Recent studies have demonstrated that surface nano-topography affect cell responses and activities. However, the molecular mechanism of the nano-structures on cellular behavior is yet to be determined. To bridge this gap, the present study was aimed to investigate the cellular and molecular responses of smooth muscle cells (SMCs) to surface nano-topography in vitro using nano-porous alumina membranes with different sizes (200 nm- and 20 nm-pores). Cellular responses such as cell adhesion, morphology, and proliferation were assessed using scanning electron microscopy (SEM), hematoxylin and eosin (HE) staining, and cell counting. The molecular cell responses were also investigated using cDNA microarrays. Results from these studies showed an unchanged response in cell adhesion, an alteration in cell morphology, and an increase in cell proliferation for cells grown on 200 nm-pore surfaces than on 20 nm-pore surfaces. In addition, exposure of SMCs to larger nano-pores induced the expression of various genes involved in cell cycle, DNA replication, cell proliferation, and signaling transduction pathways. These findings demonstrated that cellular responses of SMCs are dependent on the underlying nano-topography, and thereby suggesting nano-dimensional surface is one of the most important considerations to design of the next generation of medical devices and tissue engineering scaffolds.