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Shear stress–induced endothelial adrenomedullin signaling regulates vascular tone and blood pressure
Andras Iring, Young-June Jin, Julián Albarrán-Juárez, Mauro Siragusa, ShengPeng Wang, Péter T. Dancs, Akiko Nakayama, Sarah Tonack, Min Chen, Carsten Künne, Anna M. Sokol, Stefan Günther, Alfredo Martínez, Ingrid Fleming, Nina Wettschureck, Johannes Graumann, Lee S. Weinstein, Stefan Offermanns
Andras Iring, Young-June Jin, Julián Albarrán-Juárez, Mauro Siragusa, ShengPeng Wang, Péter T. Dancs, Akiko Nakayama, Sarah Tonack, Min Chen, Carsten Künne, Anna M. Sokol, Stefan Günther, Alfredo Martínez, Ingrid Fleming, Nina Wettschureck, Johannes Graumann, Lee S. Weinstein, Stefan Offermanns
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Research Article Vascular biology

Shear stress–induced endothelial adrenomedullin signaling regulates vascular tone and blood pressure

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Abstract

Hypertension is a primary risk factor for cardiovascular diseases including myocardial infarction and stroke. Major determinants of blood pressure are vasodilatory factors such as nitric oxide (NO) released from the endothelium under the influence of fluid shear stress exerted by the flowing blood. Several endothelial signaling processes mediating fluid shear stress–induced formation and release of vasodilatory factors have been described. It is, however, still poorly understood how fluid shear stress induces these endothelial responses. Here we show that the endothelial mechanosensitive cation channel PIEZO1 mediated fluid shear stress–induced release of adrenomedullin, which in turn activated its Gs-coupled receptor. The subsequent increase in cAMP levels promoted the phosphorylation of endothelial NO synthase (eNOS) at serine 633 through protein kinase A (PKA), leading to the activation of the enzyme. This Gs/PKA-mediated pathway synergized with the AKT-mediated pathways leading to eNOS phosphorylation at serine 1177. Mice with endothelium-specific deficiency of adrenomedullin, the adrenomedullin receptor, or Gαs showed reduced flow-induced eNOS activation and vasodilation and developed hypertension. Our data identify fluid shear stress–induced PIEZO1 activation as a central regulator of endothelial adrenomedullin release and establish the adrenomedullin receptor and subsequent Gs-mediated formation of cAMP as a critical endothelial mechanosignaling pathway regulating basal endothelial NO formation, vascular tone, and blood pressure.

Authors

Andras Iring, Young-June Jin, Julián Albarrán-Juárez, Mauro Siragusa, ShengPeng Wang, Péter T. Dancs, Akiko Nakayama, Sarah Tonack, Min Chen, Carsten Künne, Anna M. Sokol, Stefan Günther, Alfredo Martínez, Ingrid Fleming, Nina Wettschureck, Johannes Graumann, Lee S. Weinstein, Stefan Offermanns

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Figure 8

Model of the role of the adrenomedullin receptor and its downstream signaling pathway in flow-induced phosphorylation of eNOS.

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Model of the role of the adrenomedullin receptor and its downstream sign...
Laminar flow activates the mechanosensitive cation channel PIEZO1, resulting in the release of adrenomedullin (ADM), which in an autocrine or paracrine fashion activates its receptor consisting of CALCRL and RAMP2, which then through activation of the heterotrimeric G protein Gs results in the stimulatory regulation of adenylyl cyclase (AC). The increase in cAMP levels leads to activation of protein kinase A (PKA), which phosphorylates murine eNOS at serine 632, resulting in the activation of the enzyme and increased NO formation. This pathway acts synergistically with Gq/G11-mediated activation of the mechanosensitive complex consisting of PECAM-1, VE-cadherin, and VEGFR2, which phosphorylates eNOS at serine 1176 via PI3K and AKT. The latter pathway is also induced by laminar flow through PIEZO1 activation and ATP release acting on the Gq/G11-coupled purinergic P2Y2 receptor. PDE, phosphodiesterase.

Copyright © 2026 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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