Increased peripheral resistance of small distal pulmonary arteries is a hallmark signature of pulmonary hypertension (PH) and is believed to be the consequence of enhanced vasoconstriction to agonists, thickening of the arterial wall due to remodeling, and increased thrombosis. The elevation in arterial tone in PH is attributable, at least in part, to smooth muscle cells of PH patients being more depolarized and displaying higher intracellular Ca 2+ levels than cells from normal subjects. It is now clear that downregulation of voltage-dependent K + channels (e.g., Kv1.5) and increased expression and activity of voltage-dependent (Cav1.2) and voltage-independent (e.g., canonical and vanilloid transient receptor potential [TRPC and TRPV]) Ca 2+ channels play an important role in the functional remodeling of pulmonary arteries in PH. This review focuses on an anion-permeable channel that is now considered a novel excitatory mechanism in the systemic and pulmonary circulations. It is permeable to Cl − and is activated by a rise in intracellular Ca 2+ concentration (Ca
2+-activated Cl − channel, or CaCC). The first section outlines the biophysical and pharmacological properties of the channel and ends with a description of the molecular candidate genes postulated to encode for CaCCs, with particular emphasis on the bestrophin and the newly discovered TMEM16 and anoctamin families of genes. The second section provides a review of the various sources of Ca 2+ activating CaCCs, which include stimulation by mobilization from intracellular Ca 2+ stores and Ca 2+ entry through voltage-dependent and voltage-independent Ca 2+ channels. The third and final section summarizes recent findings that suggest a potentially important role for CaCCs and the gene TMEM16A in PH.Keywords: calcium-activated chloride channels, pulmonary hypertension, TMEM16A, anoctamin, bestrophin. . They are widely distributed small-conductance channels located in the plasma membrane of many cell types and are hypothesized to serve important functions in sperm maturation, fluid transport across epithelial tissues, cardiac repolarization, olfactory transduction, photoreceptor stimulation, neuronal and skeletal muscle excitation, cardiac repolarization, and vascular smooth muscle excitability and contraction. For more information on the general properties and role of CaCCs in various cell types and tissues, the reader is invited to consult excellent reviews on this topic. [1][2][3][4][5][6][7][8][9][10][11] Byrne and Large 12 were the first to report the existence of a Ca 2+ -activated Cl − conductance in smooth muscle by describing its general properties in rat anococcygeus smooth muscle. Since this initial discovery, that group and others have described this conductance in a variety of smooth muscle cells, including vascular smooth muscle cells (VSMCs). 1,4,7 The identification in 2008 by three independent groups of the TMEM16, or anoctamin, family of genes as novel candidates for CaCCs 13-15 sparked a renewed interest in refining our understan...