20-HETE: Its potential role in physiological and pathophysiological processes

20-Hydroxyeicosatetraenoic acid (20-HETE) is a critical regulator of multiorgan homeostasis. Physiologically, it maintains vascular tone by promoting vascular smooth muscle cell (VSMC) contraction and stabilizes blood pressure. Concurrently, 20-HETE facilitates vascular VSMC and endothelial cell proliferation and migration. This dual action drives vascular repair and remodeling. Through modulation of nitric oxide (NO) metabolism, it further regulates endothelial function. Pathologically, however, excessive 20-HETE synthesis associates with metabolic disorders. These include hypertension, obesity, diabetes, and non-alcoholic fatty liver disease. Importantly, 20-HETE exhibits organ-specific dual roles: (1) Renal - While maintaining sodium homeostasis, regulating renal blood flow, and modulating blood pressure under physiological conditions, it paradoxically promotes renal fibrosis and tubular injury in pathological states. (2) Brain - Physiologically preserves cerebrovascular homeostasis through vascular myogenic control of cerebral blood flow autoregulation and blood-brain barrier integrity; pathologically exacerbates cerebral injury via oxidative endothelial damage and neuroinflammatory pathways. (3) Lung - Sustains vascular function by stimulating NO-mediated pulmonary artery vasodilation and maintaining cellular viability through moderate reactive oxygen species modulation. Although drug development targeting 20-HETE has demonstrated therapeutic potential in animal models, using synthetic enzyme inhibitor HET0016 and receptor antagonist AAA, its clinical translation still faces challenges related to dual signaling pathways and precise targeting. Understanding the mechanism of action and regulatory pathways of 20-HETE may open new avenues for the diagnosis and treatment of these diseases.