Pleural cavities are lined by a polarized monolayer of mesothelial cells (MC). During pleuritis, MC are shed into effusions, and pleural obstruction may occur. Integrins are cell surface receptors mediating interactions with extracellular matrix (ECM) proteins. The distribution of beta1-, beta3-, beta4-integrins and fibronectin and laminin in normal and chronically inflamed pleura and in/on MC from pleural effusions was examined by immunomorphology and flow cytometry. Adhesion assays of MC to fibronectin and laminin were performed. In situ, resting MC expressed beta1-, beta3-, beta4-, and alphav-subunits. Activated MC were beta1- and alphav-positive and also expressed alpha3 and alpha6; beta4 was confined to the basal surface of MC; beta3 was absent. Floating MC from effusions neoexpressed alpha5 and reexpressed beta3. In vitro, MC surface expressed beta1, beta3, alpha3, alpha5, alpha6, alphav, and also alpha1 and alpha2. In normal pleura, fibronectin and laminin were components of the basement membrane. In pleuritis, the basement membrane was desintegrated. Instead, newly formed fibronectin/laminin containing fibrils extended into the submesothelial connective tissue. Floating MC freshly isolated from effusions carried fibronectin and laminin on their surface and showed specific binding to these ECM proteins. Binding was blocked by anti-beta1 or anti-alpha5 and anti-alpha6 antibodies, respectively. MC incubated with fibronectin showed a clear shift to the S phase, while laminin had no effect. In conclusion, activated and detached MC progressively enrich their integrin repertoire. By capturing soluble fibronectin and laminin and by matrix-mediated bridging, readhering MC may contribute to pleural obstruction. Further, soluble fibronectin bound to alpha5beta1 might be life-sustaining for floating MC by driving cells into cell cycle.