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The imbalance between the production of reactive oxygen species (ROS) and the availability of antioxidants or free radical scavengers can cause oxidative stress, and that further activates an abundance of transcription factors and pro-inflammatory genes such as NF-B, p53, HIF-1, PPAR-, -catenin/Wnt, and Nrf2 [5,6,7]

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After the fibrous cap formation, rupturing of the fibrous cap can be seen at the site of thinning of the fibrous cap which occurs due to continuing influx and activation of macrophages that release metalloproteinase and other proteolytic enzymes which leads to thinning of fibrous cap