While Notch, Wnt, the Nuclear Factor-kappa B (NF-κB), TNFα, Endothelin-1 (ET-1) and Caveolin-1 (Cav-1) signaling pathways as well as hypoxia, oxidative stress, hyperglycemia, dyslipidemia and shear stress forces represent EndMT-inducing stimuli (21), the downstream signaling pathways of EndMT are not fully characterized. Here, TNF is linked to Hyperglycemia.