Objective-Diabetes is associated with vascular remodeling and increased thrombin generation. Thrombin promotes vascular smooth muscle cell (SMC) mitogenesis and migration via protease-activated receptors (PAR)-1, PAR-3, and PAR-4. We investigated the effect of high glucose on expression and function of vascular thrombin receptors. Methods and Results-In human vascular SMCs, high glucose (25 versus 5.5 mmol/L) induced a rapid and sustained increase in PAR-4 mRNA, protein, and cell surface expression. PAR-1 and PAR-3 expression were not changed. High glucose pretreatment (48 hours) enhanced thrombin or PAR-4 -activating peptide but not PAR-1-activating peptide evoked intracellular calcium mobilization, migration, and tumor necrosis factor ␣ gene expression. This enhancement of thrombinstimulated migration and gene expression by high glucose was abolished by endogenous PAR-4 knockdown. PAR-4 regulation was prevented by inhibition of protein kinase (PK)C- and -␦ isoforms or nuclear factor (NF)B. Nuclear translocation of NFB in high glucose-stimulated SMCs led to PKC-dependent NFB binding to the PAR-4 promoter in a chromatin immunoprecipitation assay. Furthermore, in situ hybridization and immunohistochemistry confirmed high abundance of PAR-4 in human diabetic vessels as compared with nondiabetic vessels. Key Words: diabetes mellitus Ⅲ thrombin Ⅲ vascular muscle Ⅲ protease-activated receptors C hronically elevated plasma glucose levels in diabetes are associated with cardiovascular complications such as vascular remodeling and poor outcome after revascularization. 1,2 At the cellular level, hyperglycemia is a potent stimulus for the proliferation and migration of vascular smooth muscle cells (SMCs), 3 which are major factors contributing to vascular remodeling and accelerated atherosclerosis. 4 In addition, diabetes represents a hypercoagulable state associated with enhanced thrombin generation and increased risk of thrombotic complications. 5 Thrombin is the central component of the coagulation cascade that becomes activated when vascular injury allows contact between blood-borne components and tissue factor-expressing cells such as fibroblasts and SMCs. 6 However, the overwhelming majority of total thrombin generated is released by the thrombus after clotting is completed, 6,7 indicating functions beyond coagulation.
Conclusion-HighThrombin can exert direct coagulation-independent actions such as SMC migration and proliferation through activation of a unique family of G protein-coupled receptors, the protease-activated receptors (PARs). 8 PARs are activated through proteolytic cleavage of the extracellular N terminus, which unmasks a new N terminus that acts as a tethered ligand to autoactivate the receptor. 9 Synthetic hexapeptides mimicking this tethered ligand can elicit most of the biological actions of thrombin independently of receptor cleavage. Of the 4 PARs identified to date, PAR-1, PAR-3, and PAR-4 are activated by thrombin, whereas another receptor, PAR-2, is activated by other proteases such as activa...