Mycoplasma pneumoniae is a frequent cause of community-acquired bacterial respiratory infections in children and adults. In the present study, using a proteomic approach, we studied the effects of M. pneumoniae infection on the protein expression profile of A549 human lung carcinoma cells. M. pneumoniae infection induced changes in the expression of cellular proteins, in particular a group of proteins involved in the oxidative stress response, such as glucose-6-phosphate 1-dehydrogenase, NADH dehydrogenase (ubiquinone) Fe-S protein 2, and ubiquinol-cytochrome c reductase complex core protein I mitochondrial precursor. The oxidative status of M. pneumoniae-infected cells was evaluated, and the results revealed that M. pneumoniae infection indeed caused generation of reactive oxygen species (ROS). It was further shown that M. pneumoniae infection also induced DNA double-strand breaks, as demonstrated by the formation of ␥H2AX foci. On the other hand, an ROS scavenger, N-acetylcysteine, could inhibit the ROS generation, as well as decrease ␥H2AX focus formation. This is the first report showing that M. pneumoniae infection can directly induce DNA damage, at least partially, through the generation of ROS, and thus this report strengthens the powerful application of proteomics in the study of the pathogenesis of M. pneumoniae.Mycoplasma pneumoniae is one of the smallest self-replicating organisms capable of cell-free existence. As a human pathogen, M. pneumoniae is a major cause of community-acquired respiratory infections in children and adults, which can lead to tracheobronchitis and primary atypical pneumonia (17). Besides causing diseases in the respiratory system, M. pneumoniae has been implicated in several extrapulmonary complications arising from infection; for example, it is a factor in the development of arthritis, cardiovascular diseases, and neurotropic infections (32,34).Considerable progress in our understanding of M. pneumoniae pathogenesis has been made over the years. The activation of the host immune response and direct invasion of cells are believed to contribute to this pathogenesis (32, 37). It has been shown that attachment of M. pneumoniae to the respiratory epithelium is a prerequisite for disease (22). The close interaction between M. pneumoniae and host cells protects the bacterium from removal by the host's mucociliary clearance mechanism and allows it to proliferate and produce metabolites, which in turn can cause cytotoxic effects (32, 34). Simultaneously, M. pneumoniae attachment induces the cells' inflammatory reaction and the host's immune response. For example, upregulation of interlukin-2, -4, -5, -6, -10, -12, and -18 and interferon has been detected in bronchoalveolar lavages, blood, and lungs of M. pneumoniae-infected patients (34). Recently, it was found that the M. pneumoniae protein MPN372, which contains key amino acids similar to the pertussis toxin S1 subunit, might be responsible for airway cellular damage and other sequelae associated with M. pneumoniae infections in human...