The incubation of VSMCs with Ex-4 precisely regulates the proliferation of these cells through inhibiting NOR1 promoter activity.76 In patients with pulmonary arterial hypertension (PAH), a serious disorder which affects near to 30% of patients suffering from congenital heart disease is originated from extreme pulmonary blood flow due to excessive drug use, a genetic mutation in different factors like bone morphogenetic protein receptor type II.77,78 By applying Ex-4, the improvement of PAH is initiated via the reduction of pro-inflammatory cytokines interleukin-1α and 1β in PAH rats. This evidence concerns the gene BMPR2 and pulmonary arterial hypertension.