Importantly, RNF20 levels in TOF patients showed a significant negative correlation with genes involved in supramolecular fiber organization, including TGFB1 and other canonical TGF-β target genes, such as TGFB1I1, TAGLN, LOXL1, collagens, as well as NPPA and NPPB in CHD patients with decreased levels of RNF20 (Fig. 8b, Supplementary Fig. 9, Supplementary Data 6), further supporting a function of the increased TGF-ß signaling in CHD pathogenesis upon RNF20 loss. This evidence concerns the gene NPPB and coronary artery disorder.