P ulmonary arterial hypertension (PAH) is an obstructive vascular pathology affecting the small pulmonary arteries (PAs). It is characterized by enhanced inflammation, vasoconstriction, and proliferation/apoptosis imbalance within the artery wall, leading to increased pulmonary vascular resistance, right ventricular (RV) failure and death.1 PAH is a rare disease with an estimated prevalence of 15 to 50 cases/million 2 and its prevalence is thought to be highly underestimated [3][4][5][6] because of lack of symptom specificity. Despite recent therapeutic advances using vasodilator therapies, 1 most patients exhibit persistent poor exercise capacity and quality of life and their prognosis remains poor with a 3-year survival of 55% to 65%. 4,6,7 As in cancer, PAH is associated with sustained DNA damage, which accounts for a poly(ADP ribose) polymerase 1-dependent downregulation of and the activation of the nuclear factor of activated T cells (NFATs).8 The miR-204/NFAT axis affects mitochondrial function, bioenergetic profile and promotes the expression of oncogenes implicated in PAH, including B-cell lymphoma 2 (Bcl-2) and Survivin. 9,10 This results in the proproliferative and antiapoptotic phenotype of PAH pulmonary artery smooth muscle cells (PASMCs).