Cardiovascular disease is responsible for most of the excess mortality associated with diabetes mellitus [1], and impaired endothelium-dependent relaxation has been described in humans and in animal models of the disease [2±6]. A variety of mechanisms have been proposed to explain this observation and, in particular, the role of nitric oxide (NO) has been evaluated. Nitric oxide production has been reported to be either increased [7] or decreased [8] in the presence of high glucose concentrations. Moreover, endothelial dysfunction following hyperglycaemia is associated with increased generation of oxygen free radicals [9] and vasoconstrictor prostanoids [10,11]. The observation that diabetes-induced abnormalities of vascular relaxation are reversed when the vessel segments are exposed to indomethacin in the organ Diabetologia (2000) Abstract Aims/hypothesis. Cardiovascular disease is the leading cause of death in diabetes mellitus. Abnormal endothelium-dependent relaxation is observed both in humans and in animal models of diabetes mellitus and decreased bioavailability of nitric oxide (NO) is thought to be involved in this defect. Therefore, the aim of this study was to test whether adenovirus-mediated gene transfer of endothelial nitric oxide synthase (eNOS) alters vascular reactivity of diabetic vessels. Methods. Vascular reactivity was first assessed in thoracic aortas and carotid arteries from nine alloxan-induced diabetic (plasma glucose, 26.5 ± 1.2 mmol/l; HbA 1 c , 6.4 ± 0.3 %) and nine control rabbits (plasma glucose, 11.1 ± 1.3 mmol/l; HbA 1 c , 2.1 ± 0.1 %). Vascular reactivity was next examined in thoracic aortas of diabetic animals after ex vivo transduction with replication-deficient adenovirus encoding gene for eNOS (AdeNOS) or b-galactosidase (Adbgal).Results. After 10 weeks of hyperglycaemia, endothelium-dependent relaxation to acetylcholine was impaired in diabetic aorta, but was normal in carotid arteries from diabetic rabbits. In contrast, responses of both vessels to calcium ionophore and nitric oxide donor were normal. Histochemical staining for b-galactosidase and immunohistochemistry for eNOS showed transgene expression in the endothelium and adventitia in Adbgal and AdeNOS transduced vessels, respectively. During submaximum contractions with phenylephrine, relaxations to low concentrations of acetylcholine (3 10 ±8 to 10 ±7 mol/l) were augmented in AdeNOS transduced diabetic vessels. Conclusion/interpretation. These findings suggest that adenovirus-mediated gene transfer of eNOS to diabetic aorta alters vascular reactivity. [Diabetologia (2000) 43: 340±347]