“…Pulmonary vascular remodeling or concentric vascular wall thickening of small pulmonary arteries (PAs) and arterioles, attributable partially to enhanced proliferation and migration of PA smooth muscle cells (PASMC), is a major cause for elevated PVR in patients with PAH and chronic hypoxia-induced pulmonary hypertension (HPH) (32,54,74). Multiple cellular and molecular mechanisms have been demonstrated to contribute to the development and progression of pulmonary vascular remodeling through enhanced PASMC proliferation and migration, such as signaling cascades involving intracellular free Ca 2ϩ (12,37,50,75), K ϩ channels (51,62,73), Notch (26,69), bone morphogenetic protein/transforming growth factor- (38,42,48), and/or Akt/mammalian target of rapamycin (mTOR) (4,20,23); however, the specific sequence of events involved in the enhanced PASMC proliferation in pulmonary hypertension remains unclear.…”