There remains no treatment for chronic allograft rejection mainly manifested by progressive arteriosclerosis. We investigated the effect of Allotrap peptide RDP58 therapy on arteriosclerosis in an aortic allotransplant model. RDP58 was administered intraperitoneally at 0.1, 0.5, or 2.5 mg/kg, every other day after transplantation. RDP.58 therapy markedly inhibited vascular intimal thickening, media necrosis, and adventitial cellular inflammation. The attenuation of arteriosclerosis was associated with the induction of heme oxygenase (H0)-1 expression, inhibition of TNF-a production in aortic allografts, as well as decreased specific Allograft vasculopathy, a gradually developing and progressive obliterative vascular disease in transplanted organs, is the most characteristic feature of chronic allograft rejection and the major cause of late graft loss [l, 21. Apart from organ-specific manifestations, pathological changes of arteriosclerosis, like intimal thickening, proliferation of smooth muscle cells (SMCs), and adventitial inflammation are the most frequently observed lesions in chronic rejection [3]. Graft arteriosclerosis may be patchy and may involve large elastic arteries, small muscular arteries, or veins. The mechanism of pathogenesis of chronic rejection is still unclear. However, it is generally accepted that both immunological and non-immunological factors (metabolic stress complement-dependent cytotoxic antibodies in serum. RDP58 inhibited both smooth muscle cell (SMC) proliferation with an 80% inhibition at 100 pM without evidence of cytotoxicity and TNF-induced apoptosis of SMCs in a dosedependent fashion. These data suggest that the suppressive effect of RDP58 on allograft arteriosclerosis is due to multiple actions of the peptide, including induction of HO-1, inhibition of TNF-a, and a direct effect on SMC proliferation.