“…Furthermore, MMP2 was found to be upregulated in PXE fibroblasts; MGP was found to be highly uncarboxylated and thus inactive to counteract soft tissue mineralization; multiple pro-osteogenic pathways, that is, the BMP2-Smad-RUNX2 (BMP2: bone morphogenetic protein 2, OMIM ∗ 112261; Smad: mothers against decapentaplegic, Drosophila , homolog of, OMIM ∗ 601366; RUNX2: runt-related transcription factor 2, OMIM ∗ 60021) and TGF β 2-Smad2/3 WNT pathways (TGF β 2: transforming growth factor, β 2, OMIM ∗ 190220) and the MSX2-canonical WNT (MSX2: muscle segment homeobox, Drosophila , homolog of, 2, OMIM ∗ 123101; canonical WNT: wingless-type MMTV integration site family, OMIM ∗ 164820), were found to be upregulated in fibroblasts from PXE patients and were associated with an abnormal cholesterol and lipoprotein metabolism, reinforcing the higher cardiovascular risk found in PXE patients [ 15 , 25 , 81 , 82 ]. Very recently, Dabisch-Ruthe et al identified a strong reduction of the inorganic pyrophosphate (PPi) levels in dermal PXE fibroblasts leading to ectopic mineralization.…”