The Transcription Factor TWIST‐Related Protein 1 in Atherosclerosis

ABSTRACT TWIST‐related protein 1 (TWIST1), a basic helix–loop–helix transcription factor, participates in embryonic development and tissue homeostasis. TWIST1 significantly contributes to the pathogenesis of vascular disorders, including pulmonary arterial hypertension, tumor angiogenesis, obesity, and ocular angiogenesis. Functioning as a shear stress‐responsive transcription factor within endothelial cells, TWIST1 governs embryonic angiogenesis and drives localized endothelial dysfunction alongside atherosclerosis in adult vasculature. This review focuses on TWIST1, synthesizing current knowledge of its biological roles in vascular pathologies, encompassing endothelial‐to‐mesenchymal transition (EndMT), smooth muscle cell phenotypic modulation, and macrophage polarization. A comprehensive understanding of TWIST1’s mechanisms in vascular disease pathogenesis holds promise for developing novel therapeutic strategies.