Endothelial cells play a pivotal role in the development of atherosclerosis, An 'activated' phenotype of these cells is manifested by signal transduction-dependent expression of genes encoding cytokines, pro- and anticoagulant factors, and cell adhesion molecules. In the current study we examined the effect of ouabain, an inhibitor of Na+/K+-ATPase, on the process of endothelial cell activation, We demonstrated that ouabain was able to stimulate VCAM-1 expression and potentiate the effect of IFN-gamma on this process, Moreover, ouabain provided a complementary signal for either TNF or IFN-gamma in inducing iNOS expression, Our data also show, for the first time, that inhibition of Na+/K+-ATPase led to activation of the transcription factor, NF-kappa B, which may provide an explanation for the effects of ouabain on endothelial cells.