Objective-Nitrates are used widely in clinical practice. However, the mechanism underlying the bioactivation of nitrates to release NO remains unclear. Recent animal data suggest that mitochondrial aldehyde dehydrogenase (ALDH2) plays a central role in nitrate bioactivation, but its role in humans is not known. We investigated the role of ALDH2 in the vascular effects of nitroglycerin (NTG) Key Words: nitroglycerin â
˘ nitric oxide â
˘ nitrates â
˘ blood flow â
˘ vasodilation N itrates have been used for Ďž100 years in the treatment of angina, heart failure, and hypertension. Several different forms are in clinical use, including nitroglycerin (NTG), isosorbide mononitrate, and isosorbide dinitrate. Nevertheless, they all induce vasodilatation via NO release and display tolerance with continued use. The exact mechanism of bioactivation of nitrates is unclear, but several candidate enzymes have been suggested, including glutathione-Stransferase, 1 cytochrome p450 reductase, 2 cytochrome p450, 3 old yellow enzyme, 4 and xanthine oxidoreductase. 5 Recent work by Chen et al identified mitochondrial aldehyde dehydrogenase (ALDH2) as an important enzyme involved in the bioactivation of nitrates in animals and suggested that nitrate tolerance may be caused by ALDH2 inhibition. 6 Although the role of ALDH2 in the bioactivation of nitrates has been confirmed by subsequent in vitro and in vivo animal studies, 7-9 its role in humans remains unclear. Interestingly, a common glu504lys point mutation in the ALDH2 gene is present among people of East Asian ethnic origin and causes a low-activity form of the enzyme, with heterozygotes having ϡ6.25% of normal ALDH2 enzyme activity 10 and homozygotes 0%. The mutation is associated with flushing after alcohol ingestion, but its effect on the bioactivation of nitrates has not been investigated.To investigate the hypothesis that ALDH2 is involved in the bioactivation of nitrates in humans, we designed 2 clinical studies. In the first study, the ALDH2 inhibitor disulfiram was administered to healthy volunteers, and the vasodilatory response to NTG was measured before and after inhibition of the enzyme. In the second study, the response to NTG in a group of healthy volunteers heterozygous or homozygous for the ALDH2 mutation was compared with that in homozygous wild-type control volunteers. Venous occlusion plethysmography was used to measure forearm blood flow (FBF) responses to intra-arterial infusions of NTG in both studies. The responses to 2 other control vasodilators that do not undergo the same mechanism of bioactivation as NTG, sodium nitroprusside (SNP), which acts via direct release of NO, and verapamil, a calcium channel blocker, acting via an NO-independent mechanism, were also measured.
Methods
SubjectsSubjects were drawn from a community-based volunteer register, and all were free from cardiovascular disease and were nonsmokers. Individuals with hypertension, diabetes mellitus, hypercholesterolemia, or those receiving medication were excluded. All subjects were genotyped for th...