In 2017, Hay et al. demonstrated that severe CRS was accompanied by endothelial activation, in which the biomarkers of endothelial activation (angiopoietin-2 and von Willebrand factor) increased significantly.34 Additionally, the presence of vascular leakage and disseminated intravascular coagulation in patients with severe CRS was consistent with widespread endothelial activation. The gene discussed is VWF; the disease is congenital rubella syndrome.