During diverse pathological conditions, vascular smooth muscle cells (SMCs) characteristically change from a quiescent, contractile phenotype to a proliferative, synthetic state, migrate toward the intima, and synthesize excess extracellular matrix. Although reactive oxygen species (ROS) are generally considered to be toxic to cells, recent evidence suggests that they may also modulate multiple signaling pathways. The vascular system contains several sources of ROS, among which NADPH oxidases (NOXes) have been shown to take an important part in the regulation of cell function, with effects on growth and proliferation. In the present study, the authors investigate the ultrastructural features of SMCs and the expression profile of Nox4 in healthy and atherosclerotic human aorta to explore the possibility of a relationship between Nox4 and SMCs differentiation state. The data extend at the level of immunoelectron microscopy previous observations, demonstrating for the first time the precise distribution and the differential expression of Nox4 in the morphologically distinct SMC types of healthy and diseased human aorta.