Donate Help Contact The AHA Sign In Home
American Heart Association
Circulation
Search: search_blue_button Advanced Search
Circulation. 1999;100:292-298

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bauersachs, J.
Right arrow Articles by Ertl, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bauersachs, J.
Right arrow Articles by Ertl, G.
Right arrowPubmed/NCBI databases
*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Heart Attack
Hazardous Substances DB
*PHENYLEPHRINE
Related Collections
Right arrow Heart failure - basic studies
Right arrow Oxidant stress
Right arrow Endothelium/vascular type/nitric oxide

(Circulation. 1999;100:292-298.)
© 1999 American Heart Association, Inc.


Basic Science Reports

Endothelial Dysfunction in Chronic Myocardial Infarction Despite Increased Vascular Endothelial Nitric Oxide Synthase and Soluble Guanylate Cyclase Expression

Role of Enhanced Vascular Superoxide Production

Johann Bauersachs, MD; Anne Bouloumié, PhD; Daniela Fraccarollo, PhD; Kai Hu, MD; Rudi Busse, MD, PhD; Georg Ertl, MD

From the II. Medizinische Klinik, Universitätsklinikum Mannheim, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, and Institut für Kardiovaskuläre Physiologie, Klinikum der J.W. Goethe-Universität, Frankfurt am Main (A.B., R.B.), Germany.

Correspondence to Dr Johann Bauersachs, II. Medizinische Klinik, Klinikum, Theodor-Kutzer-Ufer, D-68135 Mannheim, Germany. E-mail johann.bauersachs{at}med2.ma.uni-heidelberg.de


*    Abstract
up arrowTop
*Abstract
down arrowIntroduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Background—Endothelial dysfunction of the peripheral vasculature is a well-known phenomenon in congestive heart failure that contributes to the elevated peripheral resistance; however, the underlying mechanisms have not yet been clarified.

Methods and Results—Dilator responses, the expression of protein and mRNA of the endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and soluble guanylate cyclase (sGC), and superoxide anion (O2-) and peroxynitrite production were determined in aortic rings from Wistar rats 8 weeks after myocardial infarction and compared with those in sham-operated animals. In rats with heart failure, the concentration-response curve of the endothelium-dependent vasodilator acetylcholine (after preconstriction with phenylephrine) was significantly shifted to the right, and the maximum relaxation was attenuated. Determination of expression levels of the 2 key enzymes for NO-mediated dilations, eNOS and sGC, revealed a marked upregulation of both enzymes in aortas from rats with heart failure, whereas iNOS expression was not changed. Pretreatment with exogenous superoxide dismutase partially restored the acetylcholine-induced relaxation in aortas from rats with heart failure. Aortic basal and NADH-stimulated O2- production assessed by use of lucigenin-enhanced chemiluminescence was significantly elevated in rats with chronic myocardial infarction. Peroxynitrite-mediated nitration of protein tyrosine residues was not different between the 2 groups of rats.

Conclusions—These results demonstrate that endothelial dysfunction in ischemic heart failure occurs despite an enhanced vascular eNOS and sGC expression and can be attributed to an increase in vascular O2- production by an NADH-dependent oxidase. By inactivation of NO, O2- production appears to be an essential mechanism for the endothelial dysfunction observed in heart failure.


Key Words: endothelium • endothelium-derived factors • myocardial infarction • heart failure • free radicals


*    Introduction
up arrowTop
up arrowAbstract
*Introduction
down arrowMethods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Endothelial dysfunction of the peripheral vasculature contributes to the elevated peripheral vascular resistance in patients with heart failure,1 2 3 as well as several animal models of cardiac dysfunction.4 5 6 However, the underlying mechanisms may be complex and have not yet been clarified. One attractive hypothesis appears to be a decrease in the production of endothelium-derived nitric oxide (NO). In a heart failure model of ventricular pacing in dogs, an endothelial hyporesponsiveness in the coronary circulation and an attenuated expression of the endothelial NO synthase (eNOS) in the aorta have been described.7 8 In contrast, other studies reported enhanced basal production of NO in heart failure,6 9 which might originate from the inducible NOS (iNOS) in the vasculature, because the expression of this high-output NO-generating enzyme has been shown in hearts from patients with dilated cardiomyopathy.10

In other pathophysiological states, such as hypercholesterolemia and hypertension, compelling evidence suggests that endothelial dysfunction results from increased vascular production of superoxide anion (O2-).11 12 13 Because O2- rapidly scavenges NO within the vascular wall, a reduction of bioactive NO might occur despite an increased NO generation.14 15 In patients suffering from heart failure, elevated levels of plasma lipid peroxides as a marker of oxidative stress have been observed.16 This is further supported by the fact that the impaired flow-induced NO-mediated dilation in patients with heart failure can be restored by short-term treatment with high doses of the antioxidant vitamin C.17

In addition, more recently, alterations of the effector system of NO, in particular a reduced expression of the cGMP-forming soluble guanylate cyclase (sGC), were identified as an important mechanism of dilator dysfunction in hypertension.18

With regard to heart failure, no data are available on O2- production within the vascular wall or on the potential alterations of the expression of smooth muscle sGC. Moreover, the influence of heart failure on vascular NOS expression is still controversial. Chronic myocardial infarction in the rat is considered to be a useful model to study the pathophysiological sequelae of heart failure. Indeed, the beneficial effects of ACE inhibitors were predicted from results obtained in this experimental model.19 In rats with heart failure due to myocardial infarction, endothelium-dependent relaxations, still normal at 1 week after coronary ligature, are reduced at 4 weeks and progressively worsen with time.20

The aim of the present study was therefore to identify the potential mechanisms underlying endothelial dysfunction in heart failure by the simultaneous determination of endothelium-dependent dilator responses, the expression of the key enzymes of the NO/cGMP system, and O2- formation in the aorta of rats 8 weeks after myocardial infarction.


*    Methods
up arrowTop
up arrowAbstract
up arrowIntroduction
*Methods
down arrowResults
down arrowDiscussion
down arrowReferences
 
Myocardial Infarction: Hemodynamic Measurements
Left coronary artery ligations were performed in adult female Wistar rats (250 to 300 g) as previously described.21 Briefly, under ether anesthesia, the thorax was opened, the heart exteriorized, and a ligature placed around the proximal left coronary artery. Sham-operated rats were treated similarly except that the operative procedure did not produce a detectable infarction. Hemodynamic studies were performed 8 weeks after coronary artery ligation as described.21 Briefly, rats were anesthetized with ether, tracheotomized, and ventilated. Saline-filled catheters were advanced from the right carotid artery and jugular vein into the left ventricle and right atrium and connected to a Millar micrometer and Statham transducer. Left ventricular systolic and diastolic pressures, mean arterial pressure, and heart rate were measured under light ether anesthesia and spontaneous respiration.

Infarct size was determined histologically by planimetry as described21 after formalin fixation, and only rats with large infarcts (>40%) were included in the study of vascular reactivity.

