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Both skeletal and cardiac myocytes undergo developmentally programmed terminal differentiation with subsequent adaptation to increased demands for mechanical output being met by hypertrophy. However, there is a fundamental difference between these two striated muscle types in terms of their ability to respond to muscle injury and cell death: in skeletal muscle, stem cells proliferate and replace lost myocytes; in cardiac muscle, the occurrence of such a mechanism is very low. Therefore, the sole structural response of the heart to cell loss (myocardial infarction) or pathological mechanical overload (hemodynamic pressure or volume overload) is myocyte hypertrophic growth.Often growth is triggered when specific cell-surface receptors are occupied by their ligands, such as growth factors and hormones, which results in the activation of either intrinsic or associated kinases. In addition to these established pathways, there is growing evidence that signals generated at the focal adhesion sites after integrin engagement with specific extracellular matrix (ECM) proteins significantly contribute to growth and survival (for review, see Schaller1). Whereas multiple pathways might be necessary for the hypertrophic phenotype of cardiomyocytes, Heidkamp and colleagues2 in this issue of Circulation Research demonstrate the importance of myocyte survival signals transmitted by focal adhesion kinase (FAK), a nonreceptor tyrosine kinase that is localized to the cell attachment site (focal adhesions).Integrins are a family of cell-surface receptors, composed of noncovalently associated α and β subunits. There are at least 20 different integrin subtypes that are formed from 12 different α and 8 different β subunits, and many of these subtypes are expressed in a cell type–specific manner,1 including the cardiac myocyte.3 A major role of integrins is to physically link the extracellular matrix environment to the intracellular actin cytoskeleton. Integrins bind to specific ECM proteins via their large extracellular domains, and the short cytoplasmic domains …

Importance of Integrin Signaling in Myocyte Growth and Survival