A Nrf2-OSGIN1&2-HSP70 axis mediates cigarette smoke-induced endothelial detachment : implications for plaque erosion

Sandro Satta, Robert Beal, Ryhs Smith, Xing Luo, Glenn Ferris, Alex Langford-Smith, Jack Teasdale, Tom Ajime, Jef Serre, Georgina Hazell, Graciela B Sala-Newby, Jason L Johnson, Svitlana Kurinna, Martin Humphries, Ghislaine Gayan-Ramirez, Peter Libby, Hans Degens, Bo Yu, Thomas W Johnson, Yvonne AlexanderHaibo Jia, Andrew C Newby, Stephen White*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

6 Citations (Scopus)


Endothelial erosion of plaques is responsible for ∼30% of acute coronary syndromes (ACS). Smoking is a risk factor for plaque erosion, which most frequently occurs on the upstream surface of plaques where the endothelium experiences elevated shear stress. We sought to recreate these conditions in vitro to identify potential pathological mechanisms that might be of relevance to plaque erosion.

Methods and results
Culturing human coronary artery endothelial cells (HCAECs) under elevated flow (shear stress of 7.5 Pa) and chronically exposing them to cigarette smoke extract (CSE) and tumour necrosis factor-alpha (TNFα) recapitulated a defect in HCAEC adhesion, which corresponded with augmented Nrf2-regulated gene expression. Pharmacological activation or adenoviral overexpression of Nrf2 triggered endothelial detachment, identifying Nrf2 as a mediator of endothelial detachment. Growth/Differentiation Factor-15 (GDF15) expression was elevated in this model, with protein expression elevated in the plasma of patients experiencing plaque erosion compared with plaque rupture. The expression of two Nrf2-regulated genes, OSGIN1 and OSGIN2, was increased by CSE and TNFα under elevated flow and was also elevated in the aortas of mice exposed to cigarette smoke in vivo. Knockdown of OSGIN1&2 inhibited Nrf2-induced cell detachment. Overexpression of OSGIN1&2 induced endothelial detachment and resulted in cell cycle arrest, induction of senescence, loss of focal adhesions and actin stress fibres, and disturbed proteostasis mediated in part by HSP70, restoration of which reduced HCAEC detachment. In ACS patients who smoked, blood concentrations of HSP70 were elevated in plaque erosion compared with plaque rupture.

We identified a novel Nrf2-OSGIN1&2-HSP70 axis that regulates endothelial adhesion, elevated GDF15 and HSP70 as biomarkers for plaque erosion in patients who smoke, and two therapeutic targets that offer the potential for reducing the risk of plaque erosion.
Original languageEnglish
Article numbercvad022
Pages (from-to)1869-1882
Number of pages14
JournalCardiovascular Research
Issue number9
Early online date18 Feb 2023
Publication statusPublished - 1 Jul 2023

Bibliographical note

Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.

Structured keywords

  • Bristol Heart Institute


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