It has also been shown that uremia induces the differentiation of vascular smooth muscle cells (VSMCs) – the most important component of the media of arteries – into osteoblast-like cells due to up-regulation of transcription factors, such as Runt-related transcription factor 2 (Runx2) and Msh homebox 2 (Msx2) and increased alkaline phosphatase activity [25]. Here, MSX2 is linked to uremia.