The signaling molecule nitric oxide (NO), first described as endothelium-derived relaxing factor (EDRF), acts as physiological activator of NO-sensitive guanylyl cyclase (NO-GC) in the cardiovascular, gastrointestinal, and nervous systems. Besides NO-GC, other NO targets have been proposed; however, their particular contribution still remains unclear. Here, we generated mice deficient for the ␤1 subunit of NO-GC, which resulted in complete loss of the enzyme. GC-KO mice have a life span of 3-4 weeks but then die because of intestinal dysmotility; however, they can be rescued by feeding them a fiber-free diet. Apparently, NO-GC is absolutely vital for the maintenance of normal peristalsis of the gut. GC-KO mice show a pronounced increase in blood pressure, underlining the importance of NO in the regulation of smooth muscle tone in vivo. The lack of an NO effect on aortic relaxation and platelet aggregation confirms NO-GC as the only NO target regulating these two functions, excluding cGMP-independent mechanisms. Our knockout model completely disrupts the NO/cGMP signaling cascade and provides evidence for the unique role of NO-GC as NO receptor.cardiovascular ͉ knockout mice ͉ cGMP ͉ platelet aggregation ͉ smooth muscle relaxation T he nitric oxide (NO)/cGMP signaling cascade regulates a plethora of physiological functions in the cardiovascular, neuronal, and gastrointestinal systems (1-3). In the vascular system, NO, first recognized as endothelium-derived relaxing factor (EDRF; ref. 4), has been shown to mediate smooth muscle relaxation and inhibition of platelet aggregation. NO is synthesized by the family of NO synthases which exist in endothelial, neuronal, and inducible forms. The prominent receptor known to date is the enzyme NO-sensitive guanylyl cyclase (NO-GC). Stimulation of NO-GC by NO results in the production of the second messenger, cGMP, which exerts its effects via cGMPdependent kinases, channels, or phosphodiesterases (5-8). Besides these cGMP-mediated effects, NO is thought to mediate a variety of effects via cGMP-independent mechanisms in the cardiovascular system (for a review, see ref. 9).To gain further insight into the NO/cGMP signaling cascade, mice deficient in NO synthases (NOS) have been generated (10)(11)(12)(13)(14). Although these mouse lines have tremendously helped to understand NO/cGMP signaling, it is still not known which of NO's effects are mediated via NO-GC and thus cGMP, or alternatively, via pathways not involving cGMP.To address this point and to further investigate the physiological role of the enzyme and of the NO/cGMP signaling cascade in vivo, we generated an NO-GC-deficient mouse line. NO-GC is a heterodimer made up of two subunits, ␣ and ␤. Two isoforms are known to exist (␣ 1 ␤ 1 and ␣ 2 ␤ 1 ; ref. 15) in which the ␤ 1 subunit acts as the dimerizing partner for either ␣ subunit. ␣ subunits in the absence of the ␤ 1 subunit do not form dimers and are not catalytically active. Thus, deletion of the ␤ 1 subunit should completely eliminate NO-GC and yield a mouse line ...

In the vascular system, the receptor for the signaling molecule NO, guanylyl cyclase (GC), mediates smooth muscle relaxation and inhibition of platelet aggregation by increasing intracellular cyclic GMP (cGMP) concentration. The heterodimeric GC exists in 2 isoforms (a 1 -GC, a 2 -GC) with indistinguishable regulatory properties. Here, we used mice deficient in either a 1 -or a 2 -GC to dissect their biological functions. In platelets, a 1 -GC, the only isoform present, was responsible for NO-induced inhibition of aggregation. In aortic tissue, a 1 -GC, as the major isoform (94%), mediated vasodilation. Unexpectedly, a 2 -GC, representing only 6% of the total GC content in WT, also completely relaxed a 1 -deficient vessels albeit higher NO concentrations were needed. The functional impact of the low cGMP levels produced by a 2 -GC in vivo was underlined by pronounced blood pressure increases upon NO synthase inhibition. As a fractional amount of GC was sufficient to mediate vasorelaxation at higher NO concentrations, we conclude that the majority of NO-sensitive GC is not required for cGMP-forming activity but as NO receptor reserve to increase sensitivity toward the labile messenger NO in vivo.

