With the term 'mechanotransduction', it is intended the ability of cells to sense and respond to mechanical forces by activating intracellular signal transduction pathways and the relative phenotypic adaptation. While a known role of mechanical stimuli has been acknowledged for developmental biology processes and morphogenesis in various organs, the response of cells to mechanical cues is now also emerging as a major pathophysiology determinant. Cells of the cardiovascular system are typically exposed to a variety of mechanical stimuli ranging from compression to strain and flow (shear) stress. In addition, these cells can also translate subtle changes in biophysical characteristics of the surrounding matrix, such as the stiffness, into intracellular activation cascades with consequent evolution toward pro-inflammatory/pro-fibrotic phenotypes. Since cellular mechanotransduction has a potential readout on long-lasting modifications of the chromatin, exposure of the cells to mechanically altered environments may have similar persisting consequences to those of metabolic dysfunctions or chronic inflammation. In the present review, we highlight the roles of mechanical forces on the control of cardiovascular formation during embryogenesis, and in the development and pathogenesis of the cardiovascular system.In the present contribution, we will focus on the role of mechanical forces in controlling the morphogenesis of the cardiovascular system and on their new emerging role as a pathology determinant. We will also describe how traction forces exerted locally by single cells or forces (e.g., laminar/perturbed shear stress, constant/oscillatory pressure) propagated passively in the tissues are converted into signals regulating intracellular biochemistry and gene expression underlying pathology progression. Definition of Cell Mechanotransduction: Outside-In and Inside-Out Communication in the Complex 3D Environment Similar to classical ligand/receptor interactions, mechanotransduction requires binding of cell surface receptors to their ligands immobilized into the extracellular matrix (ECM), or expressed at the surface of adjacent cells. Differences in the mechanical features of the ECM, or in the geometrical arrangement of receptor binding motifs, can have a direct readout on cell proliferation, differentiation and migratory responses. Mechanical cues are converted into biochemical signals by activation of intracellular cascades transmitted via the cytoskeleton and their components, for example the acto-myosin 'stress' fibers [4], the microtubules [5], the scaffolding proteins [6], and various kinases and phosphatases [7] (Figure 1). Cells 2019, 8, x 2 of 18asymmetric cellular divisions and establishment of initial embryonic polarity. Thereafter, the mechanotransduction process continues in adult life, contributing to tissue growth, homeostasis and, finally, disease programming. In the present contribution, we will focus on the role of mechanical forces in controlling the morphogenesis of the cardiovascular system and on...