Islet  cell dysfunction resulting from inflammation, ER stress, and oxidative stress is a key determinant in the progression from insulin resistance to type 2 diabetes mellitus. It was recently shown that the enzyme deoxyhypusine synthase (DHS) promotes early cytokine-induced inflammation in the  cell. DHS catalyzes the conversion of lysine to hypusine, an amino acid that is unique to the translational elongation factor eIF5A. Here, we sought to determine whether DHS activity contributes to  cell dysfunction in models of type 2 diabetes in mice and  cell lines. A 2-week treatment of obese diabetic C57BLKS/J-db/db mice with the DHS inhibitor GC7 resulted in improved glucose tolerance, increased insulin release, and enhanced  cell mass. Thapsigargin treatment of  cells in vitro induces a picture of ER stress and apoptosis similar to that seen in db/db mice; in this setting, DHS inhibition led to a block in CHOP (CAAT/enhancer binding protein homologous protein) production despite >30-fold activation of Chop gene transcription. Blockage of CHOP translation resulted in reduction of downstream caspase-3 cleavage and near-complete protection of cells from apoptotic death. DHS inhibition appeared to prevent the cytoplasmic co-localization of eIF5A with the ER, possibly precluding the participation of eIF5A in translational elongation at ER-based ribosomes. We conclude that hypusination by DHS is required for the ongoing production of proteins, particularly CHOP, in response to ER stress in the  cell.Obesity is increasing at a rapid rate worldwide, with estimates that place its prevalence at Ͼ300 million people. Obesity is perhaps the single greatest risk factor for the development of type 2 diabetes mellitus. The relationship between obesity and diabetes is complex, but it is apparent that a direct correlation exists between increasing visceral fat and insulin resistance (1-3). However, only ϳ30% of obese, insulinresistant individuals have diabetes, suggesting that other factors superimposing upon obesity must confer additional risks (4). It is now clear that defects in insulin secretion at the level of the islet  cell are paramount in the transition from a normoglycemic, insulin-resistant state to frank diabetes (5), and it is postulated that underlying genetic defects at the level of the  cell differentiates those who develop diabetes from those who do not (6). Prospective clinical (7) and autopsy (8) studies show significant reductions in  cell function and mass, respectively, in the transition from obesity-induced insulin resistance to frank type 2 diabetes.The causes of islet dysfunction and death in the setting of insulin resistance include hyperglycemia, hyperlipidemia, cytokines, and deposition of islet amyloid polypeptide (9, 10). All of these causes stimulate intersecting pathways within the islet that lead to oxidative stress, inflammation, and endoplasmic reticulum (ER) 3 stress. These stress pathways are closely intertwined, such that activators of primarily one pathway acutely (e.g. cytokines ca...