Thiazolidinediones, such as pioglitazone, seem to exert direct antiatherosclerotic and antirestenotic effects on type 2 diabetes, in part due to an induction of vascular smooth muscle cell (VSMC) apoptosis. We aimed to study the role of transforming growth factor (TGF)- in rat aortic VSMC. Pioglitazone at 100 mol/l increased apoptosis without affecting DNA synthesis, and this effect was reversed by an anti-TGF-1 antibody. Extracellular TGF-1 levels were rapidly increased after treatment with pioglitazone in a peroxisome proliferator-activated receptor (PPAR)-␥-dependent mechanism because this secretion was blocked by the PPAR-␥ inhibitor GW9662. Pioglitazone subsequently increased the nuclear recruitment of phospho-Smad2, without any effect on protein expression. According to our results, we propose that the apoptotic effect of pioglitazone on VSMC depends on the following sequence: PPAR-␥ activation, TGF-1 release, and selective phospho-Smad2 nuclear recruitment. Management of Smad signaling on VSMC might provide future clinical benefits in vascular diseases. Diabetes 54: [811][812][813][814][815][816][817] 2005 T ype 2 diabetes is a major risk factor for atherosclerosis, the leading cause of morbidity and mortality in developed countries (1). In addition, diabetic patients show an increased risk for suffering postangioplasty restenosis (2). Vascular wall size depends on a relative balance between proliferation and apoptosis (3). When the ratio of proliferation to apoptosis increases, an early atherosclerotic plaque or a postangioplasty restenosis is faced.Thiazolidinediones (TZDs) are an emerging class of antidiabetic drugs that enhance insulin sensitivity in a peroxisome proliferator-activated receptor (PPAR)-␥-dependent fashion (4). However, they have also been demonstrated to exert some direct effects in decreasing neointimal growth after balloon injury (5) and angioplasty (6), two situations with an increased ratio for vascular smooth muscle cell (VSMC) proliferation to apoptosis. Many of the studies concerning the cellular effects of TZD have focused on cell cycle and DNA synthesis regulation. Surprisingly, these effects seem to be PPAR-␥ independent (7). On the other hand, at higher doses, TZDs have been proven to induce apoptosis in VSMCs by involving PPAR-␥ (8).Transforming growth factor (TGF)-1 is an essential cytokine involved in the control of the balance between proliferation and apoptosis in VSMCs. TZDs and TGF-1 share the induction of apoptosis by similar mechanisms, such as GADD45 (9,10). In addition, some crosstalk between TGF-1 and PPAR-␥ has been described; thus, in the long term, TGF-1 inhibits PPAR-␥ expression (11), whereas PPAR-␥ agonists and PPAR-␥ itself interact with the TGF-1 signaling pathway by inhibiting Smad3 (12). Therefore, Smad2 appears as a likely target for TGF- in TZD-treated VSMCs.In the present study, we show that the apoptotic effect of the TZD pioglitazone in VSMC depends on the following sequence: PPAR-␥ agonism, rapid TGF-1 autocrine secretion, and select...