In contrast, Miyagawa et al., demonstrated that contact-mediated communication between SMC and EC activates EC derived Notch1 and alters the cells epigenome in order to regulate Notch1-dependent genes that maintain endothelial integrity and prevent pulmonary vascular remodeling in a murine model of hypoxia-induced pulmonary hypertension [126]. Here, NOTCH1 is linked to pulmonary hypertension.