Abstract-Chronic upregulation of P-selectin expression on the surface of the endothelium has been observed in and likely contributes to a number of chronic inflammatory diseases, including atherosclerosis. Agonists of P-selectin expression fall into 2 categories: those that induce a very rapid, transient increase, lasting only hours, and those that induce prolonged upregulation lasting days. It is the latter group, which includes interleukin-4 (IL-4), that is likely to be a mediator of chronic P-selectin upregulation. The increase in P-selectin expression induced by IL-4 results from increased transcriptional activation of the P-selectin gene. The aim of this study was to deduce the postreceptor signaling pathway(s) giving rise to the prolonged increase in P-selectin expression induced by IL-4. We demonstrate the existence of 2 functional signal transducer and activator of transcription 6 (Stat6) binding sites on the P-selectin promoter and further demonstrate, by functional analysis of the P-selectin promoter, that binding of activated Stat6 to at least 1 site is essential for IL-4-induction of P-selectin transcription. Site 1 (nucleotide[nt] Ϫ142) bound Stat6 with a higher affinity than did site 2 (nt Ϫ229), and this difference was reflected functionally as constructs in which only site 1 was functional showed full IL-4 inducibility, whereas constructs in which only site 2 was functional showed only 40% of maximal IL-4 inducibility. IL-4 also induced prolonged activation of Stat6, which was contingent on the continuous presence of IL-4. The sustained activation of Stat6 induced by IL-4 is likely to be a key factor leading to the prolonged activation of the P-selectin promoter, thereby resulting in prolonged P-selectin upregulation. Key Words:T he role of inflammation in the development of atherosclerosis is clearly established. The adhesion of circulating leukocytes, in particular, monocytes, to the endothelium and their subsequent migration through the endothelial barrier is a requisite step in the formation of fatty streaks, the precursors to atherosclerotic plaques. Members of the selectin family of adhesion receptors, when expressed on the surface of activated endothelial cells (ECs) during inflammation, mediate the capture of fast-flowing leukocytes, leading to leukocyte rolling on the vessel wall, a step necessary for the subsequent firm adhesion and extravasation of leukocytes (reviewed in References 1 and 2).P-selectin, a member of the selectin family of adhesion receptors, is a 140-kDa glycoprotein stored in the WeibelPalade bodies of ECs 3,4 and the ␣-granules of platelets and megakaryocytes. 5 The importance of P-selectin in inflammation is aptly demonstrated by the decrease in numbers of rolling leukocytes in P-selectin-deficient mice, resulting in delayed and decreased leukocyte extravasation during acute inflammation. 6 Increased expression of P-selectin in the blood vessels at sites of inflammation has been observed in a number of chronic inflammatory diseases such as rheumatoid arthritis, 7 Gra...