Cardiac diseases such as myocardial infarction (MI) can lead to adverse remodeling and impaired contractility of the heart due to widespread cardiomyocyte death in the damaged area. Current therapies focus on improving heart contractility and minimizing fibrosis with modest cardiac regeneration, but MI patients can still progress to heart failure (HF). There is a dire need for clinical therapies that can replace the lost myocardium, specifically by the induction of new myocyte formation from pre-existing cardiomyocytes. Many studies have shown terminally differentiated myocytes can re-enter the cell cycle and divide through manipulations of the cardiomyocyte cell cycle, signaling pathways, endogenous genes, and environmental factors. However, these approaches result in minimal myocyte renewal or cardiomegaly due to hyperactivation of cardiomyocyte proliferation. Finding the optimal treatment that will replenish cardiomyocyte numbers without causing tumorigenesis is a major challenge in the field. Another controversy is the inability to clearly define cardiomyocyte division versus myocyte DNA synthesis due to limited methods. A recent study suggests that systemic hypoxemia in adult male mice can induce cardiac myocytes to proliferate. The goal of the present experiments was to confirm these results, provide new insights on the mechanisms that induce cardiomyocyte cell cycle re-entry, and to determine if hypoxemia also induces cardiomyocyte proliferation and division in female mice. EdU mini pumps were implanted in 3-month-old, male and female C57BL/6 mice. Mice were then placed in a hypoxia chamber and the oxygen was lowered by 1% every day for 14 days to reach 7% oxygen. The animals remained in 7% inspired oxygen for 2 weeks before terminal studies. Myocyte cell cycle re-entry and division was also studied with a mosaic analysis with double markers (MADM) mouse model. MADM mice were exposed to hypoxia at 7% Oxygen as described above. Hypoxia induced cardiac hypertrophy in both left ventricular (LV) and right ventricular (RV) myocytes, with LV myocytes lengthening and RV myocytes widening and lengthening. Hypoxia induced a small increase in cardiomyocytes undergoing DNA synthesis (EdU+) in male and female C57BL/6 mice. Hypoxia induced a significant increase in myocyte cell cycle re-entry in MADM mice, but few myocytes synthesized new DNA (EdU+) and completed cytokinesis. RNA-sequencing showed upregulation in mitotic cell cycle processes but a downregulation of promoter genes for G1 to S phase transition in hypoxic mice when compared to control mice. There was also proliferation of non-myocyte cells and mild cardiac remodeling in hypoxic mice that did not disrupt cardiac function. Male and female mice exhibited similar gene expression profiles following hypoxia. Thus, systemic hypoxia induces adult cardiac myocyte cell cycle re-entry, but very few adult myocytes progress through the cell cycle to synthesize new DNA and divide into two daughter cells. / Biomedical Sciences