Three endothelin (ET) isopeptides have been identified: ET-1, ET-2 and ET-3. These have two well-established gross effects on the cardiac myocyte. They affect the contractile properties and they stimulate myocyte growth and myofibrillogenesis. There may be other effects that are less fully characterized (e.g. increased resistance apoptosis). The changes in myocyte biology are brought about by modulation of intracellular signaling pathways. ET-1 binds to the ET(A) receptor on the cell surface and stimulates hydrolysis of phosphatidylinositol 4', 5'-bisphosphate to diacylglycerol and inositol 1', 4', 5'-trisphosphate. Diacylglycerol remains in the plane of the membrane and this causes translocation of the delta- and epsilon-isoforms of protein kinase C (PKC) to that compartment, an event thought to be indicative of PKC activation. The next events (probably associated with PKC activation) are the activation of the small G-protein Ras and of the extracellular signal-regulated kinase 1/2 (ERK1/2) cascade. Over a longer time course, two protein kinase cascades related to the ERK1/2 cascade, the c-Jun N-terminal kinase and p38-mitogen-activated protein kinase (p38-mitogen) cascades, also become activated. As the signals originating from the ET(A) receptor are transmitted through these protein kinase pathways, other signaling molecules become phosphorylated, thus changing their biological activity. Such molecules include nuclear transcription factors (e.g. GATA-4, c-Jun), protein kinases (e.g. 90-kDa ribosomal protein S6 kinase, MAPK-activated protein kinase 2), and ion exchangers/channels (e.g. the Na(+)/H(+) exchanger 1). These changes are responsible for the overall biological effects of ET isopeptides on the myocyte.