The purpose of this study was to define the role of metabolic regulatory genes in the pathogenesis of vascular lesions. The glucose transporter isoform, GLUT1, was significantly increased in the neointima after balloon injury. To define the role of GLUT1 in vascular biology, we established cultured vascular smooth muscle cells (VSMCs) with constitutive upregulation of GLUT1, which led to a threefold increase in glucose uptake as well as significant increases in both nonoxidative and oxidative glucose metabolism as assessed by 13 C-nuclear magnetic resonance spectroscopy. We hypothesized that the differential enhancement of glucose metabolism in the neointima contributed to formation of lesions by increasing the resistance of VSMCs to apoptosis. Indeed, upregulation of GLUT1 significantly inhibited apoptosis induced by serum withdrawal (control 20 ؎ 1% vs. GLUT1 11 ؎ 1%, P < 0.0005) as well as Fas-ligand (control 12 ؎ 1% vs. GLUT1 6 ؎ 1.0%, P < 0.0005). Provocatively, the enhanced glucose metabolism in GLUT1 overexpressing VSMC as well as neointimal tissue correlated with the inactivation of the proapoptotic kinase, glycogen synthase kinase 3 (GSK3). Transient overexpression of GSK3 was sufficient to induce apoptosis (control 7 ؎ 1% vs. GSK3 28 ؎ 2%, P < 0.0001). GSK3-induced apoptosis was significantly attenuated by GLUT1 overexpression (GSK3 29 ؎ 3% vs. GLUT1 ؉ GSK3 6 ؎ 1%, n ؍ 12, P < 0.001), suggesting that the antiapoptotic effect of enhanced glucose metabolism is linked to the inactivation of GSK3. Taken together, upregulation of glucose metabolism during intimal lesion formation promotes an antiapoptotic signaling pathway that is linked to the inactivation of GSK3. Diabetes 50:1171-1179, 2001T he risk of restenosis and atherosclerosis after balloon angioplasty is significantly elevated in individuals with diabetes (1-3). This suggests a potential link between vascular smooth muscle cell (VSMC) glucose metabolism and the progression of lesion formation. However, the contributing role of glucose metabolism to the process of vascular lesion formation in the nondiabetic population has not been defined. Recent in vivo studies from our laboratory and others indicate that intimal VSMCs seem to have an intrinsic resistance to apoptosis (4 -6). We hypothesized that a component of the intrinsic property of intimal VSMCs to survive was related to a significant alteration in metabolic regulatory pathways.VSMCs exhibit unusually high rates of glucose utilization and lactate production under normal, well-oxygenated conditions (7,8). Glucose metabolism seems to be an important determinant of vascular reactivity (9). Moreover, recent work from our laboratory has demonstrated that hyperglycemia inhibits medial VSMC apoptosis in the murine carotid artery in response to a reduction in blood flow (10). Thus, we postulated that adaptive alterations in glucose regulatory pathways and metabolism contributed to the antiapoptotic phenotype of neointimal VSMCs.Glucose transport is the rate-limiting step in glucose metabo...