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Mechanomodulation of mitral valve disease through serotonin. Tensile strain upregulates serotonin synthesis through a mechanosensory mechanism. Serotonin interacts with the serotonin type 2B receptor and serotonin transporter (SERT) in the mitral valve activating Erk1/2 through G-protein stimulation. Erk1/2 is phosphorylated in the nucleus where it induces TGF-β signaling and transcription of genes mediating myxomatous disease.
