Vascular smooth muscle cells (VSMCs) play fundamental roles in the pathophysiology of atherosclerosis. A crucial step in VSMC biology is the switch from contractile (differentiated, quiescent, non-migratory) to synthetic (dedifferentiated, proliferative, migratory) phenotypes (Fig. 1). The exact mechanisms underlying VSMC phenotypic switch are not fully known and various pieces of information have been recently added to this puzzle [1-5]. For instance, in this issue of Atherosclerosis, Bente Halvorsen's team elegantly demonstrates that Neil3, known to participate in DNA repair, can mediate VSMC phenotypic switch via non-canonical mechanisms [6]. Intriguingly, Neil3 deficiency was shown for the first time to trigger a shift in VSMC phenotype towards a proliferating, lipid-accumulating, and secretory macrophage-like cell phenotype, without major changes in DNA damage [6].We report herein a concise overview of the main mechanisms regulating VSMC phenotypic switch, mainly relying on transcription factors and epigenetic mechanisms.