to air. Treatment of mice exposed to cigarette smoke with intravenous recombinant HSP70 attenuated intimal thickening through reduced phosphorylated extracellular signal-regulated kinase (pERK) expression in the arterial wall. In vitro experiments with rat aortic smooth muscle cells confirmed that recombinant HSP70 decreases pERK and proliferating cell nuclear antigen (PCNA) expression in cells exposed to cigarette smoke extract and H 2O2. Our study suggests that decreased expression of arterial HSP70 is an important mechanism by which exposure to cigarette smoke augments intimal thickening. The effects of recombinant HSP70 suggest a role for extracellular HSP70. arterial injury; oxidative stress; extracellular signal-regulated kinase CIGARETTE SMOKING IS ASSOCIATED with increased carotid intimal thickening or incidence of stroke (4,10,17,20,29). We have previously reported that exposure to cigarette smoke accelerates the development of arterial intimal thickening in mice after injury (1, 35). However, the underlying mechanisms of these deleterious effects are unclear. We performed preliminary studies with gene microarray analysis of spleens from mice exposed to cigarette smoke and found a 4.5-fold decreased expression of stress-response heat shock protein-70 (HSP70) compared with mice exposed to air, identifying HSP70 as a potential target for further mechanistic studies.HSPs are part of the host stress-response mechanism. Arterial injury results in oxidative stress (1,6,14), and evidence suggests that the oxidative stress response in atherosclerosis involves HSPs (31,36). HSP70 is overexpressed in atherosclerotic lesions (16). Higher serum levels of HSP70 are associated with reduced atherosclerotic intimal thickening and lower risk of coronary artery disease (38). Furthermore, thermal treatment of rats increased arterial wall HSP70 expression and attenuated intimal thickening after injury (27).HSP70 modulation of cell signaling is, in part, mediated by sequestration of the Raf-1-activator, Bag-1, and decreased phosphorylated extracellular signal regulated kinase (pERK) activation (33...