Aim:To investigate effects of icariin on cardiac gene expression and the modulation of nitric oxide (NO)signal transduction during the differentiation of embryonic stem(ES)cells into cardiomyocytes in vitro.Methods:The expression levels of cardiac developmental-dependent genes were measured using reverse transcription-polymerase chain reaction(RT-PCR).The chronotropic responses of cardiomyocytes to β-adrenoceptor stimulation were determined.The levels of cAMP and cGMP in ES cells were measured using radioimmunoassay.Endogenous NO levels were measured by using the Griess reaction.Aminoguanidine (AG) was used to confirm the influence of icariin on the endogenous NO signal pathway.Results:Icariin significantly elevated mRNA levels of cardiac transcription factors GATA4 and Nkx2.5,and cardiac-specific α-MHC,MLC-2ν and β-AR genes in a concentration-and time-dependent manner (P＜0.05).Cardiomyocytes derived from embryoid body (EB)treated with icariin were more sensitive to isoprenaline (P＜0.01).Treatment of ES cells with icariin resulted in a continued elevation in the cAMP/cGMP ratio before a shift to the cardiomyocyte phenotype (P＜0.05).AG decreased the NO level,and delayed and decreased the incidence of contracting EB to only approximately 35% on d 5+11,an effect that could be rescued by icariin.When cells were cocultured with icariin and AG,the percentage of beating EB reached a peak level of 73% on d 5+11(P＜0.05).Conclusion:The inducible effects of icariin were partly related to increase in the expression of cardiac developmental-dependent genes,and elevation of the cAMP/cGMP ratio in ES cells,as well as upregulation of endogenous NO generation during the early stages of cardiac development.