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.
The reactive nitrogen species arise once the reactive oxygen species destroy the mitochondria. This leads to the formation of the reactive nitrogen species, which are responsible for damaging DNA in arsenic poisoning. Mitochondrial damage is known to cause the release of reactive nitrogen species, due to the reaction between superoxides and nitric oxide (NO). Nitric oxide (NO) is a part of cell regulation, including cellular metabolism, growth, division and death. Nitric oxide (NO) reacts with reactive oxygen species to form peroxynitrite. In cases of chronic arsenic exposure, the nitric oxide levels are depleted, due to the superoxide reactions. The enzyme NO synthase (NOS) uses L-arginine to form nitric oxide, but this enzyme is inhibited by monomethylated arsenic (III) compounds.