To cast light on mechanisms underlying development of urothelial carcinomas (UCs) of the urinary bladder associated with Schistosomiasis, we immunohistochemically analyzed the relationship between oxidative stress markers, DNA single strand breaks (ssDNA) which could also measure the levels of base damage and apoptosis in DNA, and expression of DNA repair genes with levels of nitric oxide synthases in bladder carcinomas of Egyptian patients with or without Schistosoma hematobium infection. Marked elevation of 8-hydroxy-2 0 -deoxyguanosine (8-OHdG) levels was found in squamous cell carcinomas and UCs associated with Schistosomiasis when compared with non-Schistosomal carcinomas. This was accompanied by strong over expression of the DNA-repair genes, 8-oxoguanine-DNA-glycosylase and apurinic/ apyrimidinic endonuclease, as well as increased formation levels of ssDNA. Expression levels of inducible nitric oxide synthase (iNOS) which is known to be indirectly related to oxidative stress was higher in Schistosomal than in the non-Schistosomal carcinomas. However, expression of endothelial nitric oxide synthase was slightly stronger in non-Schistosomal than in the Schistosomal carcinomas. In conclusion, these findings suggest a strong correlation between Schistosoma haematobium infection and increased levels of oxidative stress accompanied by a continuous DNA damage and repair in UCs, all directly correlating with elevated iNOS. ' 2008 Wiley-Liss, Inc.Key words: oxidative stress; 8-OHdG; ROS; iNOS; eNOS; ssDNA; OGG1; APE-1; DNA repair; urinary bladder carcinoma; schistosomes Schistosomiasis (Bilharzia) is endemic in Egypt and also in other 75 countries worldwide, affecting more than 200 million people, and putting more than 1 billion population at great risk. 1 It has been well-documented that urinary bladder cancer is one of the major consequences of chronic infection with Schistosoma hematobium in many African and Middle East countries. 2 Among different species of Schistosoma inhibiting various countries and causing several diseases including cancers of the liver and colorectum, 3,4 the relationship between Schistosoma hematobium and urinary bladder cancer is the most important, and this organism has been classified by WHO/IARC as a Class 1 carcinogen. 5 When compared with their non-Schistosomal counterparts, Schistosoma-associated bladder carcinomas have 2 major clinicopathological features: the incidence reaches a peak in the 3rd-5th decades of life vs. the 7th decade in nonendemic areas, and there is significant increase in the ratios of squamous cell carcinomas (SCCs) to typical transitional urothelial carcinomas (UCs). 6 The SCCs associated with Schistosoma are extremely complex and heterogeneous, exhibiting a high level of resistance to radiotherapy and chemotherapy. However, they do not show distant metastasis in spite of their invasive characteristics and advanced clinical grades. Comparisons have already been made of SCCs and UCs of non-Schistosoma-related 7 and Schistosoma-associated origins, 8 but the fo...