BCL2A1 and Hyperglycemia: In addition, cultured VSMC cells grown in media with high glucose concentration (to mimic hyperglycemia of diabetes) have exhibited increased cell proliferation [23,24] Several intracellular signals elicited by high glucose are responsible for VSMC cell proliferation, including increased expression of TGF-β receptor type II via PKC-β [28], enhanced intracellular ROS production [29], and suppressed apoptosis via upregulation of bcl-xl and bfl-1/A1 levels through PI-3K and ERK1/2 pathways in VSMCs [30].