Measurement of Plasma Renin Activity
Plasma renin activity was measured as described previously21 with a commercial test kit (Sorin Biomedica Diagnostic).

Vascular Reactivity Studies
The descending thoracic aorta was dissected after removal of the heart, cleaned of connective tissue, and cut into 3 sections as described.18 The upper section (15 mm) was immediately frozen in liquid nitrogen for Western blot analysis. The lower section (10 mm) was used for measurement of O2- production, and the remainder was cut into rings 3 mm long that were mounted in an organ bath (Föhr Medical Instruments) for isometric force measurement. The rings were equilibrated for 30 minutes under a resting tension of 2 g in oxygenated (95% O2/5% CO2) Krebs-Henseleit solution (pH 7.4, 37°C) of the following composition (mmol/L): NaCl 118, KCl 4.7, MgSO4 1.2, CaCl2 1.6, K2HPO4 1.2, NaHCO3 25, and glucose 12, and the cyclooxygenase inhibitor diclofenac 1 µmol/L. Rings were repeatedly contracted by KCl 50 mmol/L until reproducible responses were obtained. Thereafter, the rings were preconstricted with phenylephrine 0.3 to 1 µmol/L to comparable constriction levels, and the relaxant response to cumulative doses of acetylcholine and to sodium nitroprusside was assessed with or without prior inhibition of the endogenous superoxide dismutase (SOD) by use of diethyldithiocarbamate (DETC, 1 mmol/L, 40 minutes, followed by repeated washout). In additional experiments, the effect of exogenous SOD on relaxant responses was assessed.

Analysis of eNOS and sGC Expression by Reverse Transcription–Polymerase Chain Reaction
Total RNAs were extracted according to the method of Chomczynski and Sacchi.22 For the reverse transcription (RT), 2 µg total RNA was incubated with 200 U reverse transcriptase (Gibco), dNTP 125 µmol/L, oligo(dT) 200 ng, and reaction buffer in a final volume of 20 µL at 37°C for 60 minutes. After a final denaturation at 94°C for 7 minutes, 5 µL of cDNA was subjected to polymerase chain reaction (PCR) consisting of denaturation at 94°C for 1 minute, followed by 90 seconds of annealing at 52°C for eNOS/GAPDH or 81°C for {alpha}1- and 65°C for ß1-subunits from the sGC and 90 seconds of elongation at 72°C for 25 to 30 cycles. The last cycle ended with 7 minutes of elongation at 72°C. The primers used (Table 1Down) were chosen as previously described.15 18 23 The PCR contained 0.4 µmol/L of each primer, dNTP 200 µmol/L, MgCl2 1 mmol/L reaction buffer, and 2.5 U Taq polymerase (Promega) in a final volume of 50 µL. The amplified cDNAs were size-fractionated by agarose gel electrophoresis, visualized under UV light by use of ethidium bromide staining, transferred to nylon membrane (Hybond-N, Amersham), and hybridized with a 32P-labeled eNOS fragment obtained from the cloned bovine eNOS cDNA, 32P-labeled GAPDH fragment isolated from PCR, and 32P-labeled human {alpha}1- and ß1-subunit cDNAs. The cDNAs were quantified after autoradiography by scanning densitometry normalized by comparison with GAPDH cDNA.


View this table:
[in this window]
[in a new window]
 
Table 1. Primers Used for PCR

Western Blot Analysis
After alcohol precipitation of the phenol phase obtained after the guanidinium isothiocyanate/phenol/chloroform extraction method,22 crude protein extracts (100 µg) were subjected to SDS-PAGE electrophoresis and transferred to nitrocellulose membranes as described.24 Proteins were detected by their respective antibodies and visualized by enhanced chemiluminescence; the autoradiographs were analyzed by scanning densitometry.

Determination of cGMP in Aortic Rings
For the determination of cGMP accumulation25 in rat aortic segments without confounding effects of endothelium-derived NO, cGMP levels were determined after denudation of the endothelium under basal conditions and after stimulation with sodium nitroprusside 1 µmol/L for 2 minutes in the presence of the phosphodiesterase inhibitor isobutylmethylxanthine (IBMX, 0.3 mmol/L) and freeze-clamped.

Measurement of Superoxide Anion and Peroxynitrite Formation
The O2- generation of the rings was assessed by lucigenin-enhanced chemiluminescence as described previously.18 Briefly, aortic segments (5 mm) were transferred into tubes containing 0.5 mL HEPES buffer and maintained at 37°C for at least 30 minutes before lucigenin 250 µmol/L was added. The luminometer (LKB-Wallac 1251) was set to report arbitrary units of light emitted and integrated over a 30-second interval, and repeated measurements were made over 3 minutes and averaged. The specific chemiluminescence signal was calculated after subtraction of background activity and expressed as counts per minute per milligram dry weight of samples (cpm/mg). Peroxynitrite formation was assessed in a similar protocol using luminol 250 µmol/L.

Materials
All biochemicals were obtained in the highest purity available from Sigma Chemical Co. The [{alpha}-32P]dCTP was purchased from Hartmann Analytic. The cloned bovine eNOS cDNA was a gift from D.G. Harrison, Emory University, Atlanta, Ga. The monoclonal eNOS antibody was purchased from Transduction Laboratories (Affiniti), and the antibody against the sGC ß1-subunit was kindly provided by Dr Peter Yuen, Memphis, Tenn.

Statistics
Dilator responses were given as percentage dilatation relative to the preconstriction level. All data in the figures and in the text are expressed as mean±SEM of experiments with aortic segments from n different animals. Statistical analysis was performed by 1-way ANOVA followed by a Bonferroni t test or by the 2-tailed Student's t test for unpaired data, where appropriate, with probability values of <0.05 considered statistically significant.


*    Results
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
*Results
down arrowDiscussion
down arrowReferences
 
Global Parameters
Global parameters of heart failure rats and sham-operated animals are shown in Table 2Down. Infarct size was 45±1%. Mean arterial blood pressure, left ventricular systolic pressure, and dP/dtmax were significantly lower in rats with chronic myocardial infarction, whereas left ventricular end-diastolic pressure was elevated. Plasma renin activity was significantly higher in rats with heart failure. Therefore, these rats demonstrated heart failure in a compensated stage.


View this table:
[in this window]
[in a new window]
 
Table 2. Global Parameters

Vasodilator Responses in Aortic Rings
In phenylephrine-preconstricted aortic rings, acetylcholine elicited a concentration-dependent relaxation that was blunted in aortas from rats with cardiac dysfunction (Figure 1ADown). Acetylcholine-induced relaxations were mediated by NO because they were abolished after incubation with the NOS inhibitor NG-nitro-L-arginine 0.3 mmol/L for 30 minutes (data not shown). Endothelium-independent relaxations induced by sodium nitroprusside were slightly but not significantly attenuated at lower concentrations in rats with heart failure, and maximum relaxation was not different (100%) in the 2 groups of rats (Figure 1BDown).



