Abstract-Dimethylarginie dimethylaminohydrolase (DDAH) degrades asymmetric dimethylarginine (ADMA), an endogenous nitric oxide (NO) synthase inhibitor, and comprises 2 isoforms, DDAH1 and DDAH2. To investigate the in vivo role of DDAH2, we generated trangenic mice overexpressing DDAH2. The transgenic mice manifested reductions in plasma ADMA and elevations in cardiac NO levels but no changes in systemic blood pressure (SBP), compared with the wild-type mice. When infused into wild-type mice for 4 weeks, ADMA elevated SBP and caused marked medial thickening and perivascular fibrosis in coronary microvessels, which were accompanied by ACE protein upregulation and cardiac oxidative stress. The treatment with amlodipine reduced SBP but failed to ameliorate the ADMA-induced histological changes. In contrast, these changes were abolished in transgenic mice, with a reduction in plasma ADMA. In coronary artery endothelial cells, ADMA activated p38 MAP kinase and the ADMA-induced ACE upregulation was suppressed by p38 MAP kinase inhibition by SB203580. In wild-type mice, long-term treatment with angiotensin II increased plasma ADMA and cardiac oxidative stress and caused similar vascular injury. In transgenic mice, these changes were attenuated. The present study suggests that DDAH2/ADMA regulates cardiac NO levels but has modest effect on SBP in normal conditions. Under the circumstances where plasma ADMA are elevated, including angiotensin II-activated conditions, ADMA serves to contribute to the development of vascular injury and increased cardiac oxidative stress, and the overexpression of DDAH2 attenuates these abnormalities. Collectively, the DDAH2/ADMA pathway can be a novel therapeutic target for vasculopathy in the ADMA or angiotensin II-induced pathophysiological conditions. (Circ Res. 2007;101:e2-e10.)Key Words: DDAH2 Ⅲ ADMA Ⅲ angiotensin II A symmetric dimethylarginine (ADMA) is an endogenous competitive inhibitor of nitric oxide synthase (NOS). Substantial evidence has been accumulated that plasma ADMA mediates the endothelial dysfunction and serves as a marker of risk for cardiovascular disease. 1-3 ADMA is degraded by the enzyme, dimethylarginine dimethylaminohydrolase (DDAH), and would subsequently affect NO metabolism. It has been demonstrated that DDAH is composed of 2 isoforms, DDAH1 and DDAH2, 4 each of which stems from different chromosomes and differs in several aspects. DDAH1 and 2 appear to have distinct tissue distributions, with DDAH1 predominating in the tissues that express nNOS and DDAH2 being coexpressed with eNOS in highly vascularized tissues. 5 Moreover, in cultured human endothelial cells, DDAH1 is uniformly distributed in the cytosol and nucleus, whereas DDAH2 is found only in the cytosol. 6 The different characteristics between these 2 isoforms suggest different physiological functions.Physiological function of DDAH1 has been elucidated by the studies using transgenic (TG) mice overexpressing DDAH1 7 and DDAH1 knockout (KO) mice. 8 In TG mice, tissue DDAH1 expression is increased and t...