Amione G, Knowlton AA. HSP60 in heart failure: abnormal distribution and role in cardiac myocyte apoptosis. Am J Physiol Heart Circ Physiol 293: H2238-H2247, 2007. First published August 3, 2007; doi:10.1152/ajpheart.00740.2007.-Heat shock protein (HSP) 60 is a mitochondrial and cytosolic protein. Previously, we reported that HSP60 doubled in end-stage heart failure, even though levels of the protective HSP72 were unchanged. Furthermore, we observed that acute injury in adult cardiac myocytes resulted in movement of HSP60 to the plasma membrane. We hypothesized that the inflammatory state of heart failure would cause translocation of HSP60 to the plasma membrane and that this would provide a pathway for cardiac injury. Two models were used to test this hypothesis: 1) a rat model of heart failure and 2) human explanted failing hearts. We found that HSP60 localized to the plasma membrane and was also found in the plasma early in heart failure. Plasma membrane HSP60 localized to lipid rafts and was detectable on the cell surface with the use of both flow cytometry and confocal microscopy. Localization of HSP60 to the cell surface correlated with increased apoptosis. In heart failure, HSP60 is in the plasma membrane fraction, on the cell surface, and in the plasma. Membrane HSP60 correlated with increased apoptosis. Release of HSP60 may activate the innate immune system, promoting a proinflammatory state, including an increase in TNF-âŁ. Thus abnormal trafficking of HSP60 to the cell surface may be an early trigger for myocyte loss and the progression of heart failure.heat shock proteins; protein trafficking; plasma membrane; cytokines HSP60 IS AN IMPORTANT MEMBER of the heat shock protein family, thought to be primarily a mitochondrial protein, although it is encoded by the nuclear genome. Previously, our laboratory (8) reported that HSP60 is doubled in end-stage heart failure. HSP60 binds Bax and Bak in the cytosol of the myocyte, and reduction in HSP60 precipitates apoptosis (6). Simulated ischemia in cardiac myocytes resulted in translocation of HSP60 to the plasma membrane before reoxygenation (5). Redistribution of HSP60 to the plasma membrane was associated with movement of Bax to the mitochondria and apoptosis.Observations of HSP60 translocation in isolated myocytes motivated studies on the redistribution of HSP60 in the failing heart, where apoptosis is thought to be a mechanism of myocyte death. To address this question, we developed a rat model of heart failure with ligation of the left anterior descending artery. Cardiac echo was used to follow changes in function and chamber size. Studies were conducted long after coronary ligation and thus reflected the progressive changes of the failing ventricle, rather than ischemia. Upregulation of HSP60 correlated with increased expression of proinflammatory cytokines, brain natriuretic peptide (BNP), and atrial natriuretic peptide (ANP) 9 and 12 wk postligation. In addition, we examined distribution of HSP60 in explanted human hearts with dilated (DCM) and ischem...