Syndecan 4 is required for endothelial alignment in flow and atheroprotective signaling

Significance Atherosclerosis, the major cause of death and illness in industrialized nations, develops in regions of arteries in which fluid flow patterns are disturbed and endothelial cells fail to align in the direction of flow. In contrast, regions of laminar flow in which cells are aligned are protected. The current work shows that the transmembrane proteoglycan syndecan 4 is required for endothelial cell alignment in the direction of flow and for the protective effect of high laminar flow, yet other flow responses are intact. The data therefore identify a role for syndecan 4 in flow direction sensing, show that sensing flow direction is separable from sensing flow magnitude, and provide new support for the key role of cell alignment in atheroprotection. Atherosclerotic plaque localization correlates with regions of disturbed flow in which endothelial cells (ECs) align poorly, whereas sustained laminar flow correlates with cell alignment in the direction of flow and resistance to atherosclerosis. We now report that in hypercholesterolemic mice, deletion of syndecan 4 (S4−/−) drastically increased atherosclerotic plaque burden with the appearance of plaque in normally resistant locations. Strikingly, ECs from the thoracic aortas of S4−/− mice were poorly aligned in the direction of the flow. Depletion of S4 in human umbilical vein endothelial cells (HUVECs) using shRNA also inhibited flow-induced alignment in vitro, which was rescued by re-expression of S4. This effect was highly specific, as flow activation of VEGF receptor 2 and NF-κB was normal. S4-depleted ECs aligned in cyclic stretch and even elongated under flow, although nondirectionally. EC alignment was previously found to have a causal role in modulating activation of inflammatory versus antiinflammatory pathways by flow. Consistent with these results, S4-depleted HUVECs in long-term laminar flow showed increased activation of proinflammatory NF-κB and decreased induction of antiinflammatory kruppel-like factor (KLF) 2 and KLF4. Thus, S4 plays a critical role in sensing flow direction to promote cell alignment and inhibit atherosclerosis.