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ABSTRACT: This study was aimed to investigate the mechanism of phosphatidylserine exposure of human erythrocytes induced by high concentrated glucose. After exposure to high concentrated glucose, the phosphatidylserine (PS) exposure and forward scatter value were analyzed by flow cytometry; the activities of caspase-3 and caspase-8 were detected; The inhibitory effect of leupeptin on cell PS exposure induced by high concentrated glucose was observed by flow cytometry and fluorescent microscopy. The results showed that the high concentrated glucose could induce PS exposure of erythrocytes and this inducing efficiency was dependent on the glucose concentrations. With increase of the glucose concentrations, the percentages of cells with exposed PS also increased. When the glucose concentration was 0.8 mol/L, the PS exposure was over 80%. However, caspase-3 and caspase-8 were not activated during PS exposure of cells induced by high concentrated glucose, but leupeptin could significantly inhibit PS exposure and volume shrinkage induced by high concentrated glucose. With increase of the leupeptin concentrations, the percentage of cells with exposed PS decreased and the cell volume increased. It is concluded that the high concentrated glucose can result in serious PS exposure, which does not depend on caspase. It can be hypothesized that the PS exposure of erythrocytes induced by high concentrated glucose may be controlled by an unknown pathway sensitive to leupeptin.