It is now accepted that interventions in early diseaseare the best possible way to modify disease course.20 Interestingly, Gremlin-1 has also been found to be critically involved inhereditary pulmonary hypertension in mice and patients with hereditary pulmonaryhypertension.21 It is possible that there is an interrelationship between IL-6 andGremlin-1 levels. The gene discussed is GREM1; the disease is pulmonary hypertension.