Heme oxygenase (HO) seems to be a novel protective factor with potent anti-inflammatory, anti-oxidant, and anti-proliferative effects. HO-1, the inducible isoform, is expressed in various tissues and is upregulated by multiple stimuli. However, humans differ quantitatively in their ability to mount an HO-1 response, modulated by two potentially functional polymorphisms in the HO-1 gene promoter region. From several studies it seems that the ability of a patient with certain genotypes to respond strongly in terms of upregulating HO-1 may be an important endogenous protective factor. In the present article we systematically review the hitherto published evidence that promoter polymorphisms in the HO-1 gene exert functional importance by influencing the level of HO-1 expression in different organ systems.