TGFB1 and endothelial dysfunction: In addition, endothelial dysfunction is closely related to ECM and VSMC alterations, as endothelial cells modulate VSMC behavior via pleiotropic effects (e.g., eNOS derives NO and interactions via the ECM, extracellular vesicles, transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF), and Notch signaling).99,100