Acetaldehyde, the major ethanol metabolite that is far more toxic and reactive than ethanol, has been postulated to be responsible for alcohol-induced tissue and cell injury. This study was to examine whether facilitated acetaldehyde metabolism affects acetaldehyde-induced oxidative stress and apoptosis. Transgene-encoding human aldehyde dehydrogenase-2 (ALDH2), which converts acetaldehyde into acetate, was constructed under chicken -actin promoter and transfected into human umbilical vein endothelial cells (HUVECs). Efficacy of ALDH2 transfection was verified using green fluorescent protein and ALDH2 enzymatic assay. Generation of reactive oxygen species (ROS) was measured using chloromethyl-2,7-dichlorodihydrofluorescein diacetate. Apoptosis was evaluated by 4,6-diamidino-2-phenylindoladihydrochloride fluorescence microscopy, quantitative DNA fragmentation, and caspase-3 assay. Acetaldehyde (0 -200 M) elicited ROS generation and apoptosis in HUVECs in a time-and concentration-dependent manner, associated with activation of the stress signal molecules ERK1/2 and p38 mitogen-activated protein (MAP) kinase. A close liner correlation was observed between the acetaldehyde-induced ROS generation and apoptosis. Interestingly, the acetaldehydeinduced ROS generation, apoptosis, activation of ERK1/2, and p38 MAP kinase were prevented by the ALDH2 transgene or antioxidant ␣-tocopherol. The involvement of ERK1/2 and p38 MAP kinase in acetaldehyde-induced apoptosis was confirmed by selective kinase inhibitors U0126, SB203580, and SB202190. Collectively, our data revealed that facilitation of acetaldehyde metabolism by ALDH2 transgene overexpression may prevent acetaldehyde-induced cell injury and activation of stress signals. These results indicated therapeutic potential of ALDH2 enzyme in the prevention and detoxification of acetaldehyde or alcohol-induced cell injury.Chronic alcohol consumption leads to cardiovascular complications such as endothelial dysfunction and alcoholic cardiomyopathy (1). Although several hypotheses have been speculated for alcohol-induced injury including direct/indirect toxicity of alcohol and accumulated fatty acid ethyl esters (2, 3), neither scenario has been fully validated by compelling clinical and experimental evidence. Acetaldehyde is the very first oxidized metabolic product of ethanol and is considered a candidate toxin for alcohol-induced tissue and cell injury. It is far more reactive than ethanol and may inhibit protein synthesis (4, 5). Our laboratory (6 -8) has shown that acetaldehyde interrupts cardiac excitation-contraction coupling and sarco(endo)plasmic reticulum Ca 2ϩ release function. Acetaldehyde has also been shown to form protein adducts leading to atherosclerotic vascular injury (9). Transgenic mice with cardiac overexpression of alcohol dehydrogenase (ADH) 1 displayed higher cardiac acetaldehyde levels associated with compromised heart function at whole heart and ventricular myocyte levels following alcohol intake (10 -12), suggesting that acetaldehyde may be one of t...