. Heat shock protects cardiac cells from doxorubicin-induced toxicity by activating p38 MAPK and phosphorylation of small heat shock protein 27. Am J Physiol Heart Circ Physiol 291: H2680 -H2691, 2006. First published June 16, 2006 doi:10.1152/ajpheart.00395.2006 and its derivatives are used as chemotherapeutic drugs to treat cancer patients. However, production of DOX-mediated reactive oxygen species (ROS) by prolonged use of these drugs has been found to cause dilative cardiomyopathy and congestive heart failure. Thus various preventive modalities have been developed to avoid this side effect. We have found that the DOX-mediated oxidant-induced toxicity in cardiac cells could be minimized by hyperthermia-induced small heat shock protein 27 (HSP27); that is, this protein acts as an endogenous antioxidant against DOX-derived oxidants such as H 2O2. Heat shockinduced HSP27 was found to act as an antiapoptotic protein (reducing ROS and Bax-to-Bcl2 ratio) against DOX, and its phosphorylated isoforms stabilized F-actin remodeling in DOX-treated cardiac cells and, hence, attenuated the toxicity. Protein kinase assays and proteomic analyses suggested that higher expression of HSP27 and its phosphorylation are responsible for the protection in heat-shocked cells. Two-dimensional gel electrophoresis showed six isoforms (nonphosphorylated and phosphorylated) of HSP27. Matrix-assisted laser desorption/ionization time of flight analyses showed ␣-and -isoforms of HSP27, which are phosphorylated by various protein kinases. Ser 15 and Ser 85 phosphorylation of HSP27 by MAPK-assisted protein kinase 2 was found to be the key mechanism in reduction of apoptosis and facilitation of F-actin remodeling. The present study illustrates that hyperthermia protects cells from DOX-induced death through induction and phosphorylation of HSP27 and its antiapoptotic and actin-remodeling activities. apoptosis; cardiomyopathy; hyperthermia ADRIAMYCIN DERIVATIVES, such as doxorubicin (DOX), are widely used as anticancer drugs. Unfortunately, prolonged use of these drugs to treat cancer patients has resulted in the development of dilative cardiomyopathy (DCM) and congestive heart failure (CHF) within a few years after cessation of treatment, irrespective of age and race (36). To avoid this side effect, new anthracyclin derivatives with less toxicity to the heart, new formulations in the form of encapsulation into delivery vehicles such as microemulsions, and new targeted delivery modalities to selectively deliver the drug to the desired site (preventing accumulation in the heart) have emerged (39).However, there has been no significant improvement in our ability to avoid this problem, and this effect has not been completely eliminated. At the same time, attempts to understand the actual mechanism of DOX-induced DCM and CHF have been appearing with increasing frequency in recent literature. Fortunately, the mechanisms whereby DOX and its analogs kill tumor cells (intended effect) and cause DCM and CHF (unwanted effects) are different, indicating...