Thrombospondins are matricellular proteins that regulate cell-cell and cell-matrix interactions (1, 2). Recent genetic association studies link the thrombospondin (TSP) 2 protein family to the development of atherosclerotic lesions (3-10). TSP-1 was found in early atherosclerotic lesions (11), in injured vascular walls (12,13), and in cardiac allografts where its expression correlated with the degree of vasculopathy (14). The genetic disruption of TSP-1 reduced the atherosclerotic lesion area in the mouse model of atherosclerosis and suggested an important role for TSP-1 in the evolution of plaque and its composition (15). In both in vivo and in vitro studies TSP-1 induced proliferation of vascular smooth muscle cells (SMC) (16,17), and both TSP-1 and TSP-2 inhibited growth of endothelial cells (18 -21); both effects are considered proatherogenic.Previous studies have documented increased TSP-1 levels in the plasma and kidneys of diabetic patients and diabetic animal models (22-25). In mesangial cells, the level of TSP-1 was upregulated by glucose by a transcriptional mechanism (26 -28). We have recently reported increased levels of TSP-1 in the blood vessels of diabetic animals (29). Moreover, TSP-1 was up-regulated by high glucose in vitro in major cell types from large blood vessels. These observations suggest that TSP-1 represents an important link between diabetes, hyperglycemia, and accelerated atherogenesis.A large number of clinical studies and trials have conclusively identified hyperglycemia as an independent risk factor for development of both micro-and macrovascular complications (30 -33). Recently, the Epidemiology of Diabetes Intervention and Complications study reported that, as compared with conventional therapy, intensive glycemic control reduced the risk of the most serious cardiovascular events such as heart attacks, stroke, and death by nearly 60%. These findings clearly underscore the importance of hyperglycemia as a critical player in the development of pathogenic complications associated with diabetes. Glucose regulates the expression of a number of vascular * This work was supported by National Institutes of Health Grants R01 DK067532, K01 DK62128, and P50 HL077107, American Heart Association Grant 0565284B, and funds from the Lerner Research Institute (Cleveland Clinic) (to O. I. S.) and by National Institutes of Health Grant R01 45418 (to P. B.). The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.