View larger version (13K):
[in this window]
[in a new window]
 
Figure 1. A, Acetylcholine-induced and B, sodium nitroprusside (SNP)–induced relaxations of phenylephrine-preconstricted aortic rings from rats with heart failure 8 weeks after myocardial infarction ({blacktriangledown}) vs sham-operated (•) animals. Results are expressed as mean±SEM from 8 to 10 separate experiments. *P<0.05, **P<0.01 vs sham.

NO- and cGMP-Generating Enzymes in the Aorta
To elucidate whether the attenuation of endothelium-dependent relaxation is the result of an alteration in the expression of the key enzymes of NO-mediated dilation, the expression of protein and mRNA of both eNOS and iNOS as well as sGC was determined in aortic segments from rats with heart failure and sham-operated animals by Western blot and RT-PCR. As shown in Figure 2Down, eNOS mRNA and protein levels were found to be significantly increased in aortas from rats with heart failure compared with sham-operated animals (2.9- and 2.1-fold increase, respectively, P<0.05, n=4), whereas the iNOS expression in the thoracic aorta, hardly detectable by Western blot analysis (Figure 3ADown), remained unchanged.



View larger version (24K):
[in this window]
[in a new window]
 
Figure 2. Comparison of eNOS expression in aortas from rats with heart failure 8 weeks after myocardial infarction vs sham-operated animals. Left, Western blot and densitometric analysis showing aortic eNOS protein levels. Right, Southern blot and densitometric analysis showing aortic eNOS mRNA levels. Values are mean±SEM from 4 separate experiments.



View larger version (57K):
[in this window]
[in a new window]
 
Figure 3. Comparison of protein expression of iNOS (A) and ß1-subunit of sGC (B) in aortas from rats with heart failure 8 weeks after myocardial infarction vs sham-operated animals. A, Representative Western blot showing aortic iNOS protein levels. B, Western blot and densitometric analysis showing aortic sGC ß1-subunit protein levels. Values are mean±SEM from 4 separate experiments.

In addition, Western blot analysis performed on whole aortic protein extracts showed that the protein level of the ß1-subunit of the sGC was markedly enhanced in rats with myocardial infarction (Figure 3BUp, 2.5-fold increase, P<0.05, n=4), whereas the RT-PCR analysis failed to detect significant differences between infarcted and sham-operated animals (data not shown).

Effects of Radical Scavengers on Vascular Reactivity and cGMP Production
Because NO- and cGMP-generating enzymes were found to be upregulated in rats with heart failure, we investigated the potential involvement of reactive oxygen species in the alteration of the endothelial function. The effects of radical scavengers were studied on the vascular reactivity and cGMP production.

In phenylephrine-constricted rings, addition of exogenous SOD 600 U/mL elicited a relaxation that was significantly enhanced in aortic rings from rats with heart failure (83±3% versus 56±4%, P<0.01). Furthermore, in the presence of exogenous SOD 200 U/mL, the relaxation induced by submaximal concentrations of acetylcholine in aortas from rats with chronic cardiac dysfunction was significantly enhanced (Figure 4Down).



View larger version (28K):
[in this window]
[in a new window]
 
Figure 4. Relaxation induced by a submaximal concentration of acetylcholine (100 nmol/L) in phenylephrine-preconstricted aortic rings from rats with heart failure 8 weeks after myocardial infarction (solid bars) and sham-operated (open bars) animals in absence or presence of either SOD 200 U/mL or DETC 1 mmol/L for 40 minutes. Results are expressed as mean±SEM from 10 to 12 separate experiments. #P<0.01 vs sham; *P<0.05 vs with SOD; **P<0.01 vs without DETC.

Conversely, after inhibition of the endogenous SOD by use of DETC 1 mmol/L for 40 minutes, the acetylcholine-induced relaxation in aortic rings was markedly depressed in aortas from sham-operated rats and abolished in animals with chronic myocardial infarction (Figure 4Up).

Basal levels of cGMP in aortas from rats with heart failure (2.4±0.4 pmol/mg protein) were not different from those in sham-operated animals (1.5±0.3 pmol/mg protein, n=6, Figure 5Down). Stimulation with sodium nitroprusside induced a marked increase in cGMP formation, and cGMP levels were lower in rats with cardiac dysfunction than in sham-operated animals. However, in the presence of the radical scavenger Tiron 10 mmol/L, sodium nitroprusside–induced cGMP formation was significantly enhanced in aortas from rats with heart failure (Figure 5Down).



View larger version (38K):
[in this window]
[in a new window]
 
Figure 5. Basal and sodium nitroprusside (SNP, 1 µmol/L)–stimulated cGMP formation in aortic rings from rats with heart failure 8 weeks after myocardial infarction (solid bars) vs sham-operated animals (open bars) in absence or presence of radical scavenger Tiron 10 mmol/L. Results are expressed as mean±SEM from 5 separate experiments. *P<0.05 vs sham and vs with Tiron.

Production of Superoxide Anions and Peroxynitrite in Aortic Segments
Finally, we assessed the production of O2- and of peroxynitrite generated by aortic rings by lucigenin- and luminol-enhanced chemiluminescence, respectively. O2- release was greater in aortas from rats with chronic myocardial infarction (Figure 6ADown). Removal of the endothelium slightly but not significantly reduced radical production in both groups (Figure 6ADown). After addition of NADH 100 µmol/L, O2- formation was markedly stimulated and significantly higher in aortas from rats with heart failure (Figure 6BDown).



View larger version (23K):
[in this window]
[in a new window]
 
Figure 6. Superoxide anion production in aortic rings from rats with heart failure 8 weeks after myocardial infarction (solid bars) vs sham-operated animals (open bars) under basal conditions (A) in presence (E+) or absence (E-) of endothelium and (B) after addition of NADH 100 µmol/L in endothelium-intact rings. Results are expressed as mean±SEM from 8 to 10 separate experiments. *P<0.05 vs sham.

The luminol-mediated luminescence as indicator of peroxynitrite formation was hardly detectable and not different in aortas from rats with chronic myocardial infarction and those from sham-operated animals. Moreover, Western blot analysis of aortic proteins with a specific antibody against nitrotyrosine to detect peroxynitrite-mediated nitration of tyrosine residues showed no increase in nitrotyrosine in rats with heart failure compared with sham-operated animals (data not shown).


*    Discussion
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
*Discussion
down arrowReferences
 
In the present study, we observed a pronounced endothelial dysfunction in rats with chronic myocardial infarction despite a marked upregulation in the expression of 2 key enzymes of vasorelaxation: eNOS, regulating the synthesis of the most important vasodilator, NO, and its target enzyme in smooth muscle cells, sGC. Our data suggest that even this upregulation is not sufficient to compensate for the increased formation of O2-, which rapidly inactivates NO.

