Interaction of calcium oxalate monohydrate (COM) crystals with renal cells has been shown to result in altered gene expression, DNA synthesis, and cell death. In the current study the role of a stress-specific p38 MAP kinase-signaling pathway in mediating these effects of COM crystals was investigated. Exposure of cells to COM crystals (20 g/cm 2 ) rapidly stimulated strong phosphorylation and activation of p38 mitogen-activated protein kinase (p38 MAP kinase) and re-initiation of DNA synthesis. Inhibition of COM crystal binding to the cells by heparin blocked the effects of COM crystals on p38 MAPK activation. We also show that specific inhibition of p38 MAPK by 4-(4-fluorophenyl)-2-(4-methylsulfonylphenyl)-5-(4-pyridyl) imidazole (SB203580) or by overexpression of a dominant negative mutant of p38 MAP kinase abolishes COM crystal-induced re-initiation of DNA synthesis. The inhibition is dose-dependent and correlates with in situ activity of native p38 MAP kinase, determined as mitogen-activated protein kinase-activated protein kinase-2 (MAPKAP kinase-2) activity in cell extracts. In summary, inhibiting activation of p38 MAPK pathway abrogated the DNA synthesis in response to COM crystals. These data are the first demonstrations of activation of the p38 MAPK signaling pathway by COM crystals and suggest that, in response to COM crystals, this pathway transduces critical signals governing the re-initiation of DNA synthesis in renal epithelial cells.Renal tubular fluid is commonly supersaturated with calcium and oxalate ions, which nucleate to form crystals of calcium oxalate monohydrate (COM), 1 the most common constituent of kidney stones. The majority of people do not form renal stones despite crystalluria (1). Up to 1.1 ϫ 10 7 crystals are excreted daily by normal individuals without any evidence of stone disease (2). It is therefore believed that uncomplicated crystalluria does not indicate kidney stone disease. The mechanisms by which urinary crystals are retained in the kidney and grow into kidney stones are not known. Finlayson (3) calculated that, given the most favorable conditions, it would take 10 h for 1-m COM crystals to grow large enough to block the duct of Bellini and become the nidus of a urinary stone. Because urinary transit time from glomerulus to the renal pelvis is ϳ3 min, crystalline particles formed in the urine flowing freely through the renal tubule do not stay in the lumen long enough to attain the dimensions required to block a collecting duct and form a urinary microlith. Therefore, the attachment of crystals to the renal epithelial cells and the cellular responses to crystal interaction are critical in understanding the pathogenesis of renal calcification.Previous studies (4 -6) in several different cell lines of renal tubular origin suggest that COM crystals bind to specific receptors on the cell surface. Furthermore, the receptors that interact with COM crystals in tubular cells may be only minimally exposed under normal circumstances and increase in number under a variety of cond...