Nitric oxide generated by the inducible form of nitric oxide synthase (iNOS) may contribute to the pathogenesis of multiple sclerosis (MS). In this report, we studied postmortem tissues of MS patients for the expression of iNOS by in situ hybridization and immunocytochemistry. Immunocytochemistry for nitrotyrosine, a putative footprint for peroxynitrite formation was also performed. In acute MS lesions, intense reactivity for iNOS mRNA and protein was detected in reactive astrocytes throughout the lesion and in adjacent normal appearing white matter. Staining of macrophages, inflammatory cell infiltrates, and endothelial cells was variable from case to case, but generally detected only in acute lesions. In chronic MS lesions reactive astrocytes at the lesion edge were positive for iNOS whereas the lesion center was nonreactive. Normal appearing white matter demonstrated little reactivity, as did tissues from noninflamed control brains. Staining for nitrotyrosine was also detected in acute but not chronic MS lesions, and displayed a diffuse parenchymal, membranous, and perivascular pattern of immunoreactivity. These results support the conclusion that iNOS is induced in multiple cell types in MS lesions and that astrocyte-derived nitric oxide could be important in orchestrating inflammatory responses in MS , particularly at the blood-brain barrier. Multiple sclerosis (MS) is an inflammatory disease of the central nervous system (CNS) that is thought to be mediated by an autoimmune attack directed against components of the myelin sheath. MS lesions are characterized by loss of myelin, oligodendrocytes, and axons associated with a mononuclear inflammatory infiltrate and a reactive gliosis. Although the mechanisms that lead to loss of function associated with these events remain poorly understood, the activation of T cells and macrophages that secrete freely diffusable factors has been widely implicated. Included in these factors are the proinflammatory cytokines interleukin (IL)-1, tumor necrosis factor-␣, IL-12, and interferon (IFN)-␥, and reactive oxygen and reactive nitrogen species. All of these factors have been shown to be elevated in active MS lesions, and animal models support a role for them in disease pathogenesis. 1,2 The anti-proliferative and/or cytotoxic effects of nitric oxide (NO) have been associated with the persistent production of high levels of NO that occurs after the activation of the inducible form of nitric oxide synthase (iNOS). 3 The expression of this enzyme in various cell types is known to be transcriptionally regulated and to be activated by a combination of pro-inflammatory signals such as ligands that activate toll-like receptors and/or cytokines such as IL-1, tumor necrosis factor-␣, and interferon-␥ (IFN-␥). 3 NO by itself demonstrates only weak toxic activity, but congeners formed by auto-oxidation such as NO 2⅐ , N 2 O 3 , and S-nitrosothiols enhance its cytotoxic potential. The toxicity of NO is also greatly enhanced when it combines with O 2Ϫ to generate peroxynitrite (ONOOϪ),...