Expression of eNOS, iNOS, and sGC
Heart failure is associated with an endothelial dysfunction of coronary arteries as well as large conductance and peripheral arteries, with considerable implications for myocardial perfusion, cardiac workload, and peripheral vascular resistance.1 7 26 From these functional studies, the mechanism underlying the reduction of agonist-stimulated dilator responses in heart failure has been proposed to be a defective production of endothelium-derived NO, and in a heart failure model of ventricular pacing in dogs as well as in monocrotaline-induced cardiac failure, a reduction of endothelial NO release was associated with an attenuated expression of eNOS.8 27 Data on basal production of NO in heart failure have been controversial: using the amount of constriction in response to an NOS inhibitor as an indirect measure for basal NO release, some investigators found an increase6 9 and speculated that expression of iNOS in the vasculature may be induced, as has been shown in hearts from patients with dilated cardiomyopathy.10 However, other reports found no difference or even a decrease of basal NO formation in patients with heart failure.28 29

Our results for the first time provide insights into the mechanisms of the alteration of endothelial function in heart failure after myocardial infarction, which represents the most important cause for cardiac failure in patients. Although in agreement with the results obtained in monocrotaline-induced heart failure,27 iNOS expression was hardly detectable in rats with chronic myocardial infarction, we observed an unexpected marked increase in the expression of eNOS. The association of an increased eNOS expression with a marked attenuation of endothelium-dependent relaxation adds to the mounting evidence that enhanced NO formation or NOS expression does not necessarily imply improved dilator function but rather may even be detrimental15 or at least a failed counterregulatory mechanism. In parallel with our results obtained in the aorta, in the myocardium of spontaneously hypertensive genetically heart failure–prone rats, an upregulation of cardiac eNOS expression has been observed; however, the functional consequences of this were not investigated.30

The second key enzyme for endothelium-dependent dilation, the sGC in smooth muscle cells, is activated after binding of endothelium-derived NO to generate large amounts of cGMP. Recently, an attenuation of aortic sGC expression was recognized as a potential mechanism of reduced dilator response in aged spontaneously hypertensive rats.18 In rats with chronic myocardial infarction, however, we observed an upregulation of sGC expression that was associated with a blunted cGMP formation in response to sodium nitroprusside. Because sGC activity is susceptible to superoxide25 and cGMP production was restored by prior treatment with the radical scavenger Tiron, enhanced production of superoxide anions may be responsible for the reduced activity of sGC despite the increase in its expression. Enhanced degradation of cGMP due to increased phosphodiesterase activity31 is not likely, because our experiments were performed in the continuous presence of a high concentration of a phosphodiesterase inhibitor. An enhanced O2- formation in rats with heart failure appears to account for the paradoxical attenuation of cGMP accumulation despite increased sGC expression.

Oxidative Stress in Heart Failure and Vascular O2- Formation
Elevated levels of plasma lipid peroxides in patients suffering from heart failure provide clear evidence of an enhanced oxidative stress under this condition.16 32 In addition, the transition from hypertrophy to heart failure in coarctation-induced hypertension was associated with an increased oxidative stress and could be prevented by treatment with the antioxidant vitamin E, thus indicating a pathophysiological role for oxidative stress in the pathogenesis of heart failure.33 High doses of vitamin C were able to restore the impaired NO-mediated dilation in patients with heart failure,17 and in line with these observations, our results provide the first direct experimental evidence for an enhanced release of reactive oxygen species from the vasculature in chronic ischemic cardiac dysfunction. The source of superoxide formation appears to be vascular smooth muscle cells, because removal of the endothelium did not significantly attenuate radical production. Cultured and native vascular smooth muscle cells are able to generate superoxide in response to the vasoconstrictor peptide angiotensin II, which stimulates the expression of an NAD(P)H-dependent oxidase.13 34 Plasma renin activity as well as tissue ACE activity is markedly elevated in heart failure.35 Therefore, an enhanced formation of angiotensin II may lead to an enhanced vascular superoxide formation through the expression of an NAD(P)H-dependent oxidase in aortic smooth muscle cells.13 34 Indeed, the observed upregulation of NADH-dependent O2- formation in aortas from rats with chronic myocardial infarction suggests that this mechanism may be operative in ischemic heart failure.

The deleterious role of O2- formation for endothelial function in ischemic cardiac dysfunction is further strengthened by the observation that exogenous SOD exerted a significantly greater relaxation in rats with chronic myocardial infarction and by the partial restoration of the acetylcholine-induced relaxation in the presence of SOD.

An imbalance between NO and superoxide production with enhanced inactivation of NO, leading to a reduction of bioactive NO despite a normal or even increased generation of NO, has been associated with endothelial dysfunction and appears to be a common feature of many cardiovascular diseases, such as hypercholesterolemia and hypertension.11 12 13 15 18 In addition, depending on the pathophysiological circumstances, NO and superoxide may react to the powerful oxidant peroxynitrite, which can form hydroxyl radicals and nitrate protein tyrosine residues.15 However, we detected neither enhanced luminol chemiluminescence nor tyrosine nitration in rats with heart failure, so there was no hint for the formation of peroxynitrite.

In conclusion, our data indicate that an increased NADH-dependent vascular O2- generation represents an important mechanism for the endothelial dysfunction in heart failure by enhancing the inactivation of NO. Even a presumably counterregulatory upregulation of eNOS and sGC is not sufficient to restore endothelium-dependent relaxations.


*    Acknowledgments
 
This work was supported in part by the Deutsche Forschungsgemeinschaft (Ba 1742/1-1) and the Forschungsfonds der Fakultät für Klinische Medizin Mannheim (0067/1997). The authors wish to thank Isabel Winter, Claudia Liebetrau, and Elke Burmeister for expert technical assistance.

Received December 16, 1998; revision received March 15, 1999; accepted March 31, 1999.


*    References
up arrowTop
up arrowAbstract
up arrowIntroduction
up arrowMethods
up arrowResults
up arrowDiscussion
*References
 
1. Kubo SH, Rector TS, Bank AJ, Williams RE, Heifetz SM. Endothelium-dependent vasodilation is attenuated in patients with heart failure. Circulation. 1991;84:1589–1596.[Abstract/Free Full Text]

2. Katz SD, Biasucci L, Sabba C, Strom JA, Jondeau G, Galvao N, Solomon S, Nikolic SD, Forman R, LeJemtel T. Impaired endothelium-mediated vasodilation in the peripheral vasculature of patients with congestive heart failure. J Am Coll Cardiol. 1992;19:918–925.[Abstract]

3. Drexler H, Hayoz D, Münzel T, Hornig B, Just H, Brunner HR, Zelis R. Endothelial function in chronic congestive heart failure. Am J Cardiol. 1992;69:1596–1601.[Medline] [Order article via Infotrieve]

4. Ontkean M, Gray R, Greenberg B. Diminished endothelium-derived relaxing factor activity in an experimental model of chronic heart failure. Circ Res. 1991;69:1088–1096.[Abstract/Free Full Text]

