Summary
Atherosclerotic plaque rupture and subsequent thrombosis is the main cause of sudden
coronary death. Remarkably, atherosclerosis only develops in certain predisposed areas
of the vasculature. Endothelial cells in these predisposed areas experience low or
oscillatory shear stress, which activates the proinflammatory and procoagulant transcription
factors activator protein 1 (AP-1) and nuclear factor B (NFB), thus inducing a proinflammatory,
procoagulant surface. In contrast, healthy endothelial cells that are exposed to prolonged
high laminar shear stress, express antiinflammatory and anticoagulant genes. The key
shear stress-induced transcription factors that govern the expression of these genes
are Krüppel-like factor 2 (KLF2) and nuclear factor erythroid 2-like 2 (Nrf2). Together
KLF2 and Nrf2 govern ~70% of the shear stress-elicited gene sets. Nrf2 potently induces
anti-inflammatory/antioxidant enzymes, while KLF2 induces anti-inflammatory and anticoagulant
proteins, most specifically endothelial Nitric oxide synthase (eNOS) and thrombomodulin
(TM). KLF2 also inhibits proinflammatory and antifibrinolytic genes through inhibition
of the proinflammatory transcription factors AP-1 and NFB. The widespread beneficial
effects of the key transcription factors KLF2 and Nrf2 on endothelial phenotype, holds
the promise that their targeted modulation might lead to a new class of cardiovascular
drugs.
Keywords
Shear stress - transcription factor - KLF2 - Nrf2