Crabtree MJ, Smith CL, Lam G, Goligorsky MS, Gross SS. Ratio of 5,6,7,8-tetrahydrobiopterin to 7,8-dihydrobiopterin in endothelial cells determines glucose-elicited changes in NO vs. superoxide production by eNOS. Am J Physiol Heart Circ Physiol 294: H1530-H1540, 2008. First published January 11, 2008 doi:10.1152/ajpheart.00823.2007 is an essential cofactor of nitric oxide synthases (NOSs). Oxidation of BH4, in the setting of diabetes and other chronic vasoinflammatory conditions, can cause cofactor insufficiency and uncoupling of endothelial NOS (eNOS), manifest by a switch from nitric oxide (NO) to superoxide production. Here we tested the hypothesis that eNOS uncoupling is not simply a consequence of BH4 insufficiency, but rather results from a diminished ratio of BH4 vs. its catalytically incompetent oxidation product, 7,8-dihydrobiopterin (BH2). In support of this hypothesis, [ 3 H]BH4 binding studies revealed that BH4 and BH2 bind eNOS with equal affinity (Kd Ϸ 80 nM) and BH2 can rapidly and efficiently replace BH4 in preformed eNOS-BH4 complexes. Whereas the total biopterin pool of murine endothelial cells (ECs) was unaffected by 48-h exposure to diabetic glucose levels (30 mM), BH2 levels increased from undetectable to 40% of total biopterin. This BH2 accumulation was associated with diminished calcium ionophore-evoked NO activity and accelerated superoxide production. Since superoxide production was suppressed by NOS inhibitor treatment, eNOS was implicated as a principal superoxide source. Importantly, BH4 supplementation of ECs (in low and high glucose-containing media) revealed that calcium ionophore-evoked NO bioactivity correlates with intracellular BH4: BH2 and not absolute intracellular levels of BH4. Reciprocally, superoxide production was found to negatively correlate with intracellular BH4:BH2. Hyperglycemia-associated BH4 oxidation and NO insufficiency was recapitulated in vivo, in the Zucker diabetic fatty rat model of type 2 diabetes. Together, these findings implicate diminished intracellular BH4:BH2, rather than BH4 depletion per se, as the molecular trigger for NO insufficiency in diabetes. nitric oxide; diabetes; endothelial dysfunction NITRIC OXIDE (NO) is a biological messenger that is produced by enzymes of the nitric oxide synthase (NOS) gene family, comprising endothelial (eNOS), inducible (iNOS), and neuronal (nNOS) isoforms. In the vasculature, eNOS-derived NO plays a pivotal role in physiological regulation of vessel tone and inflammatory status (58). Diminished availability of eNOS-derived NO is common to chronic vascular disorders that share endothelial dysfunction as a hallmark, e.g., diabetes (11,37,60), hypertension (28), and atherosclerosis (28,46). While the mechanistic basis for this attenuated NO bioavailability is uncertain, both slowed NO synthesis and accelerated NO scavenging by reactive oxygen species (ROS) have been implicated as causes (16). In contrast, levels of eNOS protein are typically unchanged or paradoxically increased. Oxidative stress, imposed by exce...