Background
Aldehdyde dehydrogenase-2 (ALDH2) is essential for the detoxification of ethanol in the liver but also catalyzes vascular bioactivation of nitroglycerin (glycerol trinitrate, GTN) to its active metabolite nitric oxide (NO), which causes vasodilation through accumulation of cyclic GMP. The clinical use of GTN as a vasodilator is hampered by loss of efficacy after prolonged treatment, and there is strong evidence that this results from mechanism-based inactivation of ALDH2 by GTN. The precise mechanism of the ALDH2/GTN reaction as well as the identity of the inactivated enzyme species is still elusive.