Abstract-Nitric oxide (NO), produced by endothelial nitric oxide synthase (eNOS), is a key signaling molecule in vascular homeostasis. Loss of NO bioavailability due to reduced synthesis and increased scavenging by reactive oxygen species is a cardinal feature of endothelial dysfunction in vascular disease states. The pteridine cofactor tetrahydrobiopterin (BH4) has emerged as a critical determinant of eNOS activity: when BH4 availability is limiting, eNOS no longer produces NO but instead generates superoxide. In vascular disease states, there is oxidative degradation of BH4 by reactive oxygen species. However, augmentation of BH4 concentrations in vascular disease by pharmacological supplementation, by enhancement of its rate of de novo biosynthesis or by measures to reduce its oxidation, has been shown in experimental studies to enhance NO bioavailability. Thus, BH4 represents a potential therapeutic target in the regulation of eNOS function in vascular disease. Key Words: tetrahydrobiopterin Ⅲ nitric oxide synthase Ⅲ superoxide N itric oxide (NO), produced by endothelial NO synthase (eNOS), is a key signaling molecule in vascular homeostasis. 1 Originally identified as endothelium-derived relaxing factor, 2,3 NO is an important regulator of vascular tone and blood pressure. In addition, NO has multiple antiatherogenic roles, including anti-inflammatory, antithrombotic, antiproliferative, and antioxidant effects (reviewed in Ignarro 1 ). Loss of NO bioavailability is a cardinal feature of endothelial dysfunction 4 that precedes the development of overt atherosclerosis and is an independent predictor of adverse cardiovascular risk. 5,6 Several factors contribute to loss of NO bioavailability in endothelial dysfunction states, including both reduced NO synthesis and NO scavenging by reactive oxygen species. 7 The regulation of NO production by eNOS is complex, but the pteridine cofactor tetrahydrobiopterin (BH4) has emerged as a critical determinant of NO synthesis. Indeed, endothelial BH4 availability appears to be a key requirement for maintaining normal endothelial function. In this article, we review the current knowledge on the regulation of eNOS by BH4 and discuss the potential importance of mechanisms linking BH4 availability with endothelial function in vascular disease.
TetrahydrobiopterinTetrahydrobiopterin (BH4) is an essential cofactor for all 3 NO synthase (NOS) isoforms and for the aromatic amino acid hydroxylases (phenylalanine hydroxylase, tyrosine-3-hydroxylase, and tryptophan-5-hydroxylase). BH4 biosynthesis proceeds from GTP via 2 intermediates, 7,8-dyhydroneopterin triphosphate and 6-pyruvoyl-5,6,7,8-tetrahydropterin (reviewed in Thony et al 8 ; Figure 1). In endothelial cells (ECs), the first and rate-limiting step in this pathway is GTP cyclohydrolase I (EC 3.5.4.16; GTPCH). The subsequent steps are catalyzed by the enzymes 6-pyruvoyl tetrahydropterin synthase (EC 4.6.1.10; PTPS) and sepiapterin reductase (EC 1.1.1.153; SR). In some cell types (for example, macrophages), inflammatory cytok...