Cardiac hypertrophy and heart failure remain leading causes of death in the United States. Many studies have suggested that, under stress, myocardium releases factors triggering protein synthesis and stimulating myocyte growth. We identified and cloned myotrophin, a 12-kDa protein from hypertrophied human and rat hearts. Myotrophin (whose gene is localized on human chromosome 7q33) stimulates myocyte growth and participates in cellular interaction that initiates cardiac hypertrophy in vitro. In this report, we present data on the pathophysiological significance of myotrophin in vivo, showing the effects of overexpression of cardiospecific myotrophin in transgenic mice in which cardiac hypertrophy occurred by 4 weeks of age and progressed to heart failure by 9 -12 months. This hypertrophy was associated with increased expression of proto-oncogenes, hypertrophy marker genes, growth factors, and cytokines, with symptoms that mimicked those of human cardiomyopathy, functionally and morphologically. This model provided a unique opportunity to analyze gene clusters that are differentially upregulated during initiation of hypertrophy versus transition of hypertrophy to heart failure. Importantly, changes in gene expression observed during initiation of hypertrophy were significantly different from those seen during its transition to heart failure. Our data show that overexpression of myotrophin results in initiation of cardiac hypertrophy that progresses to heart failure, similar to changes in human heart failure. Knowledge of the changes that take place as a result of overexpression of myotrophin at both the cellular and molecular levels will suggest novel strategies for treatment to prevent hypertrophy and its progression to heart failure.Cardiac hypertrophy and heart failure remain leading causes of death in the United States. Although the mechanisms are not well understood, previous studies have suggested that, under stress, the myocardium releases factor(s) that trigger protein synthesis and cardiomyocyte growth. In vivo and in vitro studies have shown that many growth factors contribute to the cardiac hypertrophy process (1, 2). Studies from our laboratory and others have demonstrated that factors other than high blood pressure are responsible for initiating cardiac hypertrophy in the setting of hypertension (3, 4). We hypothesized that mechanical or humoral factors act on the myocardium, inducing one or more factors that trigger protein synthesis and myocardial cell growth. Using spontaneously hypertensive rats, we identified and characterized a 12-kDa protein, myotrophin, that stimulates myocyte growth (5). The myotrophin gene was mapped, for the first time, to human chromosome band 7q33 (6). We have shown that myotrophin stimulates transcription of proto-oncogenes (e.g. c-myc, c-fos, and c-jun), (7) -myosin heavy chain (-MHC), 1 atrial natriuretic factor (ANF), and connexin (7). Large increases in myotrophin correlate with the onset of hypertrophy in spontaneously hypertensive rats and humans (8).The purpose...