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(Circulation. 2007;116:2851-2859.)
© 2007 American Heart Association, Inc.

Vascular Medicine

Altered Plasma Versus Vascular Biopterins in Human Atherosclerosis Reveal Relationships Between Endothelial Nitric Oxide Synthase Coupling, Endothelial Function, and Inflammation

Charalambos Antoniades, MD, PhD; Cheerag Shirodaria, MRCP; Mark Crabtree, PhD; Ruth Rinze, MD; Nicholas Alp, MD, PhD, MRCP; Colin Cunnington, MRCP; Jonathan Diesch, HNC; Dimitris Tousoulis, MD, PhD; Christodoulos Stefanadis, MD, FESC; Paul Leeson, PhD, MRCP; Chandi Ratnatunga, FRCS; Ravi Pillai, FRCS; Keith M. Channon, MD, FRCP

From the Department of Cardiovascular Medicine, University of Oxford, Oxford, UK (C.A., C.S., M.C., R.R., N.A., C.C., J.D., P.L., C.R., R.P., K.M.C.) and First Cardiology Department, Athens University Medical School, Athens, Greece (C.A., D.T., C.S.).

Correspondence to Dr Keith M. Channon, Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, UK. E-mail keith.channon{at}cardiov.ox.ac.uk

Received March 20, 2007; accepted October 5, 2007.

Background— Tetrahydrobiopterin (BH₄) is a key regulator of endothelial nitric oxide synthase (eNOS) activity and coupling. However, the extent to which vascular and/or systemic BH₄ levels are altered in human atherosclerosis and the importance of BH₄ bioavailability in determining endothelial function and oxidative stress remain unclear. We sought to define the relationships between plasma and vascular biopterin levels in patients with coronary artery disease and to determine how BH₄ levels affect endothelial function, eNOS coupling, and vascular superoxide production.

Methods and Results— Samples of saphenous veins and internal mammary arteries were collected from 219 patients with coronary artery disease undergoing coronary artery bypass grafting. We determined plasma and vascular levels of biopterins, vasomotor responses to acetylcholine, and vascular superoxide production in the presence and absence of the eNOS inhibitor N^G-nitro-L-arginine methyl ester. High vascular BH₄ was associated with greater vasorelaxations to acetylcholine (P<0.05), whereas high plasma BH₄ was associated with lower vasorelaxations in response to acetylcholine (P<0.05). Furthermore, an inverse association was observed between plasma and vascular biopterins (P<0.05 for both saphenous veins and internal mammary arteries). High vascular (but not plasma) BH₄ was associated with reduced total and N^G-nitro-L-arginine methyl ester–inhibitable superoxide, suggesting improved eNOS coupling. Finally, plasma but not vascular biopterin levels were correlated with plasma C-reactive protein levels (P<0.001).

Conclusions— An inverse association exists between plasma and vascular biopterins in patients with coronary artery disease. Vascular but not plasma BH₄ is an important determinant of eNOS coupling, endothelium-dependent vasodilation, and superoxide production in human vessels, whereas plasma biopterins are a marker of systemic inflammation.

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