Accumulating evidence suggests that non-steroidal anti-inflammatory drugs (NSAIDs) 2 decrease the risk of developing premalignant lesions and several types of cancer (1, 2). The potential for NSAIDs to serve as chemoprotective agents has been particularly evident for colorectal cancer, as demonstrated by epidemiological and clinical studies, as well experimental animal models. Unfortunately, even at low doses, long term NSAID usage is associated with significant gastrointestinal and renal side-effects, some of which are potentially lifethreatening (3, 4). In fact, in 1998, the number of deaths in the United States from NSAID complications paralleled the number of deaths from AIDS (5, 6). This has prompted the emergence of novel strategies in efforts to maintain the desired pharmacological effects of NSAIDs, while diminishing the deleterious properties. One such strategy led to the development of coxibs, selective cyclooxygenase 2 inhibitors, which, although they do in fact reduce gastrointestinal complications, are also associated with increased cardiovascular side-effects (7-9). Recent development of nitric oxide (NO)-donating NSAIDs (10) has refueled interest in utilizing this class of drugs in chemoprevention. NO-NSAIDs consist of a NO-releasing moiety covalently bound to a spacer (via ester linkage), which in turn is bound to the parent NSAID (Fig. 1). NO is recognized as a key modulator in a wide array of physiological pathways (11). Of particular importance with regard to chemopreventive therapy are its effects on the gastrointestinal tract. The release of NO might compensate for NSAID-induced reductions in prostaglandin levels through the capacity of NO to increase mucosal blood circulation (12) and mucous release (13), and NO's properties of inhibiting neutrophil adherence and activation (14,15). Notably, NO-NSAIDs are associated with a significant reduction in renal toxicity as well (16,17).Current evidence shows that NO-NSAIDs are substantially superior compared with their NSAID counterparts with respect to a number of biological end points, including the induction of apoptosis (18 -20), and inhibition of cellular proliferation (18,20,21), with NO-aspirin having the most potent effects (10). Studies indicate that not only are both the NSAID and the NO moieties responsible for the physiological manifestations of the drugs (22), but, particularly in the case with NO-