“…Pathogenic mutations in TGF-β signaling, such as ENG, ALK1 gene mutations, are associated with type 1 and type 2 hereditary hemorrhagic telangiectasia (HHT), as well as Loeys-dietz syndrome with cerebrovascular events ( McAllister et al, 1994 ; Cunha et al, 2017 ; Laterza et al, 2019 ). Some genome-wide association studies (GWAS) or whole exome trio sequencing have uncovered various pathogenic gene variants in the TGF-β pathway, which are associated with small vessel ischemic strokes, intracerebral hemorrhages and sporadic brain AVMs ( Weinsheimer et al, 2016 ; Yilmaz et al, 2017 ; Wang et al, 2018 ; Chung et al, 2019 ). Increased expression of TGF-β1 has been found in the brain tissue after ischemic stroke, as well as in hereditary cerebral hemorrhage with amyloidosis-Dutch type ( Krupinski et al, 1996 ; Grand Moursel et al, 2018 ), while a recent transcriptome-wide RNA sequencing study revealed that TGF-β signaling was downregulated in patients with brain AVMs ( Hauer et al, 2020 ).…”