Abstract-Cardiac myocyte loss, regardless of insult, can trigger compensatory myocardial remodeling leading to heart failure. Identifying mediators of cardiac myocyte survival may advance clinical efforts toward myocardial preservation. Angiopoietin-1 limits ischemia-induced cardiac injury. This benefit is ascribed to angiogenesis because the receptor, tie2, is largely endothelial-specific. We propose that direct, non-tie2 interactions of angiopoietin-1 on cardiac myocytes contribute to this cardioprotection. We found that mouse C2C12 skeletal myocytes lack tie2, yet dose-dependently adhered to angiopoietin-1 and angiopoietin-2 similarly to laminin, fibronectin, vitronectin, and more than to collagen-I, -III, and -IV. Adhesion was divalent cation-mediated (Mn 2ϩ , Ca 2ϩ , not Mg 2ϩ ), blocked with EDTA/EGTA, RGD-based peptides, and select integrin subunit antibodies. Similar findings were obtained with human skeletal myocytes (HSMs) and freshly isolated rat neonatal cardiac myocytes (NCMs). Furthermore, angiopoietin-1 conferred significant survival advantage exceeding that of most cell matrices, which was not fully explained by differences in cell adhesion. Angiopoietin-1 promoted survival of serum-starved C2C12, HSM, and NCM (MTT, trypan blue) and prevented taxol-induced apoptosis (caspase-3). Immobilized and soluble angiopoietin-1 phosphorylated Akt S473 and MAPK p42/44 , (not FAK Y397 ) in C2C12 more than in endothelial cells and more than did angiopoietin-2 or cell matrices. EDTA, RGD-based peptides, and some integrin antibodies blocked these responses. Angiopoietin-1 activated HSM and NCM Akt S473 and MAPK p42/44 survival pathways. We propose that this novel function contributes to developmental and cardioprotective actions of angiopoietin-1 presently attributed to vascular effects alone. Angiopoietin-1 may prove therapeutically valuable in cardiac remodeling by supporting myocyte viability and preserving pump function. The full text of this article is available online at http://circres.ahajournals.org. (Circ Res. 2005;96:e8-e24.)Key Words: angiopoietin-1 Ⅲ angiopoietin-2 Ⅲ cardiac myocytes Ⅲ adhesion molecules Ⅲ myocyte apoptosis Ⅲ skeletal myocytes T here is growing consensus that cardiomyocyte (CM) apoptosis contributes to many cardiac diseases (eg, ischemia, 1 infarction, 2 hypertension, 3 myocarditis, 4 transplant rejection, 5 and heart failure 6,7 ). Research efforts are directed at defining the incidence of CM death, the contributions to cardiac dysfunction, and the consequences of inhibiting apoptosis. Incentive is based on the rationale that CM loss reduces contractile mass of the heart and may be a preventable catalyst of heart failure. In support of this concept, low levels of CM apoptosis (23 CM/10 5 nuclei) cause lethal cardiomyopathy in mice. 8 CM apoptosis rates are higher in cardiomyopathy patients (80 to 250 CM/10 5 nuclei) compared with healthy hearts (1 to 10 CM/10 5 nuclei). 9,10 Further, ischemic preconditioning upregulates bcl-2, a cytoprotective protein, and is linked to reduced apop...