Previous studies have shown that there is a positive feedback interplay between VSMC-derived PCSK9 and mitochondrial DNA (mtDNA) damage in the proinflammatory milieu that involves mitochondrial reactive oxygen species (mtROS); this feedback loop results in inflammation, oxidative stress, and apoptosis, which directly contribute to atherosclerosis (42). The gene discussed is PCSK9; the disease is atherosclerosis.