Poly(ADP-ribose) polymerase (PARP) inhibition has recently been identified as a novel approach to treatment of experimental peripheral diabetic neuropathy (PDN). (5); 2) changes in transcriptional regulation and gene expression (5-7); and 3) poly-(ADP-ribosyl)ation and resulting inhibition of the glycolytic enzyme glyceraldehyde 3-phosphate dehydrogenase, with concomitant activation of several major pathogenetic mechanisms, i.e., nonenzymatic glycation, protein kinase C, and hexosamine pathway (2). Using a pharmacological approach with several structurally unrelated PARP inhibitors as well as PARP-deficient mice, we have recently discovered the key role of PARP in the development of early peripheral diabetic neuropathy (PDN) (3,8). Note that PARP inhibitors administered in doses resulting in complete or almost complete PARP inhibition in the diabetic peripheral nerve (3,8) appeared at least 100-fold more effective in correcting nerve conduction slowing, NAD ϩ /NADH redox imbalances, energy failure, and neurovascular dysfunction than conventional antioxidants (9,10).A recent 9-month PARP inhibitor study in the streptozotocin (STZ)-induced diabetic rat model did not reveal clearly manifest side effects (4), and PARP Ϫ/Ϫ mice do not develop obvious phenotypic changes (5). However, the long-term consequences of complete PARP inhibition in pathological conditions associated with oxidative stress, including diabetes, are unclear and can hardly be sorted out in rodents because of their limited life span. Diabetesassociated oxidative stress leads to DNA damage, e.g., in the peripheral nervous system (11), and PARP activation is an important mechanism of DNA repair (5). Therefore, it is reasonable to suggest that 1) complete PARP inhibition can potentially result in premature aging and 2) targeted delivery of PARP-1 antisense oligodeoxynucleotide-containing vectors (12) or PARP-1 RNA interference (RNAi) (13), rather than pharmacological PARP inhibition, should be considered as a future therapy of PDN (1). However, it is unlikely that such approaches will be available in clinical practice in the near future. An alternative strategy would be to develop low-dose PARP inhibitor-containing combination therapies with other agents already used in clinical practice and proven to be effective in the treatment