Arterial medial calcification (AMC) involves an increased small extracellular vesicle (sEV) secretion and apatite calcium precipitation in the arterial wall. The mechanisms mediating AMC remain poorly understood. In the present study, smooth muscle-specific acid ceramidase (Ac) gene knockout mice (Asah1 fl/fl /SM cre) were used to demonstrate the role of lysosomal ceramide signaling pathway in AMC. Asah1 fl/fl /SM cre mice were found to have more severe AMC in both aorta and coronary arteries compared to their littermates (Asah1 fl/fl /SM wt and WT/WT mice) after receiving a high dose vitamin D. These mice also had pronounced upregulation of osteopontin and RUNX2 (osteogenic markers), CD63, AnX2 (sEV markers) and ALP expression (mineralization marker) in the arterial media. In cultured coronary arterial smooth muscle cells (CASMCs) from Asah1 fl/fl /SM cre mice, high dose of P i led to a significantly increased calcium deposition, phenotypic change and sEV secretion compared to WT CASMCs, which was associated with reduced lysosome-multivesicular body (MVB) interaction. Also, GW4869, sEV release inhibitor decreased sEV secretion and calcification in these cells. Lysosomal transient receptor potential mucolipin 1 (TRPML1) channels regulating lysosome interaction with MVBs were found remarkably inhibited in Asah1 fl/fl /SM cre CASMCs as shown by GCaMP3 Ca 2+ imaging and Port-a-Patch patch clamping of lysosomes. Lysosomal Ac in SMCs controls sEV release by regulating lysosomal TRPML1 channel activity and lysosome-MVB interaction, which importantly contributes to phenotypic transition and AMC. Arterial calcification involves the accumulation or deposition of apatite calcium salts within the vascular wall that has been associated with aging, atherosclerosis, diabetes mellitus and chronic kidney disease (CKD) 1. Anatomically, arterial calcification is classified into intimal and medial calcification 2. The intimal calcification often causes occlusion of the arteries, which is characterized by accumulation of lipids, inflammation, and fibrosis observed as irregular scattered deposits in the atherosclerotic plaques 3. The arterial medial calcification (AMC) increases arterial stiffness, which is detected as continuous linear hydroxyapatite deposits in the absence of inflammatory cells along the internal elastic lamina. It is frequently observed in the elderly people or in patients with diabetic mellitus and chronic renal failure 4,5. Literature cites that under normal physiological conditions, spontaneous accumulation of calcium and phosphate levels doesn't induce arterial calcification because minerals (Ca/P i) are tightly balanced in the vasculature 6,7. Increased intracellular phosphate levels in vascular smooth muscle cells (VSMCs) directly drive their osteogenic differentiation and mineralization, inducing expression of osteogenic markers like RUNX2 and osteopontin 8,9 , associated with secretion of matrix vesicles as primary nucleation sites for calcification 7,9. Several studies including ex vivo human samples and ...