SMAD4 and hereditary hemorrhagic telangiectasia: Causative genes identified to date are ENG (encodes endoglin; mutations account for the HHT1 phenotype) [7] and ACVRL1 (encodes activin receptor-like kinase 1; mutations account for the HHT2 phenotype) [8] in 85% of HHT families, SMAD4, accounting for the juvenile polyposis–HHT phenotype, in 2% of HHT families [9] and GDF2 (encodes bone morphogenic protein 9; mutations account for the extremely rare HHT5 phenotype) [10].