Non-thermal atmospheric pressure plasma (NTAPP) has recently been applied to living cells and tissues and has emerged as a novel technology for medical applications. NTAPP affects cells not only directly, but also indirectly with previously prepared plasma-activated medium (PAM). The objective of this study was to demonstrate the preconditioning effects of "mild PAM" which was prepared under relatively mild conditions, on fibroblasts against cellular injury generated by a high dose of hydrogen peroxide (H 2 O 2 ). We observed the preconditioning effects of mild PAM containing approximately 50 μM H 2 O 2 . Hydrogen peroxide needs to be the main active species in mild PAM for it to exert preconditioning effects because the addition of catalase to mild PAM eliminated these effects. The nuclear translocation and recruitment of nuclear factor erythroid 2-related factor 2 (Nrf2) to antioxidant response elements (ARE) in heme oxygenase 1 (HO-1) promoters and the up-regulation of HO-1 were detected in fibroblasts treated with mild PAM. The addition of ZnPP, a HO-1-specific inhibitor, or the knockdown of Nrf2 completely abrogated the preconditioning effects. Our results demonstrate that mild PAM protects fibroblasts from oxidative stress by up-regulating HO-1, and the H 2 O 2 -induced activation of the Nrf2-ARE pathway needs to be involved in this reaction.Plasma is the fourth state of matter and is defined as an ionized gas. According to its gas temperature, plasma has been divided into thermal and non-thermal plasma. Non-thermal atmospheric pressure plasma (NTAPP) has recently been applied to living cells and tissues 1 and has emerged as a novel technology for clinical medicine, for example, wound healing 2 , blood coagulation 3 , sterilization 4 , and cancer treatments 1,5,6 . In these studies on its clinical application, a low dose of NTAPP was reported to induce the proliferation of cells, whereas a high dose induced apoptosis 7 . NTAPP contains variable compositions of ultraviolet light, free electrons, and charged particles as well as reactive oxygen species (ROS) such as the hydroxyl radical (• OH), superoxide (O 2 − ), ozone (O 3 ), and hydrogen peroxide (H 2 O 2 ), and reactive nitrogen species (RNS) including nitric oxide (NO• ) and peroxynitrite (ONOO − ) 8,9 . Most of the functions of NTAPP are involved in the activities of ROS and/or RNS [10][11][12] . ROS affect several signaling pathways in cells such as protein kinases, transcription factors, and cellular signaling proteins 13 . High levels of intracellular ROS are known to be harmful because they trigger significant oxidative damage in cellular macromolecules, such as nucleotides, lipid, and proteins, whereas low levels of intracellular ROS are necessary for a number of important physiological functions including intracellular signal transduction and host defenses against microorganisms 14 . "Preconditioning" is a phenomenon in which brief oxidative stress induced by low levels of ROS may result in protection against a subsequent stronger stress. The Ke...