Glyceryl trinitrate (GTN) is used in the treatment of angina pectoris and cardiac failure, but the rapid onset of GTN tolerance limits its clinical utility. Research suggests that a principal cause of tolerance is inhibition of an enzyme responsible for the production of physiologically active concentrations of NO from GTN. This enzyme has not conclusively been identified. However, the mitochondrial aldehyde dehydrogenase (ALDH2) is inhibited in GTN-tolerant tissues and produces NO 2 Ϫ from GTN, which is proposed to be converted to NO within mitochondria. To investigate the role of this enzyme in GTN tolerance, cumulative GTN concentration-response curves were obtained for both GTN-tolerant and -nontolerant rat aortic rings treated with the ALDH inhibitor cyanamide or the ALDH substrate propionaldehyde. Tolerance to GTN was induced using both in vivo and in vitro protocols. The in vivo protocol resulted in almost complete inhibition of ALDH2 activity and GTN biotransformation in hepatic mitochondria, indicating that long-term GTN exposure results in inactivation of the enzyme. Treatment with cyanamide or propionaldehyde caused a dose-dependent increase in the EC 50 value for GTN-induced relaxation of similar magnitude in both tolerant and nontolerant aorta, suggesting that although cyanamide and propionaldehyde inhibit GTN-induced vasodilation, these inhibitors do not affect the enzyme or system involved in tolerance development to GTN. Treatment with cyanamide or propionaldehyde did not significantly inhibit 1,1-diethyl-2-hydroxy-2-nitrosohydrazine-mediated vasodilation in tolerant or nontolerant aorta, indicating that these ALDH inhibitors do not affect the downstream effectors of NO-induced vasodilation. Immunoblot analysis indicated that the majority of vascular ALDH2 is present in the cytoplasm, suggesting that mitochondrial biotransformation of GTN by ALDH2 plays a minor role in the overall vascular biotransformation of GTN by this enzyme.Most current hypotheses on the mechanism of action of organic nitrates consider that these compounds act as prodrugs, in that they undergo mechanism-based biotransformation in vascular smooth muscle cells to an activator of soluble guanylyl cyclase (sGC) (presumed to be NO or a related species) ). The term clearance-based biotransformation has been coined to differentiate pathways that lead to nitrate metabolism without activation of sGC . The biotransformation of glyceryl trinitrate (GTN, nitroglycerin) yields the dinitrate metabolites glyceryl-1,2-dinitrate (1,2-GDN) and glyceryl-1,3-dinitrate (1,3-GDN) as products, and in nitrate-tolerant tissues, the biotransformation of GTN is attenuated. Formation of NO using high concentrations of GTN has been demonstrated in intact and broken cell preparations, but an enzyme in vascular smooth muscle that catalyzes the three-electron reduction of the nitrate ester group of organic nitrates to NO has not been identified (Thatcher and Weldon, 1998). Several enzymes, however, have been identified that are capable of mediating...