Abstract-Nitroglycerin (GTN) tolerance was induced in vivo (rats) and in vitro (rat and human vessels). Electrochemical detection revealed that the incubation dose of GTN (5ϫ10 Ϫ6 mol/L) did not release NO or modify O 2 consumption when administered acutely. However, development of tolerance produced a decrease in both mitochondrial O 2 consumption and the K m for O 2 in animal and human vessels and endothelial cells in a noncompetitive action. GTN tolerance has been associated with impairment of GTN biotransformation through inhibition of aldehyde dehydrogenase (ALDH)-2, and with uncoupling of mitochondrial respiration. Feeding rats with mitochondrial-targeted antioxidants (mitoquinone [MQ]) and in vitro coincubation with MQ (10 Ϫ6 mol/L) or glutathione (GSH) ester (10 Ϫ4 mol/L) prevented tolerance and the effects of GTN on mitochondrial respiration and ALDH-2 activity. Biotransformation of GTN requires functionally active mitochondria and induces reactive oxygen species production and oxidative stress within this organelle, as it is inhibited by mitochondrial-targeted antioxidants and is absent in HUVEC 0 cells. Experiments analyzing complex I-dependent respiration demonstrate that its inhibition by GTN is prevented by mitochondrial-targeted antioxidants. Furthermore, in presence of succinate (10ϫ10 Ϫ3 mol/L), a complex II electron donor added to bypass complex I-dependent respiration, GTN-treated cells exhibited O 2 consumption rates similar to those of controls, thus suggesting that complex I was affected by GTN. We propose that, following prolonged treatment with GTN in addition to ALDH-2, complex I is a target for mitochondrially generated reactive oxygen species. Our data also suggest a role for mitochondrial-targeted antioxidants as therapeutic tools in the control of the tolerance that accompanies chronic nitrate use. ) have generally been attributed to its bioconversion into the relaxant agent nitric oxide (NO), which acts on the enzyme soluble guanylate cyclase (sGC). [1][2][3] However, most studies that support the existence of such a pathway have demonstrated increases of NO only when GTN concentrations considerably exceeded the plasma levels reached during clinical dosing. 4 Moreover, the involvement of other NO-related species in the actions of GTN when used at clinically relevant concentrations is also under debate. 5,6 Different enzymes have been implicated in the bioconversion of GTN, in particular, glutathione S-transferases, 7 the cytochrome p450 system, 8 and xanthine oxidoreductase, 9 although the most recent evidence suggests a central role for mitochondrial aldehyde dehydrogenase (ALDH)-2. 10 -13 The medical use of GTN is limited by the development of tolerance, which occurs following prolonged administration or the application of high doses. This phenomenon has been related to various mechanisms, in particular, desensitization of sGC, 14 and, mainly, impairment of GTN biotransformation by inhibition of ALDH-2. 10 -12 These actions, like others associated with GTN, have been linked to a...