To determine whether selective impairment of cardiac sarcoplasmic reticulum (SR) Ca 2؉ transport may drive the progressive functional deterioration leading to heart failure, transgenic mice, overexpressing a phospholamban Val 49 3 Gly mutant (2-fold), which is a superinhibitor of SR Ca 2؉ -ATPase affinity for Ca
2؉, were generated, and their cardiac phenotype was examined longitudinally. At 3 months of age, the increased EC 50 level of SR Ca 2؉ uptake for Ca 2؉ (0.67 ؎ 0.09 M) resulted in significantly higher depression of cardiomyocyte rates of shortening (57%), relengthening (31%), and prolongation of the Ca 2؉ signal decay time (165%) than overexpression (2-fold) of wild type phospholamban (68%, 64%, and 125%, respectively), compared with controls (100%). Echocardiography also revealed significantly depressed function and impaired -adrenergic responses in mutant hearts. The depressed contractile parameters were associated with left ventricular remodeling, recapitulation of fetal gene expression, and hypertrophy, which progressed to dilated cardiomyopathy with interstitial tissue fibrosis and death by 6 months in males. Females also had ventricular hypertrophy at 3 months but exhibited normal systolic function up to 12 months of age. These results suggest a causal relationship between defective SR Ca 2؉ cycling and cardiac remodeling leading to heart failure, with a gender-dependent influence on the time course of these alterations.Cardiac hypertrophy and failure are highly complex disorders that arise as a result of a combination of mechanical, hemodynamic, hormonal, and pathological stimuli (1). In response to these effectors, the heart undergoes an adaptive response of compensatory hypertrophy (2) followed by decompensated heart failure that is characterized by defects in Ca 2ϩ handling during excitation-contraction coupling. Studies of end-stage-failing hearts have shown that the disturbed calcium homeostasis is associated with alterations in the expression levels or the activity of key Ca 2ϩ -handling proteins, leading to abnormal excitation contraction coupling and diastolic as well as systolic dysfunction (3, 4). Specifically, alterations in SR 1 Ca 2ϩ -ATPase (SERCA2a) activity, the major Ca 2ϩ transport protein in SR, have been implicated as important determinants in the deteriorated function of the failing heart (5-7). The activity of SERCA2a is regulated by phospholamban (PLB), a 52-amino acid, muscle-specific SR phosphoprotein (8 -10). Dephosphorylated PLB inhibits the Ca 2ϩ affinity of SERCA2a, whereas the phosphorylated form of PLB dissociates from SERCA2a leading to increases in Ca 2ϩ uptake rates and accelerated ventricular relaxation (11-13).The role of PLB in the regulation of basal contractility has been elucidated through the development of genetically engineered mouse models. Phospholamban ablation resulted in significant increases in cardiac contractile parameters, whereas overexpressing PLB was associated with depressed cardiac function (14, 15). Actually, an inverse relationship betwe...