NADPH oxidases belong to a group of enzymes that generate reactive oxygen species (ROS) by electron transfer from NADPH to molecular oxygen. The product of this reaction is the superoxide anion (O 2 Ϫ ), which undergoes secondary reactions. O 2 Ϫ inactivates NO to yield peroxynitrite and spontaneously or under catalysis of superoxide dismutases reacts to hydrogen peroxide. NADPH oxidases, therefore, limit vascular NO availability and facilitate reactions involving ROS. 1 It is now well understood that endothelial dysfunction is largely a consequence of NADPH oxidase activation, as well as of complex secondary reactions that involve different types of ROS. Peroxynitrite oxidizes the NO synthase cofactor tetrahydrobiopterin and stimulates kinases, which both lead to uncoupling of the endothelial NO synthase. NO and O 2 Ϫ may also affect gene expression, and, in particular, NADPH oxidase-derived hydrogen peroxide has been shown to be important in this respect. In addition to the stress-mediated ROS-stimulated gene expression, hydrogen peroxide transiently or irreversibly oxidizes biological materials and, therefore, has complex effects on signaling that are still incompletely elucidated. 1
NADPH Oxidases From Past to PresentAlthough the initial work on NADPH oxidases focused on its role for gene expression and endothelial dysfunction at large, the research of recent years aimed at the identification of specific NADPH oxidase-dependent signaling pathways, the understanding of the role of the enzymes in individual disease entities, the identification of NADPH oxidase inhibitors, and finally the demonstration of a relevance of NADPH oxidases in human cardiovascular diseases. Indeed, it is now known that patients with chronic granulomatous disease, which results from loss-of-function mutations of the NADPH oxidase, have an increased vascular NO availability and reduced vascular levels of footprint markers of ROS formation. 2 This important observation provided a direct link between NADPH oxidase and endothelial function in humans. Chronic granulomatous disease, however, is too rare and too severe to study whether the advantage in endothelial function also translates into a reduced cardiovascular disease rate. Studies on polymorphisms of NADPH oxidase genes, however, failed to draw a clear picture. 3 Thus, most data in support of a relevance of NADPH oxidases for human cardiovascular disease are based on indirect treatment studies. Several highly effective cardiovascular drugs, such as statins, peroxisome proliferator-activated receptor-␥ agonists, angiotensinconverting enzyme inhibitors, and angiotensin II type 1 (AT 1 ) receptor antagonists prevent the activation or induction of NADPH oxidases and reduce the oxidative burden in patients. 4,5 The possible conclusion that NADPH oxidases are excellent cardiovascular drug targets might, however, still be premature, in particular, in light of the failures of large prospective trials testing antioxidants. 6 These studies demonstrated that, although effective in the acute se...