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Figure 2. Integrin-mediated signaling pathways in PH. Integrin engagement activates multiple downstream signaling cascades that contribute to pulmonary vascular remodeling. (Left to right) MAPK pathway: FAK/Src-mediated activation of MAPK promotes transcription factors (c-Myc, c-Jun) driving PASMC and PAEC proliferation. PI3K/AKT pathway: integrin-FAK signaling activates PI3K/AKT, which enhances cell proliferation (via mTOR and YAP) and cell survival (via inhibition of BAD and FOXO-mediated pro-apoptotic signaling). Cross-talk with GFRs: Integrins cooperate with GFRs, amplifying downstream pathways and promoting migration and proliferation. TGF-β signaling: integrins mediate activation of latent TGF-β complexes, enabling TGF-β receptor signaling through Smad2/3-Smad4, which regulates cell proliferation and fibrosis. PH: Pulmonary hypertension, GFRs: growth factor receptors, FAK: focal adhesion kinase. Created in BioRender. He, S. (2026) https://BioRender.com/swfm3ic.