Abstract-cAMP is one of the most important second messenger in the heart. The discovery of Epac as a guanine exchange factor (GEF), which is directly activated by cAMP, raises the question of the role of this protein in cardiac cells. Here we show that Epac activation leads to morphological changes and induces expression of cardiac hypertrophic markers. This process is associated with a Ca 2ϩ -dependent activation of the small GTPase, Rac. In addition, we found that Epac activates a prohypertrophic signaling pathway, which involves the Ca 2ϩ sensitive phosphatase, calcineurin, and its primary downstream effector, NFAT. Rac is involved in Epac-induced NFAT dependent cardiomyocyte hypertrophy. Key Words:cAMP Ⅲ guanine nucleotide exchange factor Ⅲ small G protein Ⅲ transcription factor I n the heart, cyclic adenosine 3Ј,5Ј-monophosphate (cAMP) regulates many physiological processes such as contractility and relaxation. Classically, these effects are attributed to activation of hyperpolarization-activated cyclic nucleotidegated channels and protein kinase A (PKA) by cAMP. 1 The recent discovery of Epac as proteins which are directly activated by cAMP has broken the dogma surrounding cAMP and PKA. [2][3][4] Epac proteins are guanine nucleotide exchange factors (GEFs) that bind cAMP with affinities similar to that of the regulatory subunit of PKA. 2,3 They have been shown to function as GEFs for the Ras-like small GTPases Rap1 and Rap2 and are directly activated by cAMP in a PKA independent manner. 4 There are two isoforms of Epac, Epac 1 and Epac 2 both consisting of a regulatory and a catalytic region. 2,3 Epac 2 has an additional cAMP binding domain that is dispensable for cAMP-induced Rap activation. 5 After cAMP binding, Epac catalyzes the exchange of GDP for GTP on the small GTPases Rap, allowing interaction with their target effectors. 6 Recent studies indicate that Epac is involved in cell adhesion, 7,8 neurite extension, 9 and regulates insulin secretion and the amyloid precursor protein processing. 10,11 To date the role of Epac in the heart is unknown.Among the superfamily of small G proteins, the Rho family, which includes Rho, Rac, and Cdc42, has attracted much interest for they have been shown to play key roles in the generation of cytoskeletal structures. 12 Indeed, Rho is important for the formation of stress fibers and focal adhesions in fibroblasts, whereas Rac and Cdc42 are involved in the regulation of more dynamic structures such as membrane ruffles, lamellipodia and filopodia. 12 Several studies have pointed out the role of Rho proteins in the development of cardiomyocyte hypertrophy. 13 For instance, two potent hypertrophic stimuli, endothelin 1 (ET-1) and phenylephrine (PE), induce rapid activation of endogenous Rac in neonatal cardiomyocytes. 14 In addition, adenoviral infection of cardiomyocytes with a constitutive active form of Rac (Rac G12V ) increases protein synthesis and promotes morphological changes associated with myocyte hypertrophy. 15 In vivo evidence for the role of Rho proteins...