Peroxisome proliferator-activated receptor {gamma} (PPARg), the nuclear receptor that binds the insulin-sensitizing thiazolidinediones (TZDs), is prominently upregulated in intimal vascular smooth muscle cells (VSMC) after mechanical injury to the vessel wall. Several TZD PPARg ligands have been shown to inhibit neointima formation in both normal and insulinresistant vasculature. The suppression of intimal hyperplasia by TZD PPARg ligands probably results from their activity to inhibit VSMC growth and promote apoptosis. TZDs prevent VSMC proliferation by blocking the activity of regulatory proteins, such as phosphorylation of the retinoblastoma protein (Rb). Rb functions as a G 1 gatekeeper by controlling S phase gene expression mediated by the E2F transcription factor. Consistent with their effect on Rb phosphorylation, PPARg ligands inhibit the mitogenic induction of minichromosome maintenance (MCM) proteins 6 and 7, two E2F-regulated S phase genes essential for DNA replication. PPARg ligands also induced apoptosis in VSMC, which correlated with a potent induction of GADD45, a gene implicated in controlling cell growth and survival. A constitutively active form of PPARg targeted the same cell cycle regulators as did PPARg ligands, consistent with a nuclear-receptor-dependent mechanism of action. This review will summarize mechanisms through which PPARg modulates VSMC proliferation and apoptosis suggesting that PPARg itself is a novel important regulator of cell cycle and apoptosis and may provide a new therapeutic approach to prevent restenosis. Keywords: PPARg; thiazolidinedione; vascular smooth muscle; proliferation; minichromosome maintenance protein; GADD45Peroxisome proliferator-activated receptor {gamma} (PPARg) ligands have been shown to inhibit growth of vascular and cancer cells by interfering with the expression and function of multiple cell cycle regulators. 1-6 Although many studies have focused on alterations in the regulation of cell growth as a fundamental feature during atherogenesis and neointimal hyperplasia after percutaneous coronary revascularization, it is becoming increasingly evident that perturbations in the regulation of cell death may be of equal importance. 7 In vascular smooth muscle cells (VSMC), we have previously reported that the thiazolidinedione (TZD) PPARg ligands, troglitazone (TRO) and rosiglitazone (RSG), inhibit exit from G1 into S phase of the cell cycle by attenuating retinoblastoma protein (Rb) phosphorylation. 4 As illustrated in Figure 1 decreased phosphorylation of Rb by TRO and RSG likely results from their effect to elevate levels of the cyclindependent kinase inhibitor (CDKI) p27 kip1 and reduce the activity of cyclin D-and cyclin E-dependent kinases (CDK). 4 In addition, recent studies have shown that TZDs not only inhibit cell growth, but they can also induce apoptosis in VSMC. 8,9 The molecular mechanisms by which TZDs induce apoptosis in VSMC and whether they involve a PPARgdependent pathway also remain unclear.Using DNA microarray analysis, we have identifi...