Hemodynamic Shear Stress and Its Role in Atherosclerosis
 Adel M. Malek, MD, PhD; Seth L. Alper, MD, PhD; Seigo Izumo, MD


( JAMA 1999; 282:2035 - 2042 )


Figure 4. Model of Atherogenesis

Illustration of the arterial endothelial phenotypic switch from atheroprotective (left panel) to atherogenic (right panel) induced by the local low-magnitude shear stress (<4 dyne/cm2) conditions found in atherosclerosis-prone regions of vascular bifurcations.5, 22, 24 The atherogenic endothelial phenotype resulting from weak local hemodynamic shear stress at the vessel wall includes the low shear-mediated recruitment and activation of monocytes, increased platelet activation, increased vasoconstriction and paracrine growth stimulation of vessel wall constituents, increased oxidant state, and increased apoptosis and cellular turnover (right panel). taus Indicates shear stress; NO, nitric oxide; EC, endothelial cell; and NOS, endothelial nitric oxide sythase. For other abbreviations, see footnote to Table 1.

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