(1,2) In particular, arsenic trioxide treatment has proven to be curative of acute promyelocytic leukemia (APL) and markedly improves the clinical outcome of even refractory or relapsed APL.(3) Arsenicals are now being tested against a variety of other tumors, including solid tumors.(4) However, arsenicals can be quite toxic and concern about serious side-effects has been raised, such as the potential for fatal hepatotoxicity in patients undergoing arsenical chemotherapy for cancer.(5) The liver is a major organ for arsenic toxicity and metabolism.(6) Individual variation in susceptibility to arsenicinduced toxicity clearly occurs and is probably related to genetic polymorphisms associated with altered capacity for methylation of inorganic arsenic.(5) Thus, adjuvant pharmacological agents that effectively and specifically limit arsenical hepatotoxicity could potentially increase arsenical therapeutic utility.Nitric oxide (NO) is a signaling mediator produced by cells involved in numerous critical functions.(7) Recently, several novel NO-donating compounds have shown promising features related to their pharmacological use in cancer chemotherapy. Indeed, the production of site-specific and/or novel NO-donating agents is an important trend in the development of agents with therapeutic and chemo-preventive potential.(8) For instance, our work indicates that O 2 -vinyl 1-(pyrrolidin-1-yl)diazen-1-ium-1,2 diolate (V-PYRRO/NO) mitigates the hepatotoxicity of various compounds both in vivo and in vitro, including the potentially hepatotoxic chemotherapeutic metalloid, arsenic. is structurally similar to V-PYRRO/NO, but has an additional carboxylic acid and appears to have liver specificity, as it is metabolized to release NO by cytochrome P450, (12) the most important of which appears to be CYP2E1.(13) The major limiting effects of arsenical chemotherapy would be hepatotoxicity. (14) However, whether V-PROLI/NO is protective against arsenic toxicity in liver or liver cells has not been defined.Metallothionein (MT) is a small, soluble, cysteine-rich, metalbinding protein that helps detoxicate various metals and metalloids.(15) In fact, a recent study showed that human populations poorly expressing MT may be more sensitive to chronic arsenic intoxication.(16) Furthermore, arsenic induces MT expression both in vitro and in vivo, (17)(18)(19) and arsenic or its methylated metabolites interacted with MT in a stoichiometric fashion. (17) Taken together, these data suggest that MT can decrease arsenic toxicity. In this regard, V-PYRRO/NO pretreatment greatly enhances arsenic induction of MT probably as part of its mechanism in reducing arsenic toxicity.(11) NO released from NOdonating compounds increases MT levels, at least indirectly. (20) Mitogen-activated protein kinases (MAPK) are a family of serine/threonine phosphorylating proteins which can mediate signal transduction pathways from a variety of extracellular signals to regulate the expression of specific genes. The major MAPK, the extracellular signal-regulated kinases ...