Bone morphogenic protein 4 (BMP4), which falls into the transforming growth factors-β (TGF-β) superfamily, plays an essential role in cartilage formation, bone mineralization, and early embryonic development.1 BMP4 and BMP2 both bind to the BMPRII, which then dimerize with BMPRI. The dimerization and phosphorylation of BMPRI leads to the activation of canonical Smad1/5/8 in the cytoplasm. Smad1/5/8 associates with co-Smad, Smad4, and translocate to the nucleus. This Smad complex will bind to the Smadresponsive element and induce the transcription of Smad-target genes.3 In addition to the canonical Smad signaling, BMP4 also activates ERK (extracellular signal-regulated kinases) and p38/JNK non-Smad pathway in certain cell types for finetuning of its action. 3,4 In the cardiovascular system, mutations or anomalies of BMP are associated with the development of pulmonary hypertension, cardiovascular calcification, stroke, and type 2 diabetes mellitus. 5 In the vasculature, BMP4 acts as a proinflammatory cytokine to stimulate superoxide anion production and exerts inflammatory effects through NADPH oxidases. BMP4 expression is upregulated in human calcified atherosclerotic plaques, 6 and oscillatory sheer stress induces endothelial expression of BMP4.7 BMP4 increases the expression and activity of cyclooxygenase-2 and, in turn, the production of vasoconstrictive prostanoids to impair endothelial function in arteries from rats, mice, and human.8 BMP4 also induces endothelial cell apoptosis through oxidative stress, 9 and it stimulates protein carbonylation involved in endothelial dysfunction.10 BMP4 enhances foam cell formation by © 2016 American Heart Association, Inc. Objective-Bone morphogenic protein 4 (BMP4) is an important mediator of endothelial dysfunction in cardio-metabolic diseases, whereas platelet-derived growth factors (PDGFs) are major angiogenic and proinflammatory mediator, although the functional link between these 2 factors is unknown. The present study investigated whether PDGF mediates BMP4-induced endothelial dysfunction in diabetes mellitus. Approach and Results-We generated Ad-Bmp4 to overexpress Bmp4 and Ad-Pdgfa-shRNA to knockdown Pdgfa in mice through tail intravenous injection. SMAD4-shRNA lentivirus, SMAD1-shRNA, and SMAD5 shRNA adenovirus were used for knockdown in human and mouse endothelial cells. We found that PDGF-AA impaired endothelium-dependent vasodilation in aortas and mesenteric resistance arteries. BMP4 upregulated PDGF-AA in human and mouse endothelial cells, which was abolished by BMP4 antagonist noggin or knockdown of SMAD1/5 or SMAD4. BMP4-impared relaxation in mouse aorta was also ameliorated by PDGF-AA neutralizing antibody. Tail injection of Ad-Pdgfa-shRNA ameliorates endothelial dysfunction induced by Bmp4 overexpression (Ad-Bmp4) in vivo. Serum PDGF-AA was elevated in both diabetic patients and diabetic db/db mice compared with nondiabetic controls. Pdgfa-shRNA or Bmp4-shRNA adenovirus reduced serum PDGF-AA concentration in db/db mice. PDGF-AA neutralizing antibody or ...