Connective tissue growth factor (CCN2, also known as CTGF) is a matricellular protein that appears to play an important role in hepatic stellate cell (HSC)-mediated fibrogenesis. After signal peptide cleavage, the full-length CCN2 molecule comprises four structural modules (CCN2(1-4)) and is susceptible to proteolysis by HSC yielding isoforms comprising essentially modules 3 and 4 (CCN2(3-4)) or module 4 alone (CCN2(4)). In this study we show that rat activated HSC are capable of adhesion to all three CCN2 isoforms via the binding of module 4 to integrin alpha(v)beta(3), a process that is dependent on interactions between module 4 and cell surface heparan sulfate proteoglycans (HSPGs). These findings are based on several lines of evidence. First, integrin alpha(v)beta(3) was detected in HSC lysates by immunoprecipitation and Western blot, and CCN2(4)-mediated HSC adhesion was blocked by anti-integrin alpha(v)beta(3) antibody. Second, as assessed by immunoprecipitation and solid phase binding assay, CCN2(4) bound directly to integrin alpha(v)beta(3) in cell-free systems. Third, destruction or inhibition of synthesis of cell surface HSPGs with, respectively, heparinase or sodium chlorate abrogated HSC adhesion to CCN2(4). Fourth, prior occupancy of heparin-binding sites on CCN2(4) with soluble heparin completely blocked HSC adhesion. These findings indicate that integrin alpha(v)beta(3) functions as a co-receptor with HSPGs for CCN2(4)-mediated HSC adhesion. Furthermore, by peptide mapping and site-directed mutagenesis we demonstrated that the sequence IRTPKISKPIKFELSG within CCN2(4) is a unique binding domain for integrin alpha(v)beta(3) that is sufficient to mediate integrin alpha(v)beta(3)- and HSPG-dependent HSC adhesion. These findings offer the possibility of developing novel antifibrotic therapies that target the integrin-binding domain.