PARylation is a posttranslational protein modification carried out by PAR polymerase (PARP) enzymes. The best known member of the PARP family is a DNA nick sensor enzyme that becomes activated by DNA breaks. Activated PARP cleaves NAD into nicotinamide and ADP-ribose and covalently attaches a PAR polymer to itself and other suitable acceptors such as histones. Via PARylation or protein-protein interactions PARP regulates among others chromatin organization, DNA repair, transcription and replication. Excessive DNA damage can also trigger a PARP-mediated necrotic cell death pathway. The peroxynitrite-PARP activation pathway is an important target in stroke, myocardial ischemia-reperfusion injury, inflammations, shock, diabetes and related complications. PARP inhibitors may also be used as adjuvant chemotherapeutic agents in cancer.