Reactive oxygen species
Arsenic can cause oxidative stress through the formation of reactive oxygen species (ROS), and reactive nitrogen species (RNS). Reactive oxygen species are produced by the enzyme NADPH oxidase, which transfers electrons from NADPH to oxygen, synthesizing a superoxide, which is a reactive free radical. This superoxide can react to form hydrogen peroxide and a reactive oxygen species. The enzyme NADPH oxidase is able to generate more reactive oxygen species in the presence of arsenic, due to the subunit p22phax, which is responsible for the electron transfer, being upregulated by arsenic. The reactive oxygen species are capable of stressing the endoplasmic reticulum, which increases the amount of the unfolded protein response signals. This leads to inflammation, cell proliferation, and eventually to cell death. Another mechanism in which reactive oxygen species cause cell death would be through the cytoskeleton rearrangement, which affects the contractile proteins.