Summary. Background: The nitric oxide (NO)/cyclic guanosine monophosphate (cGMP) signaling cascade is involved in the precise regulation of platelet responses. NO released from the endothelium is known to activate NO-sensitive guanylyl cyclase (NO-GC) in platelets. By the generation of cGMP and subsequent activation of cGMP-dependent protein kinase (PKG), NO-GC mediates the reduction of the intracellular calcium and inhibits platelet adhesion and aggregation. However, NO has been postulated to influence these platelet functions also via cGMP-independent mechanisms. Objective: We studied the effect of NO on platelets lacking NO-sensitive guanylyl cyclase with regards to aggregation, adhesion, calcium mobilization and bleeding time. Methods and results: Here, we show that NO signaling leading to inhibition of agonist-induced platelet aggregation is totally abrogated in platelets from mice deficient in NO-GC (GCKO). Even at millimolar concentrations none of the several different NO donors inhibited collagen-induced aggregation of GCKO platelets. In addition, NO neither affected adenosine 5¢-diphosphate (ADP)-induced adhesion nor thrombin-induced calcium release in GCKO platelets. Although the NO-induced cGMP signal transduction was totally abrogated cyclic adenosine monophosphate (cAMP) signaling was still functional; however, cGMP/cAMP crosstalk was disturbed on the level of phosphodiesterase type 3 (PDE3). These in vitro data are completed by a reduced bleeding time indicating the lack of NO effect in vivo. Conclusions: We conclude that NO-GC is the only NO receptor in murine platelets mediating the inhibition of calcium release, adhesion and aggregation: lack of the enzyme leads to disturbance of primary hemostasis.

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Background: Randomized controlled trials have shown that dexamphetamine sulfate (DEX) is efficacious in the treatment of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents; however, data on the effectiveness and safety of DEX in routine practice are scarce. Objective: This study investigated the long-term effectiveness and safety of Attentin ® (immediate-release DEX) in children and adolescents with ADHD in routine practice. Methods: ATTENTION was a multicenter, prospective, observational, non-interventional study that enrolled pediatric patients with ADHD (aged 6-17 years) with a clinically inadequate response to previous methylphenidate (MPH) treatment.Patients were assessed at baseline and two follow-up visits after approx. 6 and 12 months of DEX treatment. The primary endpoint was the investigator-rated ADHD rating scale IV (ADHD-RS-IV) total score change from baseline to the first follow-up visit. Results: The study enrolled 140 patients (mean age: 11.2 years). Significant reductions in ADHD-RS-IV total scores were observed in the titration phase and were maintained up to the second follow-up visit. The mean ADHD-RS-IV total score change from baseline to the first follow-up visit was -11.9 (27.1 vs. 13.4, p < .001). Beneficial effects of DEX were observed on both ADHD-RS-IV subscales ('hyperactivity/impulsivity' and 'inattention') and in both children and adolescents. Clinical response, defined as a reduction in the ADHD-RS-IV total score of at least 30% at the first follow-up visit, was observed in 78.1% of patients. Patients reported an average onset of action of 36.2 minutes and an average duration of action of 6.5 hours after intake of the first dose of DEX in the morning. DEX was well tolerated. Small significant increases in mean systolic and diastolic blood pressure compared to baseline were observed. Conclusions: Attentin ® is an effective and well-tolerated long-term treatment for pediatric ADHD patients with a clinically inadequate response to previous MPH treatment.

NO-sensitive guanylyl cyclases are the most important receptors for the signalling molecule NO. Activation of guanylyl cyclase by NO leads to the formation of the intracellular messenger cGMP. The enzyme is a heterodimer which consists of two subunits, α and β. Three different subunits exist in vivo: Two α subunits (α 1 and α 2 ) and one β subunit (β 1 ). Functional enzymes are formed by heterodimerization. The two known guanylyl cyclase isoforms are composed of one of either α subunit and the β 1 subunit (i.e. α 1 β 1 and α 2 β 1 ).Although the function of NO-sensitive guanylyl cyclase has been extensively studied during the last 30 years (e.g. its role in smooth muscle relaxation, platelet inhibition, leukocyte adhesion or neurotransmission) many functions of the enzyme and its product cGMP await further clarification.In order to elucidate the role of NO-sensitive guanylyl cyclase in vivo we generated mice in which the β 1 subunit of the enzyme was knocked out. Based on the fact that the β 1 subunit is the dimerizing partner for both α subunits, we expect these mice not to show any cGMP formation upon NO stimulation. Investigation of these mice will provide further information on the importance of NOsensitive guanylyl cyclase.