Accumulating data support the view that sepsis is associated with an acquired intrinsic derangement in the ability of cells to consume O 2, a phenomenon that has been termed "cytopathic hypoxia." We sought to use an in vitro "reductionist" model system using cultured cells stimulated with proinflammatory cytokines to test the hypothesis that cytopathic hypoxia is mediated, at least in part, by depletion of intracellular levels of NAD ϩ / NADH secondary to activation of the nuclear enzyme poly-(ADP-ribose) polymerase (PARP). We measured O2 consumption by Caco-2 enterocytes growing on microcarrier beads after cells were incubated for 24 h under control conditions or with cytomix, a mixture of tumor necrosis factor-␣, interleukin-1, and interferon-␥. Immunostimulated cells consumed O2 at about one-half the rate of control cells, but this effect was largely prevented if any one of the following pharmacological agents was present during the period of incubation with cytomix: 4,5-dihydroxy-1,3-benzene disulfonic acid, a superoxide radical anion scavenger; 2-(4-carboxyphenyl)-4,4,5,5-tetramethylimidazoline-1-oxyl-3-oxide, a nitric oxide scavenger; 5,10,15,20-HCl, a chemically dissimilar and more potent PARP inhibitor. The decrease in O 2 uptake induced by cytomix was associated with decreased cellular levels of NAD ϩ /NADH. The decrease in cellular NAD ϩ /NADH content and the decrease in O2 uptake induced by cytomix were completely abrogated if liposome-encapsulated NAD ϩ was added to the cultures during immunostimulation. Empty liposomes also increased O2 uptake by immunostimulated Caco-2 cells, but much less effectively than liposomes containing NAD ϩ . These data are consistent with the view that enterocytes exposed to proinflammatory cytokines consume less O2 due to NAD ϩ /NADH depletion secondary to activation of PARP by ONOO Ϫ or other oxidants.poly(ADP-ribose) polymerase; nitric oxide; peroxynitrite; enterocyte; epithelium; intestinal ACCUMULATING DATA SUPPORT the view that sepsis is associated with an acquired intrinsic derangement in the ability of cells to consume O 2 . This phenomenon has been termed "cytopathic hypoxia" (15). Direct and indirect evidence exists for the development of cytopathic hypoxia in sepsis (or related inflammatory conditions, such as endotoxemia) in experimental animals. For example, tissue PO 2 has been shown to increase in rats (33) and pigs (42) infused with purified lipopolysaccharide (LPS) and also in human patients with septic shock (5). In an indirect way, these data suggest that the ability of cells to extract O 2 from arterial blood is impaired in these conditions, which are associated with systemic inflammation. More direct evidence comes from a study performed by Kantrow et al. (22), where it was shown that the rate of O 2 consumption by hepatocytes isolated from septic rats was less than that by liver cells from control rats. More recently, King et al. (25), working in our laboratory, showed that ex vivo O 2 consumption by ileal mucosa was decreased (relative to the norm...