diabetes; endothelial nitric oxide synthase ACCELERATED ATHEROSCLEROSIS, one of the major vascular complications of diabetes, is attributed to hyperglycemia mediatedendothelial dysfunction (6). Endothelial dysfunction is characterized by the loss of nitric oxide (NO) bioactivity in the vessel wall with concomitant increase in superoxide release, which impairs vasodilatation, inhibits protection against leukocyteendothelial interactions, platelet aggregation, and adhesion and smooth muscle cell proliferation (3,17,31). The optimal generation of NO from endothelial nitric oxide synthase (eNOS) activity is dependent on several factors, including availability of the substrate L-arginine (9) and the cofactor tetrahydrobiopterin (BH4) (1). The activation of eNOS is a complex process and may be regulated by 1) both transcriptional and posttranslational mechanisms, 2) site-specific phosphorylation of eNOS, 3) protein-protein interactions, 4) prosthetic groups, and 5) calcium and calmodulin (8).eNOS has been shown to interact with several regulatory proteins such as heat shock protein-90 (Hsp-90), caveolin-1, G protein-coupled receptors, NO-interacting protein (NOSIP), Dynamin-2, and Porin (8). In endothelial cells, both BH 4 and Hsp-90 have been shown to be important effectors in regulating eNOS activity. Hsp-90 is known to regulate calciumdependent dissociation of eNOS from caveolin-1, enzyme activation, maturation, and trafficking, followed by the Aktdependent activation and phosphorylation of serine 1177 (human eNOS) or serine 1179 (bovine eNOS) (8). Phosphorylation of eNOS is a key posttranslational modification that was believed to be a key determinant of eNOS activity associated with NO generation. The binding of Hsp-90 to eNOS ensures the transition from the early Ca 2ϩ -dependent to the late phosphorylation-dependent activation of eNOS (18). Failure of this binding has been demonstrated to cause eNOS uncoupling and increased eNOS-dependent superoxide anion production (20,28,30).A recent study in the diabetes literature has demonstrated that chronic exposure of endothelial cells to high glucose (HG) conditions downregulate both protein interaction between eNOS and Hsp-90 and the recruitment of activated Akt. The end result is the deactivation of eNOS and imbalance in NO versus reactive oxygen species (ROS) levels (18). Evidence of metformin-stimulated NOS in vivo (5) by promoting the association of Hsp-90 further supports the results of an earlier study (18) and confirms the concept that elevated glucose downregulates the interaction of eNOS and Hsp-90.Parallel studies investigating NO production in endothelial cells under conditions of HG suggested that HG-mediated endothelial dysfunction involves activation of IKK, which inhibits insulin receptor substrate (IRS-1)/phosphatidylinositol 3-kinase (PI3 kinase) signaling and therefore attenuates NO production (14). This has been implicated in insulin resistance, a common complication of diabetes.Requirement of Hsp-90 for the activation of IKK complex consisting of ...