Abstract-Reactive oxygen species (ROS)-mediated cell injury contributes to the pathophysiology of cardiovascular disease and myocardial dysfunction. Protection against ROS requires maintenance of endogenous thiol pools, most importantly, reduced glutathione (GSH), by NADPH. In cardiomyocytes, GSH resides in two separate cellular compartments: the mitochondria and cytosol. Although mitochondrial GSH is maintained largely by transhydrogenase and isocitrate dehydrogenase, the mechanisms responsible for sustaining cytosolic GSH remain unclear. Glucose-6-phosphate dehydrogenase (G6PD) functions as the first and rate-limiting enzyme in the pentose phosphate pathway, responsible for the generation of NADPH in a reaction coupled to the de novo production of cellular ribose. We hypothesized that G6PD is required to maintain cytosolic GSH levels and protect against ROS injury in cardiomyocytes. We found that in adult cardiomyocytes, G6PD activity is rapidly increased in response to cellular oxidative stress, with translocation of G6PD to the cell membrane. Furthermore, inhibition of G6PD depletes cytosolic GSH levels and subsequently results in cardiomyocyte contractile dysfunction through dysregulation of calcium homeostasis. Cardiomyocyte dysfunction was reversed through treatment with either a thiol-repleting agent (L-2-oxothiazolidine-4-carboxylic acid) or antioxidant treatment (Eukarion-134), but not with exogenous ribose. Finally, in a murine model of G6PD deficiency, we demonstrate the development of in vivo adverse structural remodeling and impaired contractile function over time. We, therefore, conclude that G6PD is a critical cytosolic antioxidant enzyme, essential for maintenance of cytosolic redox status in adult cardiomyocytes. Deficiency of G6PD may contribute to cardiac dysfunction through increased susceptibility to free radical injury and impairment of intracellular calcium transport. The full text of this article is available online at http://www.circresaha.org. (Circ Res. 2003;93:e9-e16.)Key Words: glucose-6-phosphate dehydrogenase Ⅲ cardiomyocytes Ⅲ oxidant injury Ⅲ contractile dysfunction Ⅲ intracellular calcium R eactive oxygen species (ROS)-mediated cell injury contributes to the pathophysiology of cardiovascular disease and myocardial dysfunction. 1-3 These ROS originate from multiple sources, including cellular oxidase complexes and as mitochondrial byproducts of aerobic metabolism. 3,4 To protect against ROS, cardiomyocytes contain a highly active cellular antioxidant defense. Central to the neutralization of ROS is the endogenous thiol, reduced glutathione (GSH), and glutathione cycling. 5,6 GSH provides the reducing equivalents necessary for the conversion of hydrogen peroxide and lipid peroxides to water and lipid alcohols, respectively, thereby preventing degradation to highly toxic free radicals, including hydroxyl and peroxyl radicals. 7 GSH also plays an important role in protecting against oxidation of protein sulfhydryl groups. 8 In the presence of ROS, the cellular redox state is altere...