Editorial: Heart valve diseases: from molecular mechanisms to clinical implications

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Editorial on the Research Topic Heart valve diseases: from molecular mechanisms to clinical implicationsHeart valve disease (HVD) is considered a serious global health problem.Around 2.5% of the population present some degree of HVD (Aluru et al., 2022) being aortic stenosis (AS) and mitral valve diseases (MVD) the most common forms of HVD (Hollenberg, 2017).This Research Topic "Heart valve diseases: from molecular mechanisms to clinical implications" includes five articles aiming at characterizing the molecular mechanisms underlying HVD.Serotonin or 5-hydroxytryptamine (5-HT) is a multifaceted neurotransmitter that regulates important physiological processes such as cognition or memory and also exerts hormonal, autocrine, paracrine, and endocrine actions (Young, 2007).Soluble serotonin can bind to 5-HT receptors: 2A and 2B receptors and activates the Erk1/2 signaling pathway.Erk1/2 pathway is involved in cell proliferation, cell differentiation, and extracellular matrix (ECM) remodeling (Liu et al., 2019).In the past decades, several authors showed that serotonin pathway plays a role in the development of HVD.Thus, the overactivation of 5-HT2A-2B receptors by 5-HT agonist drugs (Ergot derivates, dopamine agonists, amphetamine derivates) can contribute to the development of HVD through valve interstitial cells (VICs) activation and proliferation (Jian et al., 2002;Elangbam, 2010).Most of the studies have been performed in the context of MVD (Thalji et al., 2015;Ayme-Dietrich et al., 2017;Driesbaugh et al., 2018;Ayme-Dietrich et al., 2019;Ibarrola et al., 2020;Garcia-Pena et al., 2021), showing that both receptors are overactivated in mitral valve prolapse.In this Research Topic, the review by Waldum and Wahba described the mechanisms of serotonin signaling in HVD development more in detail. Serotonin is transported in the blood by platelets. The authors suggested that in HVD, i.e., AS, platelets can release serotonin directly in the valves inducing HVD through 5-HT2B receptor activation. Waldum and Wahba summarize the main studies that demonstrate the involvement of serotonin receptors in HVD using different animal models (Sheep, mouse, and rat) as well as human samples.Otherwise, no clinical studies have been conducted to analyze the impact of 5HT receptor expression or the impact of the 5HT receptor antagonist in humans.

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