5. Kaiser L, Spickard RC, Olivier NB. Heart failure depresses endothelium-dependent responses in canine femoral artery. Am J Physiol. 1989;256:H962–H967.[Abstract/Free Full Text]

6. Drexler H, Lu W. Endothelial dysfunction of hindquarter resistance vessels in experimental heart failure. Am J Physiol. 1992;262:H1640–H1645.[Abstract/Free Full Text]

7. Wang J, Sevanian A, Xu XB, Wolin MS, Hintze TH. Defective endothelium-mediated control of coronary circulation in conscious dogs after heart failure. Am J Physiol. 1994;266:H670–H680.[Abstract/Free Full Text]

8. Smith CJ, Sun D, Hoegler C, Roth BS, Zhang X, Zhao G, Xu XB, Kobari Y, Pritchard K, Sessa WC, Hintze TH. Reduced gene expression of vascular endothelial NO synthase and cyclooxygenase-1 in heart failure. Circ Res. 1996;78:58–64.[Abstract/Free Full Text]

9. Habib F, Dutka D, Crossman D, Oakley CM, Cleland JGF. Enhanced basal nitric oxide production in heart failure: another failed counter-regulatory vasodilator mechanism? Lancet. 1994;344:371–373.[Medline] [Order article via Infotrieve]

10. Haywood GA, Tsao PS, von der Leyen HE, Mann MJ, Keeling PJ, Trindade PT, Lewis NP, Byrne CD, Rickenbacher PR, Bishopric NH, Cooke JP, McKenna WJ, Fowler MB. Expression of inducible nitric oxide synthase in human heart failure. Circulation. 1996;93:1087–1094.[Abstract/Free Full Text]

11. Ohara Y, Peterson TE, Harrison DG. Hypercholesterolemia increases endothelial superoxide production. J Clin Invest. 1993;91:2546–2551.

12. Grunfeld S, Hamilton CA, Mesaros S, McClain SW, Dominiczak AF, Bohr DF, Malinski T. Role of superoxide in the depressed nitric oxide production by the endothelium of genetically hypertensive rats. Hypertension. 1995;26(pt 1):854–857.

13. Rajagopalan S, Kurz S, Münzel T, Tarpey M, Freeman BA, Griendling KK, Harrison DG. Angiotensin II-mediated hypertension in the rat increases vascular superoxide production via membrane NADH/NADPH oxidase activation. J Clin Invest. 1996;97:1916–1923.[Medline] [Order article via Infotrieve]

14. Nava E, Noll G, Lüscher TF. Increased activity of constitutive nitric oxide synthase in cardiac endothelium in spontaneous hypertension. Circulation. 1995;91:2310–2313.[Abstract/Free Full Text]

15. Bouloumié A, Bauersachs J, Linz W, Schölkens BA, Wiemer G, Fleming I, Busse R. Endothelial dysfunction coincides with an enhanced NO synthase expression and superoxide anion production. Hypertension. 1997;30:934–941.[Abstract/Free Full Text]

16. Belch JJF, Bridges AB, Scott N, Chopra M. Oxygen free radicals and congestive heart failure. Br Heart J. 1991;65:245–248.[Abstract/Free Full Text]

17. Hornig B, Arakawa N, Kohler C, Drexler H. Vitamin C improves endothelial function of conduit arteries in patients with chronic heart failure. Circulation. 1998;97:363–368.[Abstract/Free Full Text]

18. Bauersachs J, Bouloumié A, Mülsch A, Wiemer G, Fleming I, Busse R. Vasodilator dysfunction in aged spontaneously hypertensive rats: changes in NO synthase III and soluble guanylyl cyclase expression, and in superoxide anion production. Cardiovasc Res. 1998;37:772–779.[Abstract/Free Full Text]

19. Pfeffer JM, Pfeffer MA, Braunwald E. Influence of chronic captopril therapy on the infarcted left ventricle of the rat. Circ Res. 1985;57:84–95.[Abstract/Free Full Text]

20. Teerlink JR, Clozel M, Fischli W, Clozel JP. Temporal evolution of endothelial dysfunction in a rat model of chronic heart failure. J Am Coll Cardiol. 1993;22:615–620.[Abstract]

21. Fraccarollo D, Hu K, Galuppo P, Gaudron P, Ertl G. Chronic endothelin receptor blockade attenuates progressive ventricular dilatation and improves cardiac function in rats with myocardial infarction: possible involvement of myocardial endothelin system in ventricular remodeling. Circulation. 1997;96:3963–3973.[Abstract/Free Full Text]

22. Chomczynski P, Sacchi N. Single step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem. 1987;162:156–159.[Medline] [Order article via Infotrieve]

23. Papapetropoulos A, Marczin N, Mora G, Milici A, Murad F, Catravas JD. Regulation of vascular smooth muscle soluble guanylyl cyclase activity, mRNA and protein levels by cAMP-elevating agents. Hypertension. 1995;26:696–704.[Abstract/Free Full Text]

24. Fleming I, Fisslthaler B, Busse R. Calcium signaling in endothelial cells involves activation of tyrosine kinases and leads to the activation of mitogen-activated protein kinases. Circ Res. 1995;76:522–529.[Abstract/Free Full Text]

25. Mülsch A, Bauersachs J, Schäfer A, Stasch JP, Kast R, Busse R. Effect of YC-1, an NO-independent, superoxide-sensitive stimulator of soluble guanylyl cyclase, on smooth muscle responsiveness to nitrovasodilators. Br J Pharmacol. 1997;120:681–689.[Medline] [Order article via Infotrieve]

26. Ramsey MW, Goodfellow J, Jones CJH, Luddington LA, Lewis MJ, Henderson AH. Endothelial control of arterial distensibility is impaired in chronic heart failure. Circulation. 1994;92:3212–3219.[Abstract/Free Full Text]

27. Comini L, Bachetti T, Gaia G, Pasini E, Agnoletti L, Pepi P, Ceconi C, Curello S, Ferrari R. Aorta and skeletal muscle NO synthase expression in experimental heart failure. J Mol Cell Cardiol. 1996;28:2241–2248.[Medline] [Order article via Infotrieve]

28. Mohri M, Egashira K, Tagawa T, Kuga T, Tagawa H, Harasawa Y, Shimokawa H, Takeshita A. Basal release of nitric oxide is decreased in the coronary circulation in patients with heart failure. Hypertension. 1997;30(pt 1):50–56.

