Platelet-derived serotonin (5-HT) is involved in liver regeneration. The liver is also the metastatic site for malignant enterochromaffin (EC) cell "carcinoid" (neuroendocrine) neoplasms, the principal cellular source of 5-HT. We hypothesized that 5-HT produced by metastatic EC cells played a role in the hepatic tumor-microenvironment principally via 5-HT 7 receptor-mediated activation of hepatocyte IGF-1 synthesis and secretion. Using isolated rat hepatocytes, we evaluated 5-HT 7 receptor expression (using PCR, sequencing and western blot). ELISA, cell transfection and western blots delineated 5-HT-mediated signaling pathways (pCREB, AKT and ERK). IGF-1 synthesis ⁄ secretion was evaluated using QPCR and ELISA. IGF-1 was tested on small intestinal neuroendocrine neoplasm proliferation, while IGF-1 production and 5-HT 7 expression were examined in an in vivo SCID metastasis model. Our results demonstrated evidence for a functional 5-HT 7 receptor. 5-HT activated cAMP ⁄ PKA activity, pCREB (130-205%, P < 0.05) and pERK ⁄ pAKT (1.2-1.75, P < 0.05). Signaling was reversed by the 5-HT 7 receptor antagonist SB269970. IGF-1 significantly stimulated proliferation of two small intestinal neuroendocrine neoplasm cell lines (EC 50 : 7-70 pg ⁄ mL) and could be reversed by the small molecule inhibitor BMS-754807. IGF-1 and 5-HT were elevated (40-3003) in peri-tumoral hepatic tissue in nude mice, while 5-HT 7 was increased fourfold compared to sham-operated animals. We conclude that hepatocytes express a cAMP-coupled 5-HT 7 receptor, which, at elevated 5-HT concentrations that occur in liver metastases, signals via CREB ⁄ AKT and is linked to IGF-1 synthesis and secretion. Because IGF-1 regulates NEN proliferation, identification of a role for 5-HT 7 in the hepatic metastatic tumor microenvironment suggests the potential for novel therapeutic strategies for amine-producing mid-gut tumors. (Cancer Sci 2013; 104: 844-855) S erotonin, also known as 5-hydroxytryptamine (5-HT), is a biogenic amine produced by enterochromaffin (EC) cells of the gastrointestinal tract.(1) In the blood, 5-HT is carried by platelets (2) and exported to various sites in the body, where it produces mitogenic effects.(3-6) Recently, 5-HT has been considered a modifier of liver function (7) due to the autonomic nervous system input (8) as well as the blood flow within this organ.(9) This amine is thought to regulate proliferation and function of a number of key resident liver cells, including hepatocytes, stellate cells and sinusoidal endothelial cells. (10) 5-HT 1A,1B,1D,1F,2A,2B,2C,3A,3B receptors are known to be expressed on hepatocytes.(10,11) While the 5-HT 1 family inhibits cAMP, (12) 5-HT 2 receptors signal through PLC and 5-HT 4,6,7 receptors stimulate PKA ⁄ cAMP. Neither the complete 5-HT receptor profile nor the intracellular pathways associated with 5-HT-mediated stimulation of hepatocyte function are known.(7) We hypothesized that PKA-dependent as well as PKA-independent cAMP effects and AKT signaling are linked to 5-HT driven hepatocyte st...