Thus, sEng synergizes with hypercholesterolemia to aggravate endothelial and vessel wall dysfunction in vivo [43,45] and shows pro-inflammatory activity via nuclear factor-kappa B (NFkB) and interleukin 6 (IL6) in human endothelial cells in vitro [78]. Here, NFKB1 is linked to familial hypercholesterolemia.