Abstract-The proteasome is responsible for the degradation of oxidized proteins, and proteasome inhibition has been shown to generate oxidative stress in vitro. Atherosclerosis is thought to be initiated as a consequence of increased endogenous oxidative stress. The current study was designed to assess whether chronic proteasome inhibition is associated with early coronary atherosclerosis. Female pigs, 3 months of age, were randomized to a normal (N) or high-cholesterol (HC) diet (2% cholesterol, 15% lard) without or with twice weekly subcutaneous injections of the proteasome inhibitor (PSI) MLN-273 (0.08 mg/kg, NϩPSI and HCϩPSI) for a period of 12 weeks (nϭ5 per group). Coronary vasorelaxation to bradykinin (10 Ϫ10.5 to 10Ϫ 6.5 mol/L) and sodium nitroprusside (10 Ϫ9 to 10 Ϫ5 mol/L) was assessed by in vitro organ chamber experiments, intima-media ratio by morphometric analysis of Elastica-van Gieson-stained slides, and intima superoxide production by dihydroethidium fluorescence. Vasorelaxation to 10 Ϫ6.5 mol/L bradykinin was reduced in HC compared with N (69Ϯ7 versus 90Ϯ2%, PϽ0.05) and further reduced in NϩPSI and HCϩPSI (57Ϯ6 and 48Ϯ13%, PϽ0.05 versus N and HC for each). Compared with N (0.03Ϯ0.01), intima-media ratio was higher in NϩPSI (0.09Ϯ0.04, PϽ0.01) and HCϩPSI (0.15Ϯ0.06, PϽ0.05). Compared with N (0.6Ϯ0.9% of intima area), dihydroethidium fluorescence was higher in HC, NϩPSI, and HCϩPSI (8.9Ϯ1.6, 6.0Ϯ3.5, and 7.2Ϯ3.9% of intima area, PϽ0.05 for all). Thus, chronic proteasome inhibition is associated with increased coronary artery oxidative stress and early atherosclerosis. These findings support the significance of the proteasome and related protein quality control for vascular biology and pathology. Key Words: atherosclerosis Ⅲ endothelial dysfunction Ⅲ oxidative stress Ⅲ proteasome Ⅲ ubiquitin A therosclerotic cardiovascular disease (ASCVD) is considered to be initiated as a response to an injurious stimulus, or clinically, a cardiovascular risk factor. 1 A common denominator of the pathophysiological mode of action of many cardiovascular risk factors is an increase in the generation of reactive oxygen species, especially superoxide anions, surpassing antioxidant capabilities and resulting in oxidative stress. 2,3 Superoxide anions rapidly react with NO, generating, for instance, the highly cytotoxic product peroxynitrite and its footprint nitrotyrosine. 4 In addition, modification of signaling pathways leads to the alteration of the activity and expression of transcription factors and growth factors. The functional and structural consequences of these molecular changes include impairment of endotheliumdependent vasorelaxation and intimal thickening, constituting the early stage of atherosclerosis. 4 -6 Eighty to 90% of all intracellular proteins are degraded via the 20S proteasome, a barrel-shaped complex formed by 2 outer (␣) rings and 2 inner () rings, each composed of 7 subunits. 7 The 1, 2, and 5 subunits harbor caspase-like, trypsin-like, and chymotrypsin-like activities, respectively, w...