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When compared with the control, at a concentration of 20 % and an incubation period of 48 h, the WPSE significantly increased the levels of lactate dehydrogenase, and markers of oxidative stress including thiobarbituric acid reactive substances, superoxide dismutase, catalase, and reduced glutathione. Moreover, the concentrations of proinflammatory cytokine (tumor necrosis factor \u03b1), and adhesion molecules (E-selectin and intercellular adhesion molecule-1) were also significantly augmented. Likewise, WPSE triggered mitochondrial dysfunction, DNA oxidative damage, as well as apoptosis in TeloHAEC cells. Similarly, cells cultured with WPSE have shown increased expression of phosphorylated nuclear factor-\u03baB and hypoxia-inducible factor 1-\u03b1 (HIF-1\u03b1). In conclusion, our study showed that WPSE triggers endothelial inflammation, oxidative stress, DNA damage, mitochondrial dysfunction, and apoptosis via mechanisms involving the activation of nuclear factor-\u03baB and HIF-1\u03b1.<\/jats:p>","DOI":"10.33549\/physiolres.935409","type":"journal-article","created":{"date-parts":[[2025,3,24]],"date-time":"2025-03-24T12:14:55Z","timestamp":1742818495000},"page":"69-78","source":"Crossref","is-referenced-by-count":3,"title":["Direct Effects of Waterpipe Smoke Extract on Aortic Endothelial Cells: An In Vitro Study"],"prefix":"10.33549","author":[{"given":"N","family":"Zaaba","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Yuvaraju","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Beegam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O","family":"Elzaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Arafat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Attoub","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Nemmar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"19169","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"1.\tTaati B, Arazi H, Suzuki K. 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