Endothelial-derived nitric oxide, which is produced by endothelial nitric oxide synthase (eNOS), may play an important role in colorectal carcinogenesis. However, the putative contribution of common eNOS genetic polymorphisms to colorectal cancer risk remains unknown. We genotyped 3 polymorphisms of eNOS (T-786C, G894T, and intron4b/a) in 727 colorectal adenocarcinoma cases and 736 age-and sex-matched healthy controls in Taiwan. Genotypes of the T-786C and G894T polymorphisms were determined by fluorescence polarization assays and the 27-bp variable number of tandem repeat (VNTR) polymorphism in intron 4 (intron4b/a) was analyzed by PCR. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Among younger participants ( 60 yrs), the intron4a variant genotype was associated with a significantly increased risk of colorectal cancer, compared with the intron4bb genotype (OR 5 1.60, 95% CI 5 1.04-2.46). In addition, those young individuals bearing a greater number of high-risk genotypes (OR > 1, i.e., CT1TT for T-786C, ba1aa for intron4b/a, and GG for G894T) of eNOS had a higher colorectal cancer risk (p trend 5 0.039). Compared with younger individuals without any putative high-risk genotypes, those with 3 high-risk genotypes had a significantly greater cancer risk (OR 5 1.89, 95% CI 5 1.04-3.43). Our results suggest that the eNOS intron4b/a polymorphism may contribute to early-onset colorectal cancer risk in the Taiwanese population. ' 2008 Wiley-Liss, Inc.Key words: colorectal cancer; endothelial nitric oxide synthase; polymorphisms; early-onset The free radical nitric oxide (NO) is synthesized during the conversion of L-arginine to L-citrulline by nitric oxide synthase (NOS) isoforms, i.e., endothelial (e), inducible (i) and neuronal (n) NOS. 1 NO has an impact on multiple physiologic and pathophysiologic processes, including vasodilatation, neuronal transmission, smooth muscle relaxation, immunity, and carcinogenesis. [2][3][4] Data with respect to the role of NO in tumor promotion or inhibition are conflicting. 4 Studies suggest that overproduction of NO can cause DNA damage and inhibit DNA repair 5 and that NO also promotes tumor angiogenesis and metastasis. 6 However, other studies suggest that NO may protect cells from DNA damage by upregulating p53, 7 poly(ADP-ribose) polymerase (PARP) 8 and DNA-dependent protein kinase (DNA-PK). 9 Moreover, NO may exert antitumor effects with the reduction of tumor cell adhesion to endothelium, 10 activation of antioxidant defenses 11 and induction of apoptosis. 12 Studies have demonstrated elevated NOS expression and activity in ovarian cancer, 13 breast cancer 14 and central nervous system tumors. 15 However, expression of NOS in colorectal cancer has not been extensively investigated and results are controversial. Chhatwal et al. 16 found aberrant expression of NOS activity in colonic polyps and carcinomas compared to normal mucosa. Three studies also found diminished expression of eNOS in colorectal tumor tissues, 17-19 whereas ...