P ulmonary vascular tone is largely determined by potassium and calcium currents in the smooth muscle cells (SMCs) of the small resistance arteries. Under normoxic circumstances an outward potassium current (I K ) passes through voltage-gated (K v ), calcium-activated (K Ca ), and background tandem-pore domain (K 2P ) potassium channels. The latter (coded by the KCNK family of genes) include the twik-related acid sensitive K ϩ channel TASK and TASKlike channels. This current keeps the resting membrane potential in the range of Ϫ50 to Ϫ60 mV and inhibits calcium entry through L-type calcium channels. 1 Vasodilator substances such as nitric oxide and prostacyclin, released from the endothelium, increase I K , one of several actions that lead to further vasodilatation. 2,3 Vasoconstrictor substances, such as endothelin, can inhibit I K 4 and/or release calcium from the sarcoplasmic reticulum. 5 In addition to vasoactive effects, an increase in cytosolic potassium inhibits smooth muscle cell apoptosis, 6 and an increase in cytosolic calcium promotes cellular proliferation. 7 Consequently, the inhibition of I K is important not only in causing membrane depolarization and calcium entry but also in stimulating vascular remodeling and in the development of chronic pulmonary hypertension. Agents that can cause pulmonary hypertension, such as the anorectic drugs and hypoxia, inhibit I K 8,9 and also enhance calcium release from the sarcoplasmic reticulum, leading to subsequent repletion of calcium through store-operated channels. 10,11,12 The smooth muscle cells in the resistance pulmonary arteries of patients with pulmonary arterial hypertension (PAH) exhibit both reduced I K and decreased expression of K v channels, 13 and also increased expression of the TRPC (transient receptor potential, canonical) genes that code for store-operated and receptor-operated calcium channels. 14 The decreased expression and function of the K v channels may relate to a mutation in the gene for the bone morphogenetic protein receptor 2 observed in some PAH patients, 15 as the normal function of the receptor increases K v channel activity. 16 Serotonin and its receptors have been implicated in the pathogenesis of idiopathic pulmonary arterial hypertension for several reasons. Plasma serotonin levels have been reported to be elevated in these patients and have remained high even after lung transplantation, indicating that the levels are not secondary to the pulmonary hypertension. 17 This observation implies that either serotonin plays an etiologic role or is linked to an etiologic agent. Plasma serotonin levels are elevated in rats treated with the anorectic agent, dexfenfluramine, 18 which has been implicated in the onset of some cases of PAH. 19 The metabolite nor-dexfenfluramine itself is an agonist of the serotonin 2B receptor (5HT 2B ) and to a lesser extent of the 5HT 2A and 5HT 2C receptors. 20 There is strong evidence of overexpression of the 5HT transporter in the pulmonary arteries of patients with pulmonary hypertension. 21 T...