Several lines of evidence suggest that the serotonin (5-hydroxytryptamine, 5-HT) regulates cardiovascular functions during embryogenesis and adulthood. 5-HT binds to numerous cognate receptors to initiate its biological effects. However, none of the 5-HT receptor disruptions in mice have yet resulted in embryonic defects. Here we show that 5-HT 2B receptor is an important regulator of cardiac development. We found that inactivation of 5-HT2B gene leads to embryonic and neonatal death caused by heart defects. 5-HT 2B mutant embryos exhibit a lack of trabeculae in the heart and a specific reduction in the expression levels of a tyrosine kinase receptor, ErbB-2, leading to midgestation lethality. These in vivo data suggest that the Gq-coupled receptor 5-HT 2B uses the signaling pathway of tyrosine kinase receptor ErbB-2 for cardiac differentiation. All surviving newborn mice display a severe ventricular hypoplasia caused by impaired proliferative capacity of myocytes. In adult mutant mice, cardiac histopathological changes including myocyte disarray and ventricular dilation were consistently observed. Our results constitute genetic evidence that 5-HT via 5-HT2B receptor regulates differentiation and proliferation of developing and adult heart. This mutation provides a genetic model for cardiopathy and should facilitate studies of both the pathogenesis and therapy of cardiac disorders in humans.neuregulin ͉ knockout ͉ proliferation ͉ transactivation S erotonin (5-hydroxytryptamine) (5-HT) first isolated as a vasoconstrictor from blood was later identified in the central nervous system (CNS). It is found in three main areas of the body: the intestinal wall, platelets, and CNS. The functions of 5-HT in CNS as a neurotransmitter are numerous and appear to involve control of appetite, sleep, memory and learning, temperature regulation, mood, behavior (including sexual and hallucinogenic behavior), and endocrine regulation (1). Peripherally, 5-HT, which is stored in platelets, appears to play a major role in homeostasis, blood pressure regulation, cardiovascular functions (2), motility of the gastrointestinal tract (3), and carcinoid tumor pathology (4). Independently of its location in adults, 5-HT also has been detected during zygotic cleavage divisions, gastrulation and neurulation in embryos of sea urchins, frogs, chicken, and Drosophila. The presence of 5-HT and its receptors in early embryogenesis and the ability of 5-HTspecific pharmacological agents (5) to interfere with embryonic development suggested that early embryos use 5-HT before the onset of neurogenesis to regulate cell proliferation and͞or morphogenetic movements (6, 7). Furthermore, 5-HT has been suspected for years to regulate craniofacial and cardiovascular morphogenesis: In embryos grown in the presence of either a high concentration of 5-HT or 5-HT-specific reuptake inhibitors, a decreased proliferation of myocardium, cardiac mesenchyme, and endothelium has been reported, indicating that 5-HT may regulate proliferation in the embryonic heart (8).Th...