Integrins are expressed by virtually all cells and play key roles in a range of cellular processes. Changes in the integrin surface repertoire provide a means of altering the strength and ligand preferences of cell adhesion. Recent research has examined the affinity modulation of integrins, a rapid and versatile mechanism of cell adhesion regulation. Studies with a prototype, alpha IIb beta 3, indicate that intracellular events influence the conformation and ligand-binding affinity of the extracellular domain of integrins. This 'inside-out' signal transduction appears to be mediated through the integrin cytoplasmic domains. In addition, in some cases affinity modulation of integrins may be cell-type specific. The clarification of the mechanisms of integrin affinity modulation should help explain rapid changes in cell adhesion that occur during cell migration, aggregation and the cell cycle.