“…GAG chain hyperelongation occurs by growth factor stimulation of the expression of the GAG chain synthesizing enzymes in vascular smooth muscle cells (VSMCs) Ivey and Little, 2008;Yang et al, 2009;Burch et al, 2010;Cardoso et al, 2010;Yang et al, 2010;Osman et al, 2014). Prevention of this change in proteoglycan structure by targeting the hormone and growth factor signalling pathways has been proposed and demonstrated as a therapeutic target to prevent atherosclerosis (Ballinger et al, 2004;Little et al, 2007;Osman et al, 2008;Little et al, 2011); the signalling pathways are the preferred target because these pathways are specific for VSMCs which is not the case for the action of the elongation enzymes themselves which are ubiquitously expressed and functional in most tissues of the body.…”