Decoding vascular aging: Substrate stiffness and shear stress orchestrate endothelial inflammation and remodelling via mechanosensitive pathways

Vascular ageing is a major contributor to cardiovascular disease and is closely linked to vascular stiffness. Stiffening of the vascular wall disrupts endothelial homeostasis and promotes chronic inflammation, yet the underlying mechanisms remain poorly understood due to technological limitations. Here, we used a previously developed in vitro microfluidic model to investigate how biomechanical forces, specifically substrate stiffness and shear stress, interact to regulate endothelial cell behaviour. Using RNA sequencing and functional assays, we found that endothelial cells exposed to both physiological and high levels of shear stress were more sensitive to increases in substrate stiffness. Under these conditions, the cells exhibited a greater number of differentially expressed genes and enhanced activation of inflammatory signalling pathways, suggesting that mechanical stiffening promotes endothelial inflammation and contributes to vascular ageing. We identified enriched pathways involved in inflammatory signalling and extracellular matrix (ECM) remodelling in response to substrate stiffness. Endothelial cells exposed to high shear stress and increased stiffness showed up-regulation of genes such as ICAM1, VCAM1, LAMB3, and MMP28, which are known to mediate leukocyte adhesion and ECM remodelling. Importantly, benchmarking our engineered in vitro microfluidic model using human aortic tissue confirmed concordant molecular and histological changes between stiff (aged) and soft (healthy) aortas. Ultimately, this validated microfluidic platform provides proof of concept that biomechanical forces characteristic of vascular ageing drive endothelial inflammation and vascular remodelling, offering new mechanistic insight and a powerful experimental framework to advance therapeutic strategies targeting vascular stiffness and age-related vascular disease.