Abstract-Hyperhomocysteinemia (HH) is an independent risk factor for atherosclerosis, including peripheral arterial occlusive disease (PAOD). Because angiogenesis and collateral vessel formation are important self-salvage mechanisms for ischemic PAOD, we examined whether HH modulates angiogenesis in vivo in a rat model of hindlimb ischemia. Rats were divided into 3 groups: the control group was given tap water, the HH group was given water containing, and the HHϩL-arg group was given water containing methionine (1 g ⅐ kg [1][2][3][4][5] Moreover, it has been established that modest HH occurs in up to 40% of patients with stroke, myocardial infarction, and/or peripheral arterial obstructive disease (PAOD). 1,6 HH may exert multiple adverse effects on cells composing the vascular wall. In particular, homocysteine induces endothelial dysfunction and thereby accelerates atherosclerosis. 7,8 Light-and electron-microscopic studies of arteries and arterioles from humans and animals have revealed that HH alters endothelial morphology. 5,7,9 HH has also been shown to attenuate endothelium-dependent vasodilatation, 8,10,11 presumably because of the inactivation of endothelium-derived NO (EDNO). 8 In addition, HH has been shown to produce oxygenderived free radicals that further inactivate EDNO. 12,13 We and others have recently reported that EDNO is an important endogenous modulator of angiogenesis. 14 -17 For example, angiogenesis induced by substance P, an endothelium-dependent vasodilator, 14 or vascular endothelial growth factor, 15,16 a potent angiogenic cytokine, was significantly attenuated by inhibitors of NO synthase (NOS). More recently, we showed that angiogenesis occurring after surgically induced hindlimb ischemia was severely impaired in mice lacking the gene for the endothelial constitutive NOS. 17 Although such adverse effects of HH on endothelial cells (ECs) have been documented in numerous studies, the effects of HH on angiogenesis and collateral vessel formation in response to tissue ischemia have not been examined as yet. This issue is clinically relevant inasmuch as HH is an independent risk factor for PAOD. In patients with PAOD, regional angiogenesis and collateral vessel formation from surrounding tissues are critical self-defense mechanisms for tissue survival. 18 Accordingly, we investigated the effects of HH on angiogenesis, collateral vessel formation, and regional blood flow in a rat model of surgically induced hindlimb ischemia. We also investigated whether oral supplementation of L-arginine, a substrate for NOS, had favorable effects on a potential HH-mediated impairment of angiogenesis.