(ECs) in the direction of the flow is considered a key factor in maintaining endothelial integrity in an active hemodynamic environment. Our recent studies showed that exposure to oxidized LDL (oxLDL), one of the major proatherogenic lipoproteins, significantly increases the stiffness of human aortic ECs, suggesting that oxLDL may have a significant impact on the sensitivity of ECs to mechanical stimuli. In this study, we show that oxLDL strongly enhances the ability of ECs to realign in the direction of the flow and facilitates the formation of F-actin stress fibers under static and flow conditions. The impact of oxLDL on the flow-induced realignment is observed on whole cell and single-fiber levels. We also show that, similar to the effect of oxLDL on endothelial stiffness, the impact of oxLDL on flow-induced realignment can be simulated by methyl--cyclodextrininduced cholesterol depletion, supporting the hypothesis that oxLDL acts as cholesterol acceptor, rather than cholesterol donor, for ECs. Finally, we propose that oxLDL/cholesterol depletion-induced sensitization of ECs to flow may be a result of an increase in cellular stiffness and a respective increase in membrane-cytoskeleton tension.cholesterol; lipid rafts HEMODYNAMIC FORCES GENERATED by blood flow are known to play prominent roles in the acute control of vascular tone, regulation of arterial structure, and localization of atherosclerotic lesions (12,19,31). The primary tissue that is affected by the hemodynamic environment is vascular endothelium, a single-cell layer that constitutes the inner lining of the blood vessels and exists on the blood-vascular wall interface. Multiple studies have shown that endothelial cells (ECs) respond to flow by a variety of mechanisms, including cytoskeleton rearrangement, activation of multiple signaling pathways, and changes in gene expression (for review see 24,25,34). Although the exact mechanisms responsible for conversion of mechanical stimuli to the biological responses are not fully understood, it is generally accepted that the cytoskeleton provides the structural framework for transmission of mechanical signals throughout the cell. Flow-induced changes of endothelial morphology, such as realignment in the direction of flow and cell elongation, are suggested to be important for maintaining endothelial integrity in active flow environments (9,20,25).Our recent studies showed that endothelial mechanical properties are strongly affected by exposure of cells to the oxidized form of low-density lipoproteins (oxLDL) (6). More specifically, exposure to oxLDL, but not the unoxidized form of LDL, resulted in a significant decrease in the deformability/increase in stiffness of aortic ECs, as measured by micropipette aspiration (microaspiration), as well as an increase in the ability of ECs to generate force on the cell-substrate interface (6). Depletion of cellular cholesterol had the same effect (6) and also increased membrane-cytoskeleton adhesion (37). Multiple studies have shown that deformability of the cellu...