Concerning the potential biological significance of this in AAA, although in cell culture physical hypoxia was a discrete modulator of NOR-1/cIAP2 and a poor inducer of human VSMC apoptosis, it should be taken into account that not only hypoxia but also inflammation, a well known inducer of NOR-1 and a trigger of apoptosis48, 49, may work in concert producing additive or synergistic effects on gene expression and cell apoptosis. Here, BIRC3 is linked to triple-A syndrome.