Since Twist1 is a mechanosensitive gene and senses ECM stiffness (Fattet et al., 2020) and contributes to mechanosensitive pathology [e.g., pulmonary fibrosis (Mammoto et al., 2016), pulmonary hypertension (Mammoto et al., 2018, 2020), cancer (Fattet et al., 2020), atherosclerosis (Mahmoud et al., 2016, 2017)], Twist1 may sense changes in the ECM microenvironment in the obese adipose tissues and control angiogenesis and adipogenesis. The gene discussed is TWIST1; the disease is pulmonary arterial hypertension.