Studies with purified nitric oxide synthase from rat cerebellum have confirmed previous reports that product formation is enhanced by tetrahydrobiopterin [H4B; 6-(L-erythro-1,2-dihydroxypropyl)- 5,6,7,8-tetrahydropterin]. The effect of the natural isomer, (6R)-H4B, is observed at extremely low (<0.1 ,uM) concentrations and is remarkably selective. At these concentrations, only the diastereoisomer (6S)-H4B, the structural isomer 7-(L-eiythro-1,2-dihydroxypropyl) -5,6,7,8-tetrahydropterin, and 7,8-dihydrobiopterin showed detectable effects. Our observations are inconsistent with a stoichiometric role for H4B in the oxygenation of arginine [e.g., Stuehr, D. J., Kwon, N. S., Nathan, C. F.,Chem. 266, 6259-62631. Activity is initially independent of added H4B; enhanced product formation with H4B is observed only as incubation progresses. The effect of H4B is catalytic, with each mole of added H4B supporting the formation of >15 mol of product. Recycling of H4B was excluded by direct measurement during nitric oxide synthesis and by the demonstration that nitric oxide synthase is not inhibited by methotrexate. These combined results exclude R4B as a stoichiometric reactant and suggest that H4B enhances product formation by protecting enzyme activity against progressive loss. Preliminary studies indicate that the decreased activity in the absence of added H4B does not depend on catalytic turnover of the enzyme. The role of H4B may be allosteric or it may function to maintain some group(s) on the enzyme in a reduced state required for activity.Nitric oxide synthase (NOS) catalyzes the oxygenation of arginine in the presence of NADPH to form nitric oxide, citrulline, and NADP'. The enzyme is of great interest because nitric oxide appears to participate in a variety of physiological processes. In addition to its classic role as the endothelium-derived relaxing factor in mediating vasodilation (1-3), nitric oxide has been implicated in regulating macrophage antitumor and antimicrobial activity, platelet adhesion, and cerebellar signaling (4). Nitric oxide stimulates guanylate cyclase, yielding increased production of cyclic GMP that is proposed to mediate cerebellar signaling and possibly other physiological effects of nitric oxide (4). NOS has been reported in a variety of mammalian tissues (4).Differences in cofactor, substrate, and inhibitor specificities suggest that NOS may exist in at least three distinct forms (4-6).Tetrahydrobiopterin [H4B; 6-(L-erythro-1,2-dihydroxypropyl)-5,6,7,8-tetrahydropterin] causes a marked and specific stimulation of macrophage NOS (7,8). The original studies of Bredt and Snyder (9) of purified brain (cerebellar) NOS did not include the effects of H4B. However, recent studies show that activity of cerebellar NOS is also increased by H4B (10, 11). The biochemical basis for this effect is poorly understood. Studies of the macrophage enzyme (7, 12, 13) have been interpreted as showing that H4B participates stoichiometrically in the reaction; i.e., it provides reducing equivalents req...