Hypoxic pulmonary vasoconstriction is unique to pulmonary arteries and serves to match lung perfusion to ventilation. However, in disease states this process can promote hypoxic pulmonary hypertension. Hypoxic pulmonary vasoconstriction is associated with increased NADH levels in pulmonary artery smooth muscle and with intracellular Ca 2؉ release from ryanodine-sensitive stores. Because cyclic ADP-ribose (cADPR) regulates ryanodine receptors and is synthesized from -NAD ؉ , we investigated the regulation by -NADH of cADPR synthesis and metabolism and the role of cADPR in hypoxic pulmonary vasoconstriction. Significantly higher rates of cADPR synthesis occurred in smooth muscle homogenates of pulmonary arteries, compared with homogenates of systemic arteries. When the -NAD ؉ :-NADH ratio was reduced, the net amount of cADPR accumulated increased. This was due, at least in part, to the inhibition of cADPR hydrolase by -NADH. Furthermore, hypoxia induced a 10-fold increase in cADPR levels in pulmonary artery smooth muscle, and a membrane-permeant cADPR antagonist, 8-bromocADPR, abolished hypoxic pulmonary vasoconstriction in pulmonary artery rings. We propose that the cellular redox state may be coupled via an increase in -NADH levels to enhanced cADPR synthesis, activation of ryanodine receptors, and sarcoplasmic reticulum Ca 2؉ release. This redox-sensing pathway may offer new therapeutic targets for hypoxic pulmonary hypertension.Since it was first described over 50 years ago, hypoxic pulmonary vasoconstriction (HPV) 1 has been recognized as the critical and distinguishing characteristic of the blood vessels of the lung (1). Thus, in marked contrast to systemic arteries, which dilate in response to hypoxia, pulmonary arteries constrict. Physiologically, HPV contributes to the matching of lung perfusion and ventilation. However, when alveolar hypoxia is global, as it is in disease states such as cystic fibrosis, emphysema, and mountain sickness, it results in pulmonary hypertension, which can ultimately lead to right heart failure. Unfortunately, the precise mechanisms that underpin HPV remain to be identified, and current therapies for hypoxic pulmonary hypertension are poor.Certain key characteristics of HPV have been described. In isolated pulmonary arteries, HPV is biphasic. An initial transient constriction (phase 1) is followed by a slowly developing, sustained phase of constriction (phase 2). It is widely thought that the first phase of constriction is initiated by a reduction in membrane K ϩ conductance in pulmonary artery smooth muscle cells (2-4), membrane depolarization, and Ca 2ϩ influx through voltage-gated Ca 2ϩ channels (5-8). Phase 2 of the constriction is tonic and may depend on the release of a vasoconstrictor from the endothelium, which sensitizes the contractile apparatus to Ca 2ϩ (9, 10). Our recent findings (11) do not support the above hypothesis. They suggest that hypoxia may, by activating a mechanism intrinsic to pulmonary artery smooth muscle cells, induce intracellular Ca 2ϩ rele...