Objective-Although it has been reported that oral administration of tetrahydrobiopterin (BH4) prevents endothelial dysfunction and vascular oxidative stress in various rat models, the effect of treatment with BH4 on atherogenesis remains unclear. Methods and Results-In this study, we investigated whether oral BH4 treatment might slow the progression of atherosclerosis using hypercholesterolemic apolipoprotein E-knockout mice. We report that ingesting BH4 in drinking water is sufficient to inhibit atherogenesis in mice. Furthermore, we report that BH4 treatment improves endothelial dysfunction and attenuates increased mRNA expression of NADPH oxidase components, as well as a number of inflammatory factors, such as LOX-1 and MCP-1, in the aortas of apolipoprotein E-knockout mice. Key Words: apolipoprotein E-knockout mouse Ⅲ atherosclerosis Ⅲ endothelial function Ⅲ tetrahydrobiopterin N itric oxide (NO) inhibits atherogenesis through a number of mechanisms, including anti-inflammatory, antithrombotic, antiproliferative, and antioxidant effects. 1 Loss of NO bioavailability is a cardinal feature of endothelial dysfunction 2 preceding the development of atherosclerosis, and is an independent risk factor for cardiovascular disease. 3,4 A critical determinant of endothelial nitric oxide synthase (eNOS) activity is the availability of the nitric oxide synthase (NOS) cofactor tetrahydrobiopterin (BH4). When BH4 levels are inadequate, the enzymatic reduction of molecular oxygen by eNOS is no longer coupled to L-arginine oxidation, resulting in superoxide, rather than NO, production, thereby inducing vascular oxidative stress and endothelial dysfunction.
Conclusion-StrategiesIn hypercholesterolemic apolipoprotein E-knockout (ApoE-KO) mice, endothelium-dependent vascular relaxation is impaired, NO synthesis is reduced, and vascular superoxide production is increased. 5,6 Transgenic overexpression of eNOS in ApoE-KO mice surprisingly results in enhanced vascular superoxide production, reduced NO bioavailability, and accelerated atherosclerosis. 7 BH4 levels are reduced in the aortas of these mice compared with wild-type (WT) controls, but dietary BH4 supplementation reduces superoxide production and increases NO synthesis. Furthermore, transgenic overexpression of GTP-cyclohydrolase I, the ratelimiting enzyme of de novo BH4 synthesis, in ApoE-KO mice attenuates endothelial dysfunction and atherosclerosis. 8 In this model, endothelial cell BH4 levels are specifically increased without elevation of plasma BH4 levels. These results suggest that increased eNOS protein alone is insufficient to maintain NO synthesis in the setting of hypercholesterolemia, and that adequate BH4 levels are essential to prevent eNOS uncoupling where endothelial dysfunction exists. In contrast, van Haperen et al 9 also crossbred ApoE-KO mice with another line of eNOS transgenic mice that they created and reported that atherosclerotic lesion size was reduced by eNOS overexpression. Regarding the mechanisms, they cited the reductions of blood pressure a...