though ATP has been shown to act as a modulator in various kidney functions, its effect on renal proximal tubule cell (PTC) proliferation has not been elucidated. This study investigated the effect of ATP on cell proliferation and the effect of its related signal pathways on primary cultured PTCs. Treatment with Ͼ10 Ϫ5 M ATP for 1 h stimulated incorporation of thymidine and bromodeoxyuridine. ATP (10 Ϫ4 M)-induced stimulation of thymidine incorporation was blocked by suramin (a P2X and P2Y receptor antagonist), reactive blue 2 (a P2Y receptor antagonist), MRS-2159 (a P2X1 receptor antagonist), and MRS-2179 (a P2Y1 receptor antagonist). ATP increased intracellular Ca 2ϩ concentration, which was blocked by suramin, methoxyverapamil, and EGTA. ATP-induced stimulation of cell proliferation was also blocked by EGTA (an extracellular Ca 2ϩ chelator), methoxyverapamil (a Ca 2ϩ antagonist), and nifedipine (an L-type Ca 2ϩ channel blocker), suggesting a role for Ca 2ϩ influx. ATP-induced phosphorylation of p38 and p44/42 MAPKs was blocked by nifedipine. ATP increased expression levels of cyclindependent kinase (CDK)-2, CDK-4, and cyclin E, which were blocked by suramin, reactive blue 2, MRS-2179, MRS-2159, and nifedipine. However, ATP decreased expression levels of p21 WAF1/Cip1 and p27 kip1 . ATP-induced stimulation of thymidine incorporation and increase of CDK-2 and CDK-4 expression were blocked by SB-203580 (a p38 MAPK inhibitor) and PD-98059 (an MEK inhibitor), but not by SP-600125 (a JNK inhibitor). In conclusion, ATP stimulates proliferation by increasing intracellular Ca 2ϩ concentration and activating p38, p44/42 MAPKs, and CDKs in PTCs. cell proliferation; calcium influx RENAL EPITHELIAL CELLS RELEASE a significant number of nucleotides into the nephron tubules. The released ATP plays an important role in a variety of cells, including epithelial cells, and mediates or modulates a range of physiological process (17,18,47). It has been reported that ATP significantly increases the [ 3 H]thymidine uptake of growth-arrested mesangial cells via P2-purinergic receptors (45). P2X receptors form ligand-gated, nonselective cation channels, whereas the P2Y receptor is a G protein-coupled membrane protein (25). It has been reported that proximal tubule cells (PTCs) express P2X and P2Y receptors, which suggests that these receptors might play a role in DNA synthesis and proliferation in renal PTCs (13, 16). Recently, Ca 2ϩ has been shown to be an essential regulator of the cell cycle, and the duration of the Ca 2ϩ response controls a wide range of cell functions, including proliferation (15). Indeed, the proliferation of PTCs is accompanied by modifications in Ca 2ϩ homeostasis (2,12,20).Therefore, an ATP-induced elevation of intracellular Ca 2ϩ concentration ([Ca 2ϩ ] i ) might be of particular importance in regulation of cell proliferation (4). However, there is little information on the regulatory mechanisms of cell proliferation by ATP in renal PTCs.In addition to [Ca 2ϩ ] i , mitogen-activated protein kinase (MAP...