Atherosclerosis is enhanced in arterial segments exposed to disturbed flow. Perturbed shear stress increases the expression of oxidation-sensitive responsive genes (such as ELK-1 and p-JUN) in the endothelium. Evidence suggests that polyphenolic antioxidants contained in the juice derived from the pomegranate can contribute to the reduction of oxidative stress and atherogenesis. The aim of the present study was to evaluate the effects of intervention with pomegranate juice (PJ) on oxidation-sensitive genes and endothelial NO synthase (eNOS) expression induced by high shear stress in vitro and in vivo. Cultured human coronary artery endothelial cells (EC) exposed to high shear stress in vitro and hypercholesterolemic mice were used in this study. PJ concentrate reduced the activation of redox-sensitive genes (ELK-1 and p-JUN) and increased eNOS expression (which was decreased by perturbed shear stress) in cultured EC and in atherosclerosis-prone areas of hypercholesterolemic mice. Moreover, oral administration of PJ to hypercholesterolemic mice at various stages of disease reduced significantly the progression of atherosclerosis. This experimental study indicates that the proatherogenic effects induced by perturbed shear stress can be reversed by chronic administration of PJ. This approach may have implications for the prevention or treatment of atherosclerosis and its clinical manifestations.V ascular endothelial cells (EC) are constantly subjected to hemodynamic forces inducing shear stress, which stimulates physiologically the release of NO by constitutively expressed endothelial NO synthase (eNOS) (1). Perturbed shear stress alone or high shear stress associated with other classical risk factors of atherosclerosis may trigger signal transduction events that in turn may lead to endothelial dysfunction and enhanced atherogenesis (2-4). It has been demonstrated that areas highly prone to atherosclerosis have unique patterns of disturbed flow, characterized by regions of flow separation, recirculation, and temporal and spatial gradients of shear stress (4). Furthermore, vascular EC under perturbed shear stress increase their production of reactive oxygen species and other free radicals that are capable of inducing oxidative stress (5-12). NO controls vascular oxidative stress and the expression of redox-regulated genes (13,14). Evidence exists that eNOS activity is reduced at sites of perturbed shear stress (2, 5-8, 11).There is an abundant mythological and ancient history regarding the pomegranate fruit (15)(16)(17)(18)(19)(20). In Greece, pomegranate fruit (Punica granatum L.) was known as the ''fruit of the dead,'' and in the Hebrew tradition, pomegranates adorned the vestments of the high priest. In Babylonia, the pomegranate was an agent of resurrection, and the Persians believed that pomegranate seeds conferred invincibility on the battlefield. In China, the pomegranate fruit symbolized longevity. The fruit of the pomegranate (Ϸ50% of total pomegranate weight) consists of 80% juice and 20% seeds. The fresh ...