We have shown that a novel NADPH oxidase isoform, NOX5-S, is the major isoform of NADPH oxidases in an esophageal adenocarcinoma (EA) cell line, FLO, and is overexpressed in Barrett's mucosa with high-grade dysplasia. NOX5-S is responsible for acid-induced reactive oxygen species production. In this study, we found that mRNA levels of NOX5-S were significantly higher in FLO EA cells than in the normal human esophageal squamous cell line HET-1A or in a Barrett cell line, BAR-T. The mRNA levels of NOX5-S were also significantly increased in EA tissues. The data suggest that NOX5-S may be important in the development of EA. Mechanisms of functional regulation of NOX5-S are not fully understood. We show that small G protein Rac1 was present in HET-1A cells, BAR-T cells, and EA cell lines FLO and OE33. Rac1 protein levels were significantly higher in FLO and OE33 cells than in HET-1A or BAR-T cells. Knockdown of Rac1 with Rac1 small interfering RNA significantly decreased acid-induced increase in H2O2 production in FLO EA cells. Overexpression of constitutively active Rac1 significantly increased H2O2 production, an increase that was blocked by knockdown of NOX5-S. By immunofluorescence staining and immunoprecipitation, we found that NOX5-S was present in the cytosol of FLO EA cells and colocalized with Rac1 and SERCA1/2 Ca 2ϩ -ATPase which is located in the endoplasmic reticulum membrane. We conclude that Rac1 may be important in activation of NOX5-S in FLO EA cells.Barrett's esophagus; SERCA1/2 Ca 2ϩ -ATPase ESOPHAGEAL ADENOCARCINOMA (EA) has increased in incidence over the past four decades (6, 39). It is characterized by a poor prognosis, with a median survival time following diagnosis of Ͻ18 mo, and a 5-yr survival rate of Ͻ20% in operable tumors (44). The major risk factor for EA is gastroesophageal reflux disease (GERD) complicated by Barrett's esophagus (BE) (26). Approximately 10% of GERD patients develop BE where esophageal squamous epithelium damaged by acid reflux is replaced by a metaplastic, intestinal type epithelium. The specialized intestinal metaplasia is associated with a 30-to 125-fold increased risk for the development of esophageal adenocarcinoma, with an estimated cancer incidence of about 0.5-1.0% per year, i.e., one cancer per 100 -200 patients for each year of observation (14,16,49). A middle-aged individual with BE for 20 yr or more has an estimated 10 -20% lifetime risk of developing esophageal adenocarcinoma, which is similar to the risk of lung cancer among heavy smokers or of liver cancer among chronic hepatitis B virus carriers (49). However, the mechanisms responsible for the progression from metaplasia to adenocarcinoma are not known. Acid reflux may play an important role in the progression from metaplasia to dysplasia and to adenocarcinoma in patients with BE because of the following: 1) cultured biopsy specimens of intestinal metaplastic cells demonstrate a significant increase in tritiated thymidine uptake when explants are briefly exposed to acid (21); 2) long-term inhibition of...