The role of TGF-beta signaling in atherosclerosis is complex, and it is possible that increased expression of HTRA1 by phenotypically modulated smooth muscle cells and endothelial cells inhibits atherogenic TGF-beta signaling, thereby preventing neointima formation and pathogenic EndoMT similar to neointima formation seen in CARASIL.48 The gene discussed is HTRA1; the disease is atherosclerosis.