29. Kubo SH, Rector TS, Bank AJ, Raij L, Kraemer MD, Tadros P, Beardslee M, Garr MD. Lack of contribution of nitric oxide to basal vasomotor tone in heart failure. Am J Cardiol. 1994;74:1133–1136.[Medline] [Order article via Infotrieve]

30. Khadour FH, Kao RH, Park S, Armstrong PW, Holycross BJ, Schulz R. Age-dependent augmentation of cardiac endothelial NOS in a genetic rat model of heart failure. Am J Physiol. 1997;273:H1223–H1230.[Abstract/Free Full Text]

31. Supaporn T, Sandberg SM, Borgeson DD, Heublein DM, Luchner A, Wei C-M, Dousa T, Burnett JCJ. Blunted cGMP response to agonists and enhanced glomerular cyclic 3',5'-nucleotide phosphodiesterase activities in experimental congestive heart failure. Kidney Int. 1996;50:1718–1725.[Medline] [Order article via Infotrieve]

32. Keith M, Geranmayegan A, Sole MJ, Kurian R, Robinson A, Omran A, Jeejeebhoy KN. Increased oxidative stress in patients with congestive heart failure. J Am Coll Cardiol. 1998;31:1352–1356.[Abstract/Free Full Text]

33. Dhalla AK, Hill MF, Singal PK. Role of oxidative stress in transition of hypertrophy to heart failure. J Am Coll Cardiol. 1996;28:506–514.[Abstract]

34. Griendling KK, Minieri CA, Ollerenshaw JD, Alexander RW. Angiotensin II stimulates NADH and NADPH oxidase activity in cultured vascular smooth muscle cells. Circ Res. 1994;74:1141–1148.[Abstract/Free Full Text]

35. Wollert KC, Studer R, von Bülow B, Drexler H. Survival after myocardial infarction in the rat: role of tissue angiotensin converting enzyme inhibition. Circulation. 1994;90:2457–2467.[Abstract/Free Full Text]




This article has been cited by other articles:


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
I. H. Zucker, H. D. Schultz, K. P. Patel, W. Wang, and L. Gao
Regulation of central angiotensin type 1 receptors and sympathetic outflow in heart failure
Am J Physiol Heart Circ Physiol, November 1, 2009; 297(5): H1557 - H1566.
[Abstract] [Full Text] [PDF]


Home page
J. Physiol.Home page
S. Koba, Z. Gao, and L. I. Sinoway
Oxidative stress and the muscle reflex in heart failure
J. Physiol., November 1, 2009; 587(21): 5227 - 5237.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
S. Apostolakis, G. Y.H. Lip, and E. Shantsila
Monocytes in heart failure: relationship to a deteriorating immune overreaction or a desperate attempt for tissue repair?
Cardiovasc Res, October 28, 2009; (2009) cvp327v2.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
Z. Bagi
Mechanisms of coronary microvascular adaptation to obesity
Am J Physiol Regulatory Integrative Comp Physiol, September 1, 2009; 297(3): R556 - R567.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
H. Tsutsui, S. Kinugawa, and S. Matsushima
Mitochondrial oxidative stress and dysfunction in myocardial remodelling
Cardiovasc Res, February 15, 2009; 81(3): 449 - 456.
[Abstract] [Full Text] [PDF]


Home page
Mol. Pharmacol.Home page
Y.-M. Lu, F. Han, N. Shioda, S. Moriguchi, Y. Shirasaki, Z.-H. Qin, and K. Fukunaga
Phenylephrine-Induced Cardiomyocyte Injury Is Triggered by Superoxide Generation through Uncoupled Endothelial Nitric-Oxide Synthase and Ameliorated by 3-[2-[4-(3-Chloro-2-methylphenyl)-1-piperazinyl]ethyl]-5,6-dimethoxyindazole (DY-9836), a Novel Calmodulin Antagonist
Mol. Pharmacol., January 1, 2009; 75(1): 101 - 112.
[Abstract] [Full Text] [PDF]


Home page
J. Appl. Physiol.Home page
A. J. Donato, I. Eskurza, K. L. Jablonski, L. B. Gano, G. L. Pierce, and D. R. Seals
Cytochrome P-450 2C9 signaling does not contribute to age-associated vascular endothelial dysfunction in humans
J Appl Physiol, October 1, 2008; 105(4): 1359 - 1363.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
D. Fraccarollo, J. D. Widder, P. Galuppo, T. Thum, D. Tsikas, M. Hoffmann, H. Ruetten, G. Ertl, and J. Bauersachs
Improvement in Left Ventricular Remodeling by the Endothelial Nitric Oxide Synthase Enhancer AVE9488 After Experimental Myocardial Infarction
Circulation, August 19, 2008; 118(8): 818 - 827.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
M. L. Marro, C. Peiro, C. M. Panayiotou, R. S. Baliga, S. Meurer, H. H. H. W. Schmidt, and A. J. Hobbs
Characterization of the Human {alpha}1{beta}1 Soluble Guanylyl Cyclase Promoter: KEY ROLE FOR NF-{kappa}B(p50) AND CCAAT-BINDING FACTORS IN REGULATING EXPRESSION OF THE NITRIC OXIDE RECEPTOR
J. Biol. Chem., July 18, 2008; 283(29): 20027 - 20036.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
A. P. C. Davel, L. E. Fukuda, L. L. De Sa, C. D. Munhoz, C. Scavone, D. Sanz-Rosa, V. Cachofeiro, V. Lahera, and L. V. Rossoni
Effects of isoproterenol treatment for 7 days on inflammatory mediators in the rat aorta
Am J Physiol Heart Circ Physiol, July 1, 2008; 295(1): H211 - H219.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
G. K. Soukhova-O'Hare, R. V. Ortines, Y. Gu, A. D. Nozdrachev, S. D. Prabhu, and D. Gozal
Postnatal Intermittent Hypoxia and Developmental Programming of Hypertension in Spontaneously Hypertensive Rats: The Role of Reactive Oxygen Species and L-Ca2+ Channels
Hypertension, July 1, 2008; 52(1): 156 - 162.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
E. Jebelovszki, C. Kiraly, N. Erdei, A. Feher, E. T. Pasztor, I. Rutkai, T. Forster, I. Edes, A. Koller, and Z. Bagi
High-fat diet-induced obesity leads to increased NO sensitivity of rat coronary arterioles: role of soluble guanylate cyclase activation
Am J Physiol Heart Circ Physiol, June 1, 2008; 294(6): H2558 - H2564.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
P. C. Colombo, D. Onat, and H. N. Sabbah
Acute heart failure as "acute endothelitis" -- Interaction of fluid overload and endothelial dysfunction
Eur J Heart Fail, February 1, 2008; 10(2): 170 - 175.
[Full Text] [PDF]


