influx. Transgenic cardiac overexpression of the human P2X4 receptor showed an in vitro phenotype of enhanced basal contractility. The objective here was to determine the in vivo cardiac physiological role of this receptor. Specifically, we tested the hypothesis that this receptor plays an important role in modulating heart failure progression. Transgenic cardiac overexpression of canine calsequestrin (CSQ) showed hypertrophy, heart failure, and premature death. Crossing the P2X4R mouse with the CSQ mouse more than doubled the lifespan (182 Ϯ 91 days for the binary CSQ/P2X4R mouse, n ϭ 35) of the CSQ mouse (71.3 Ϯ 25.4 days, n ϭ 50, P Ͻ 0.0001). The prolonged survival in the binary CSQ/P2X4R mouse was associated with an improved left ventricular weight-to-body weight ratio and a restored -adrenergic responsiveness. The beneficial phenotype of the binary mouse was not associated with any downregulation of the CSQ level but correlated with improved left ventricular developed pressure and ϮdP/dt. The enhanced cardiac performance was manifested in young binary animals and persisted in older animals. The increased contractility likely underlies the survival benefit from P2X 4 receptor overexpression. An increased expression or activation of this receptor may represent a new approach in the therapy of heart failure. cardiac failure; contraction; isoproterenol; purines; adenine nucleotide ATP HAS LONG BEEN DEMONSTRATED to stimulate cardiac myocyte contractility at submicromolar concentrations (3,4,5,18,23). Recent studies show that activation of the P2X receptor subtype of the extracellular ATP receptor family increases the contractility of both cardiac myocytes and the intact heart (3,4,5,9,17,18,23). P2X receptors are ligand-gated ion channels whose activation results in sodium and calcium entry (6,10,12,19,24). Transgenic overexpression of the P2X 4 subtype of this family of receptor channels exhibits a phenotype of enhanced basal cardiac contractility and output in a working heart model (9). While these data suggest that the P2X receptor subfamily may mediate the effect of ATP on cardiac contractility, the potential cardiac physiological role of this receptor channel is not known. Because of the enhanced cardiac contractile performance of the P2X 4 receptor (P2X 4 R) transgenic mouse, it is possible that P2X 4 receptor overexpression will modulate the progression of heart failure. To test this hypothesis, the P2X 4 R mouse was crossed with the calsequestrin (CSQ) mouse model of cardiac hypertrophy and heart failure. The CSQ model of severe heart failure is generated by overexpressing the sarcoplasmic reticulum (SR) calcium-binding protein CSQ, which disrupts coordinated regulation of calcium release. The model showed a phenotype of hypertrophy that progress to dilated cardiomyopathy, failure, and premature cardiac death by 16 wk of age (2, 11). Here, we tested whether the cardiac P2X 4 R mediates a beneficial effect on the progression to heart failure in the CSQ-overexpressing mouse. We find that the binary CSQ/P2...