Inhibition of EndoMT can alleviate cardiac fibrosis.256,257 Transforming growth factor-β (TGF-β) is believed to play a crucial role in fibrosis associated with EndoMT in various cardiovascular diseases.257,258 A discovery was made indicating that lactate promotes cardiac fibrosis and exacerbates cardiac dysfunction following MI by promoting EndoMT.259 Under hypoxic conditions, lactate activates the TGF-β/Smad2 signaling pathway in ECs to facilitate EndoMT. Here, SMAD2 is linked to myocardial infarction.