Home page
Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
W.-Y. Lin, R. M. Levin, P. Chichester, R. Leggett, Y.-S. Juan, A. Johnson, P. Neumann, C. Whitbeck, A. Guven, B. Kogan, et al.
Effects of L-arginine and L-NAME on chronic partial bladder outlet obstruction in rabbit
Am J Physiol Regulatory Integrative Comp Physiol, December 1, 2007; 293(6): R2390 - R2399.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
C. L. Sartorio, D. Fraccarollo, P. Galuppo, M. Leutke, G. Ertl, I. Stefanon, and J. Bauersachs
Mineralocorticoid Receptor Blockade Improves Vasomotor Dysfunction and Vascular Oxidative Stress Early After Myocardial Infarction
Hypertension, November 1, 2007; 50(5): 919 - 925.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
C. Doerries, K. Grote, D. Hilfiker-Kleiner, M. Luchtefeld, A. Schaefer, S. M. Holland, S. Sorrentino, C. Manes, B. Schieffer, H. Drexler, et al.
Critical Role of the NAD(P)H Oxidase Subunit p47phox for Left Ventricular Remodeling/Dysfunction and Survival After Myocardial Infarction
Circ. Res., March 30, 2007; 100(6): 894 - 903.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
Y. Xu, R.H. Henning, E. Lipsic, A. van Buiten, W.H. van Gilst, and H. Buikema
Acetylcholine stimulated dilatation and stretch induced myogenic constriction in mesenteric artery of rats with chronic heart failure
Eur J Heart Fail, February 1, 2007; 9(2): 144 - 151.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
E. Takimoto and D. A. Kass
Role of Oxidative Stress in Cardiac Hypertrophy and Remodeling
Hypertension, February 1, 2007; 49(2): 241 - 248.
[Full Text] [PDF]


Home page
Eur J Heart FailHome page
G. Csanyi, M. Bauer, W. Dietl, M. Lomnicka, T. Stepuro, B. K. Podesser, and S. Chlopicki
Functional alterations in NO, PGI2 and EDHF pathways in the aortic endothelium after myocardial infarction in rats
Eur J Heart Fail, December 1, 2006; 8(8): 769 - 776.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
J. J. M. Greer, A. K. Kakkar, J. W. Elrod, L. J. Watson, S. P. Jones, and D. J. Lefer
Low-dose simvastatin improves survival and ventricular function via eNOS in congestive heart failure
Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2743 - H2751.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Cell Physiol.Home page
C. D. Searles
Transcriptional and posttranscriptional regulation of endothelial nitric oxide synthase expression
Am J Physiol Cell Physiol, November 1, 2006; 291(5): C803 - C816.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
D. Hilfiker-Kleiner, U. Landmesser, and H. Drexler
Molecular Mechanisms in Heart Failure: Focus on Cardiac Hypertrophy, Inflammation, Angiogenesis, and Apoptosis
J. Am. Coll. Cardiol., October 27, 2006; 48(9_Suppl_A): A56 - A66.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
S. Iida, Y. Chu, R. M. Weiss, Y. M. Kang, F. M. Faraci, and D. D. Heistad
Vascular effects of a common gene variant of extracellular superoxide dismutase in heart failure
Am J Physiol Heart Circ Physiol, August 1, 2006; 291(2): H914 - H920.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
J. Bauersachs and D. Fraccarollo
Endothelial NO Synthase Target of Aldosterone
Hypertension, July 1, 2006; 48(1): 27 - 28.
[Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
H. Post and B. Pieske
Arginase: a modulator of myocardial function
Am J Physiol Heart Circ Physiol, May 1, 2006; 290(5): H1747 - H1748.
[Full Text] [PDF]


Home page
J. Appl. Physiol.Home page
E. Ponsot, S. P. Dufour, J. Zoll, S. Doutrelau, B. N'Guessan, B. Geny, H. Hoppeler, E. Lampert, B. Mettauer, R. Ventura-Clapier, et al.
Exercise training in normobaric hypoxia in endurance runners. II. Improvement of mitochondrial properties in skeletal muscle
J Appl Physiol, April 1, 2006; 100(4): 1249 - 1257.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
D. D. Heistad
Oxidative Stress and Vascular Disease: 2005 Duff Lecture
Arterioscler Thromb Vasc Biol, April 1, 2006; 26(4): 689 - 695.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
T. Thum, D. Fraccarollo, P. Galuppo, D. Tsikas, S. Frantz, G. Ertl, and J. Bauersachs
Bone marrow molecular alterations after myocardial infarction: Impact on endothelial progenitor cells
Cardiovasc Res, April 1, 2006; 70(1): 50 - 60.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
B. Westendorp, R. G. Schoemaker, H. Buikema, F. Boomsma, D. J. van Veldhuisen, and W. H. van Gilst
Progressive left ventricular hypertrophy after withdrawal of long-term ACE inhibition following experimental myocardial infarction
Eur J Heart Fail, March 1, 2006; 8(2): 122 - 130.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
T. J. Guzik, J. Sadowski, B. Guzik, A. Jopek, B. Kapelak, P. Przybylowski, K. Wierzbicki, R. Korbut, D. G. Harrison, and K. M. Channon
Coronary Artery Superoxide Production and Nox Isoform Expression in Human Coronary Artery Disease
Arterioscler Thromb Vasc Biol, February 1, 2006; 26(2): 333 - 339.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Renal Physiol.Home page
Y. Wang, S. Kramer, T. Loof, S. Martini, S. Kron, H. Kawachi, F. Shimizu, H.-H. Neumayer, and H. Peters
Enhancing cGMP in experimental progressive renal fibrosis: soluble guanylate cyclase stimulation vs. phosphodiesterase inhibition
Am J Physiol Renal Physiol, January 1, 2006; 290(1): F167 - F176.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
H. Mollnau, M. Oelze, M. August, M. Wendt, A. Daiber, E. Schulz, S. Baldus, A. L. Kleschyov, A. Materne, P. Wenzel, et al.
Mechanisms of Increased Vascular Superoxide Production in an Experimental Model of Idiopathic Dilated Cardiomyopathy
Arterioscler Thromb Vasc Biol, December 1, 2005; 25(12): 2554 - 2559.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Chen, Y. Li, P. Zhang, J. H. Traverse, M. Hou, X. Xu, M. Kimoto, and R. J. Bache
Dimethylarginine dimethylaminohydrolase and endothelial dysfunction in failing hearts
Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H2212 - H2219.
[Abstract] [Full Text] [PDF]


Home page
BloodHome page
A. J. Begonja, S. Gambaryan, J. Geiger, B. Aktas, M. Pozgajova, B. Nieswandt, and U. Walter
Platelet NAD(P)H-oxidase-generated ROS production regulates {alpha}IIb{beta}3-integrin activation independent of the NO/cGMP pathway
Blood, October 15, 2005; 106(8): 2757 - 2760.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
N. Kobayashi, F. A. DeLano, and G. W. Schmid-Schonbein
Oxidative Stress Promotes Endothelial Cell Apoptosis and Loss of Microvessels in the Spontaneously Hypertensive Rats
Arterioscler Thromb Vasc Biol, October 1, 2005; 25(10): 2114 - 2121.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
C.-F. Lam and Z. S. Katusic
Genetic modification of vascular endothelial function as therapeutic strategy in heart failure
Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H518 - H519.
[Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
S. Iida, Y. Chu, J. Francis, R. M. Weiss, C. A. Gunnett, F. M. Faraci, and D. D. Heistad
Gene transfer of extracellular superoxide dismutase improves endothelial function in rats with heart failure
Am J Physiol Heart Circ Physiol, August 1, 2005; 289(2): H525 - H532.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
U. Landmesser, F. Bahlmann, M. Mueller, S. Spiekermann, N. Kirchhoff, S. Schulz, C. Manes, D. Fischer, K. de Groot, D. Fliser, et al.
Simvastatin Versus Ezetimibe: Pleiotropic and Lipid-Lowering Effects on Endothelial Function in Humans
Circulation, May 10, 2005; 111(18): 2356 - 2363.
[Abstract] [Full Text] [PDF]


