We tested the hypothesis that phosphatidylinositol 3-kinase (PI 3-kinase)-dependent activation of Akt is essential for the expression of cardiac heat-shock protein 72 (HSP72) and that this pathway is impaired in the streptozotocin (STZ)-induced diabetic heart. STZ-induced male diabetic rats were treated with insulin (STZ-insulin group, n ؍ 26) or vehicle (STZ-vehicle group, n ؍ 61) for 3 weeks. Whole-body hyperthermia (43°C for 20 min) was applied, and the heart was isolated 24 h later. Compared with control heart, hyperthermia-induced HSP72 expression and phosphorylation of Akt were attenuated in the STZvehicle heart. Pretreatment with wortmannin attenuated hyperthermia-induced HSP72 expression and phosphorylation of Akt. In isolated perfused heart experiments, the hyperthermia-treated STZ-vehicle heart showed poor left ventricular functional recovery during reperfusion after no-flow global ischemia compared with hyperthermiatreated control heart. Insulin treatment restored HSP72 expression and reperfusion-induced functional recovery. In cultured neonatal rat cardiomyocytes, hyperthermiainduced HSP72 expression was enhanced by insulin, together with tolerance against hypoxia-reoxygenation injury. Wortmannin and LY294002 inhibited hyperthermia-induced HSP72 expression and phosphorylation of Akt. Our results indicate that activation of Akt, in a PI 3-kinase-dependent manner, is essential for hyperthermia-induced HSP72 expression in association with cardioprotection, suggesting impairment of this signaling pathway in the STZ-induced diabetic heart, probably due to insulin deficiency. Diabetes 55: 1307-1315, 2006 S tudies from our laboratory and those of other investigators have shown that heat-shock protein 72 (HSP72), induced by hyperthermia, protects the heart against ischemia-reperfusion injury (1-3). Streptozotocin (STZ)-induced diabetic rats have been widely used as a model of insulin-deficient diabetes and are known to exhibit various cardiac abnormalities (4). However, the effects of STZ-induced diabetes on HSP72 expression in the heart remain inconclusive. Joyeux et al. (5) reported that, although hyperthermia induced comparable expression levels of HSP72 in normal and diabetic hearts, the size of the infarction induced by coronary artery occlusion followed by reperfusion was larger in the diabetic than in the normal heart. Based on these observations, Joyeux et al. (5) concluded that the myocardial protective effect of hyperthermia did not extend to STZ-induced diabetic rats and seemed to be unrelated to the HSP72 level. Recently, however, Qi et al. (6) reported that preconditioning with a -opioid receptor agonist, U50,488H, increased cardiac HSP72 expression and reduced the infarct size induced by coronary artery occlusion in the normal heart 24 h after preconditioning but not in the STZ-induced diabetic rat heart. They concluded that lack of a U50,488H cardioprotective effect could, at least in part, be due to impaired synthesis of HSP72 in the STZ-induced diabetic heart (6).Activation of Akt prom...