The aims of this study were to assess whether high-dose treatment with an endothelin 1 (ET1) ETA antagonist could correct deficits in peripheral nerve conduction and blood flow in streptozotocin-diabetic rats and to examine interactions between ET1 and the renin-angiotensin system using low-dose single and combined treatments with ETA and AT1 antagonists. After B wk of diabetes, sciatic motor nerve conduction velocity (NCV) was approximately 20% reduced. High-dose ETA antagonist treatment for 2 wk corrected NCV to the extent of 84%. A approximately 48% diabetic deficit in nutritive endoneurial blood flow was also 88% corrected by the ETA antagonist. Combined treatment with low-doses of ETA and AT1 antagonists, selected to give approximately 20% amelioration of diabetic NCV deficits on their own, resulted in 66% correction. This was greater than expected for a simple additive effect between the antagonists, demonstrating a synergistic interaction. From NCV dose-response curves, the combined treatment effect was equivalent to a 4.2- to 8.9-fold dose increase for the individual antagonists. In parallel, joint treatment markedly improved sciatic nutritive endoneurial perfusion. Thus, the data strongly implicate ET1, acting via ETA receptors in the etiology of neurovascular dysfunction in experimental diabetic neuropathy. Furthermore, they demonstrate synergistic interactions between ET1 and renin-angiotensin systems that, if present in neuropathic patients, could potentially be used to obtain a therapeutic advantage.