Atherosclerosis is a cardiovascular disease that affects the integrity of the arteries and the flow of blood. Indicators of atherosclerosis are, but not limited to, increased expression of Cell Adhesion Molecules (CAMs) on the vascular endothelium, recruitment of serum monocytes (MO) to the endothelium, transmigration of MO across the endothelial layer, maturation of MO to macrophages, plaque formation, and vessel occlusion and rupture. Monocyte adhesion is regulated by the balance between membrane (mCAM) and soluble (sCAMs). We found that Kallikrein-6 (KLK6) cleaves membrane Vascular Cell Adhesion Molecule-1 (mVCAM-1) on vascular endothelial cells, and hypothesized that this proteolytic cleavage event may affect the balance between relative levels of mCAM and sCAM. Since cigarette smoking increases the risk of developing atherosclerosis, we hypothesized that serum extracts of smoke increase the presence of mCAMs and decrease the abundance of sCAMs, thus increasing the likelihood of MO binding to the endothelium. Furthermore, we conjectured that smoking may increase the incidence of plaque formation by affecting an mVCAM-1 protease, leading to decreased sVCAM-1. We determined that in Human Carotid Endothelial Cells (HCEC) (1) Lipopolysaccharide and Tumor Necrosis Factor-alpha increased mVCAM-1 and mICAM-1 (2) cigarette smoke extract (CSE) decreased sVCAM-1, but not sICAM-1, production in timeand dose-dependent manners, (3) KLK6 increased sVCAM-1 and sICAM-1 production in time-and dosedependent manners, (4) aprotinin, a serine protease inhibitor, decreased sVCAM-1, but not sICAM-1, production in a dose-dependent fashion, and (5) KLK6 reversed aprotinin inhibition of sVCAM-1, but not sICAM-1, production.