Background: Hypoxia and inflammation are hallmarks of critical illness, related to multi-ple organ failure. A possible mechanism leading to multiple organ failure is hypoxia-or inflammation-induced down-regulation of the detoxifying glyoxalase system that clears di-carbonyl stress. The dicarbonyl methylglyoxal (MGO) is a highly reactive agent produced by metabolic pathways such as anaerobic glycolysis and gluconeogenesis. MGO leads to protein damage and ultimately multi-organ failure. Whether detoxification of MGO into D-lactate by glyoxalase functions appropriately under conditions of hypoxia and inflamma-tion is largely unknown. We investigated the effect of inflammation and hypoxia on the MGO pathway in humans in vivo.Methods: After preh...