An R120G missense mutation in ␣-B-crystallin (CryAB), a small heat-shock protein (HSP), causes a desmin-related cardiomyopathy (DRM) that is characterized by the formation of aggregates containing CryAB and desmin. The mutant CryAB protein leads to the formation of inclusion bodies, which contain amyloid oligomer intermediates (amyloid oligomer) in the cardiomyocytes. To further address the underlying mechanism(s) of amyloid oligomer formation in DRM linked to the CryAB R120G, a recombinant CryAB R120G protein was generated. The purified CryAB R120G protein can form a toxic amyloid oligomer, whereas little immunoreactivity was observed in the wild-type CryAB protein. A native PAGE showed that the oligomerized form was present in the CryAB R120G protein, whereas only a high molecular mass was detected in the wildtype CryAB. The oligomerized CryAB R120G of around 240 -480 kDa showed strong positive immunoreactivity against an anti-oligomer antibody. The CryAB R120G amyloid oligomer was unstable and easily lost its conformation by -mercaptoethanol and SDS. Recombinant HSP25 or HSP22 proteins can directly interrupt oligomer formation by the CryAB R120G protein, whereas the amyloid oligomer is still present in the mixture of the wild-type CryAB and CryAB R120G proteins. This interruption by HSP25 and HSP22 was confirmed in a cardiomyocyte-based study using an adenoviral transfection system. Blockade of amyloid oligomer formation by HSP25 and HSP22 recovered the ubiquitin proteosomal activity and cellular viability. Blockade of oligomer formation by small HSP may be a new therapeutic strategy for treating DRM as well as other types of amyloid-based degenerative diseases.Many systemic and neurodegenerative disorders whose etiologies are linked to misfolded or unfolded proteins are characterized by the accumulation of intracellular or extracellular protein deposits or aggregates (1). The pathologies of these diseases are complex, and the accumulation of misfolded and unfolded proteins in the cells can contribute to or be causal for at least some of these neurodegenerative and systemic diseases (2). However, the direct relationship between the protein deposition and the disease pathology is still controversial. Recent reports suggest that amyloid  (A) 2 and other amyloidogenic proteins exert their cellular toxicity as soluble amyloid oligomeric intermediates (amyloid oligomer) but not as insoluble aggregates or fibrils (3-6). These soluble amyloid oligomer proteins generally appear to have -sheet structures, whose formation is correlated with the appearance of a hydrophobic environment (6, 7). Several reports indicate that the soluble amyloid oligomer may be more important in pathogenesis than the insoluble fibrillar amyloid deposits (8 -11). An antibody that specifically recognizes the structure of the amyloid oligomer reacts with oligomers generated from all types of amyloidogenic proteins and peptides, such as A-(1-42), ␣-synuclein, polyglutamine, and prions (6). This result implies that the amyloid oligomer has ...