Type 2 diabetics have an increased risk of developing atherosclerosis, suggesting the mechanisms that cause this disease are enhanced by insulin resistance. In this study we examined the effects of gene knock-out (KO) of lipocalin-type prostaglandin D 2 synthase (L-PGDS), a protein found at elevated levels in type 2 diabetics, on diet-induced glucose tolerance and atherosclerosis. Our results show that L-PGDS KO mice become glucose-intolerant and insulin-resistant at an accelerated rate when compared with the C57BL/6 control strain. Adipocytes were significantly larger in the L-PGDS KO mice compared with controls on the same diets. Cell culture data revealed significant differences between insulinstimulated mitogen-activated protein kinase phosphatase-2, protein-tyrosine phosphatase-1D, and phosphorylated focal adhesion kinase expression levels in L-PGDS KO vascular smooth muscle cells and controls. In addition, only the L-PGDS KO mice developed nephropathy and an aortic thickening reminiscent to the early stages of atherosclerosis when fed a "diabetogenic" high fat diet. We conclude that L-PGDS plays an important role regulating insulin sensitivity and atherosclerosis in type 2 diabetes and may represent a novel model of insulin resistance, atherosclerosis, and diabetic nephropathy.Cardiovascular disease is the primary cause of morbidity and mortality in people with non-insulin-dependent diabetes mellitus (1). Type 2 diabetics have a significantly increased risk of developing hypertension, atherosclerosis, and restenosis after angioplasty or stent implantation (2, 3). These phenomena are partially attributable to the abnormal accumulation of vascular smooth muscle cells (VSMCs) 1 within the intima of blood vessels resulting from alterations in migration, proliferation, and apoptosis (4, 5).Previously, we have demonstrated that lipocalin-type prostaglandin D 2 synthase (L-PGDS) inhibits the exaggerated growth phenotype of VSMCs isolated from hypertensive rats (6). The mechanism appears to involve the inhibition of insulinstimulated protein kinase B (Akt) and glycogen synthase kinase-3 phosphorylation (6). We have also shown that VSMC apoptosis and migration are both altered by L-PGDS and that any beneficial effects of L-PGDS are absent in VSMCs isolated from diabetic animals (7). In addition, L-PGDS is ultimately responsible for the synthesis of the naturally occurring peroxisome proliferator activator receptor ␥ ligand, 15-deoxy-⌬ 12,14 prostaglandin J 2 , already known to induce apoptosis (8). Moreover, thiazolidinediones, which are synthetic peroxisome proliferator activator receptor ␥ ligands, have been shown to increase insulin sensitivity and enhance insulin-stimulated glucose transport into muscle (9) and exert other beneficial cardiovascular effects such as blocking VSMC growth and migration to delay the onset of atherosclerosis (10, 11).Several other findings have emerged suggesting that L-PGDS has important vascular functions. Inoue et al. (12) have demonstrated that elevated serum L-PGDS levels co...