While shear stress theoretically induced by Impella could activate nuclear factor kappa B (NF-κB), promoting endothelial dysfunction and inflammation, proteomic studies have demonstrated that Impella suppresses NF-κB, leading to a reduction in monocyte adhesion and migration through chemokine ligands 3 downregulation [19]. The gene discussed is NFKB1; the disease is endothelial dysfunction.