Phosphatase and tensin homolog on chromosome 10 (PTEN) is downregulated during hypertrophic and cancerous cell growth, leading to activation of the prosurvival Akt pathway. However, PTEN regulation in cardiac myocytes upon exposure to hypoxia remains unclear. We explored the role of PTEN in response to hypoxia/ischemia in the myocardium. We validated that PTEN is a transcriptional target of activating transcription factor 2 (ATF-2) and is positively regulated via a p38/ATF-2 signaling pathway. Accordingly, hypoxia-induced upregulation of phosphorylation of ATF-2 and PTEN were reversed by a dominant negative mutant p38. Inhibition of PTEN in cardiomyocytes attenuated hypoxiainduced cell death and apoptosis. Cardiac-specific knockout of PTEN resulted in increased phosphorylation of Akt and forkhead box O 1 (forkhead transcription factors), limited infarct size in animals exposed to ischemia-reperfusion injury, and ameliorated deterioration of left ventricular function and remodeling following permanent coronary artery occlusion. In addition, the activation of Bim, FASL, and caspase was coupled with PTEN activation, all of which were attenuated by PTEN inhibition. In conclusion, cardiomyocyte-specific conditional PTEN deletion limited myocardial infarct size in an in vivo model of ischemia-reperfusion injury and attenuated adverse remodeling in a model of chronic permanent coronary artery ligation. p38; activating transcription factor 2; Akt; forkhead box O 1; FAS ligand; ischemia; infarct size; reperfusion PHOSPHOINOSITIDE 3-KINASE (PI3K) phosphorylates phosphatidylinositol, producing phosphatidylinositol (3,4,5)-triphosphate (PIP3), which recruits and facilitates activation of Akt (14, 32). Phosphatase and tensin homolog on chromosome 10 (PTEN) is a dual protein-lipid phosphatase that degrades PIP3 to inactive phosphatidylinositol (4,5)-diphosphate (PIP2; Refs. 22,26,38,47) and so negatively regulates the PI3K/Akt prosurvival signaling pathway. Loss or mutation of PTEN, with subsequent uncontrolled activation of the prosurvival pathways, is common in many tumors, including endometrial carcinoma, melanoma, renal, breast, prostate, and lung cancer (6, 9, 23). Dysregulation of PTEN has also been reported in heart diseases such as cardiac hypotrophy, heart failure, and ischemic heart disease (37,46,55,58). We (18) have shown that pharmacological inhibition of PTEN protects the heart against ischemiareperfusion injury through upregulation of the PI3K/Akt/endothelial nitric oxide synthase/ERK prosurvival pathway. Overexpression of PTEN increases apoptosis in neonatal cardiomyocytes, whereas expression of inactive mutant PTEN leads to Akt activation and reduces apoptosis (42). Moreover, myocardial levels of PTEN are increased in diabetic rats compared with nondiabetic rats, leading to reduced ability to phosphorylate Akt and, hence, blunting the protective effects of ischemic preconditioning (31, 52). Only two studies (41, 46) have assessed the effect of genetic deletion of PTEN on myocardial infarct size, both in an is...