Exposure to chronic hypoxia leads to the development of pulmonary hypertension through persistent vasoconstriction as well as structural remodeling of pulmonary vessels. Proliferation of smooth muscle cells is an important component of pulmonary vascular remodeling that results in increased medial muscular wall thickness. Among a number of mediators of pulmonary hypertension, serotonin (5-hydroxytryptamine (5-HT) 1 ) appears to play an important role in the remodeling of the pulmonary circulation (1-3).Evidence for the role of 5-HT in the development of pulmonary hypertension was first recognized in fawn-hooded rats, in which a genetic deficit in 5-HT platelet storage and high plasma levels of 5-HT are associated with a susceptibility to developing pulmonary hypertension in response to mild hypoxia (4). A further study showed that a continuous intravenous infusion of 5-HT during a 2-week exposure of rats to hypoxia potentiated the development of pulmonary hypertension (2). The role of 5-HT in pulmonary hypertension appears to be through the serotonin transporter (SERT), as mice deficient for SERT developed less hypoxic pulmonary hypertension and vascular remodeling than did control animals exposed to the same conditions (3).High levels of plasma 5-HT have been observed in humans in association with primary pulmonary hypertension (5, 6). More recently, Eddahibi et al. (7) report that pulmonary artery smooth muscle cells (PASMC) from patients with primary pulmonary hypertension grow faster than the cells from control subjects due to increased expression of SERT. The importance of 5-HT in human pulmonary hypertension is supported by clinical observations that pulmonary hypertension is associated with the use of amphetamine-like appetite suppressants, fenfluramine, dexfenfluramine, and aminorex (8). The mechanism of these appetite suppressants on PASMC may involve both direct interactions with SERT and a stimulation of SERT expression (9 -11).5-HT can mediate cell signaling by interacting with several subtypes of 5-HT receptors or through SERT, which transports 5-HT across the membrane using a Na ϩ /Cl Ϫ gradient. In bovine PASMC, only one 5-HT receptor has been identified, which resembles the 5-HT1A or 5-HT4 receptor (12, 13). However, mitogenic and hypertrophic responses by 5-HT are believed to be due to the action of SERT (14). The mechanism of 5-HT signaling for PASMC growth through SERT has been shown to involve tyrosine phosphorylation of GTPase-activating protein (15) and the production of reactive oxygen species (ROS) such