Shear-Induced Macrophage Secretome Promotes Endothelial Permeability

Background: Discrete subaortic stenosis is a pediatric cardiovascular disease marked by fibrotic growth within the left ventricular outflow tract (LVOT), leading to severe complications, including left ventricular hypertrophy, aortic regurgitation, and arrhythmias. Despite surgical intervention, a 20-30% recurrence rate suggests a complex underlying pathophysiology. Elevated flow and resultant hemodynamic shear stress within the LVOT are key factors in DSS development. While effects of shear stress on endothelial cells have been studied, the impact on macrophages and their interactions with endothelial cells remains unclear. Methods: In this study, human monocyte-derived macrophages (MDMs) and human aortic endothelial cells (HAECs) were subjected to shear stress using a cone-and-plate viscometer. Cellular crosstalk was evaluated through conditioned media (CM) transfers. Gene expression, permeability and chemotaxis assays, immunofluorescent staining, and ELISAs assessed cellular responses. Results: MDMs exposed to shear stress exhibited a pro-inflammatory response with upregulated TNF and CXCL8 genes. HAECs exposed to MDM-CM showed increased expression of inflammatory markers (VCAM-1, ICAM-1) and decreased VE-Cadherin and CD31, indicating increased permeability. Permeability assays confirmed that HAECs became more permeable when exposed to MDM-CM. Chemotaxis assays showed time-dependent monocyte migration in both MDM-CM and HAEC-CM. Immunofluorescent staining revealed diminished VE-Cadherin and CD31 in HAECs exposed to MDM-CM. Conclusions: Overall, pathological shear stress induced macrophages to secrete factors that increased endothelial permeability and perpetuated an inflammatory response. This interaction likely exacerbates fibrosis in DSS, promoting recurrence post-surgery. Understanding these mechanisms opens potential therapeutic avenues targeting inflammatory crosstalk between macrophages and endothelial cells, which could mitigate fibrosis and improve patient outcomes.