Home page
J. Pharmacol. Exp. Ther.Home page
R. B. Pereira, C. L. Sartorio, D. V. Vassallo, and I. Stefanon
Differences in Tail Vascular Bed Reactivity in Rats with and without Heart Failure following Myocardial Infarction
J. Pharmacol. Exp. Ther., March 1, 2005; 312(3): 1321 - 1325.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
J. Bauersachs and A. Schafer
Tetrahydrobiopterin and eNOS dimer/monomer ratio-a clue to eNOS uncoupling in diabetes?
Cardiovasc Res, March 1, 2005; 65(4): 768 - 769.
[Full Text] [PDF]


Home page
CirculationHome page
S. D. Katz, K. Hryniewicz, I. Hriljac, K. Balidemaj, C. Dimayuga, A. Hudaihed, and A. Yasskiy
Vascular Endothelial Dysfunction and Mortality Risk in Patients With Chronic Heart Failure
Circulation, January 25, 2005; 111(3): 310 - 314.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
P. C. Colombo, J. E. Banchs, S. Celaj, A. Talreja, J. Lachmann, S. Malla, N. B. DuBois, A. W. Ashton, F. Latif, U. P. Jorde, et al.
Endothelial Cell Activation in Patients With Decompensated Heart Failure
Circulation, January 4, 2005; 111(1): 58 - 62.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
Y. Chen, M. Hou, Y. Li, J. H. Traverse, P. Zhang, D. Salvemini, T. Fukai, and R. J. Bache
Increased superoxide production causes coronary endothelial dysfunction and depressed oxygen consumption in the failing heart
Am J Physiol Heart Circ Physiol, January 1, 2005; 288(1): H133 - H141.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Regul. Integr. Comp. Physiol.Home page
J.-M. Li and A. M Shah
Endothelial cell superoxide generation: regulation and relevance for cardiovascular pathophysiology
Am J Physiol Regulatory Integrative Comp Physiol, November 1, 2004; 287(5): R1014 - R1030.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
U. Landmesser, N. Engberding, F. H. Bahlmann, A. Schaefer, A. Wiencke, A. Heineke, S. Spiekermann, D. Hilfiker-Kleiner, C. Templin, D. Kotlarz, et al.
Statin-Induced Improvement of Endothelial Progenitor Cell Mobilization, Myocardial Neovascularization, Left Ventricular Function, and Survival After Experimental Myocardial Infarction Requires Endothelial Nitric Oxide Synthase
Circulation, October 5, 2004; 110(14): 1933 - 1939.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
J. Widder, T. Behr, D. Fraccarollo, K. Hu, P. Galuppo, P. Tas, C. E Angermann, G. Ertl, and J. Bauersachs
Vascular endothelial dysfunction and superoxide anion production in heart failure are p38 MAP kinase-dependent
Cardiovasc Res, July 1, 2004; 63(1): 161 - 167.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
A. Schafer, D. Fraccarollo, P. Tas, I. Schmidt, G. Ertl, and J. Bauersachs
Endothelial dysfunction in congestive heart failure: ACE inhibition vs. angiotensin II antagonism
Eur J Heart Fail, March 1, 2004; 6(2): 151 - 159.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
N. J. Alp and K. M. Channon
Regulation of Endothelial Nitric Oxide Synthase by Tetrahydrobiopterin in Vascular Disease
Arterioscler Thromb Vasc Biol, March 1, 2004; 24(3): 413 - 420.
[Abstract] [Full Text]


Home page
HypertensionHome page
Y. Taniyama and K. K. Griendling
Reactive Oxygen Species in the Vasculature: Molecular and Cellular Mechanisms
Hypertension, December 1, 2003; 42(6): 1075 - 1081.
[Abstract] [Full Text] [PDF]


Home page
Proc. Natl. Acad. Sci. USAHome page
I. G. Sharina, E. Martin, A. Thomas, K. L. Uray, and F. Murad
CCAAT-binding factor regulates expression of the {beta}1 subunit of soluble guanylyl cyclase gene in the BE2 human neuroblastoma cell line
PNAS, September 30, 2003; 100(20): 11523 - 11528.
[Abstract] [Full Text] [PDF]


Home page
Journal of Renin-Angiotensin-Aldosterone SystemHome page
W. Linz, G. Itter, L. W Dobrucki, T. Malinski, and G. Wiemer
Ramipril improves nitric oxide availability in hypertensive rats with failing hearts after myocardial infarction
Journal of Renin-Angiotensin-Aldosterone System, September 1, 2003; 4(3): 180 - 185.
[Abstract] [PDF]


Home page
Physiol. GenomicsHome page
Y. Chen, S. Park, Y. Li, E. Missov, M. Hou, X. Han, J. L. Hall, L. W. Miller, and R. J. Bache
Alterations of gene expression in failing myocardium following left ventricular assist device support
Physiol Genomics, August 15, 2003; 14(3): 251 - 260.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
A. Friebe and D. Koesling
Regulation of Nitric Oxide-Sensitive Guanylyl Cyclase
Circ. Res., July 25, 2003; 93(2): 96 - 105.
[Abstract] [Full Text] [PDF]


Home page
Journal of Renin-Angiotensin-Aldosterone SystemHome page
D. G Harrison, Hua Cai, U. Landmesser, and K. K Griendling
The Pickering Lecture British Hypertension Society, 10th September 2002: Interactions of angiotensin II with NAD(P)H oxidase, oxidant stress and cardiovascular disease
Journal of Renin-Angiotensin-Aldosterone System, June 1, 2003; 4(2): 51 - 61.
[Abstract] [PDF]


Home page
Cardiovasc ResHome page
A. Schafer, D. Fraccarollo, S. K Hildemann, P. Tas, G. Ertl, and J. Bauersachs
Addition of the selective aldosterone receptor antagonist eplerenone to ACE inhibition in heart failure: effect on endothelial dysfunction
Cardiovasc Res, June 1, 2003; 58(3): 655 - 662.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
L. J. Dixon, D. R. Morgan, S. M. Hughes, L. T. McGrath, N. A. El-Sherbeeny, R. D. Plumb, A. Devine, W. Leahey, G. D. Johnston, and G. E. McVeigh
Functional Consequences of Endothelial Nitric Oxide Synthase Uncoupling in Congestive Cardiac Failure
Circulation, April 8, 2003; 107(13): 1725 - 1728.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
S. Gschwend, H. Buikema, R. H. Henning, Y. M. Pinto, D. de Zeeuw, and W. H. van Gilst
Endothelial dysfunction and infarct-size relate to impaired EDHF response in rat experimental chronic heart failure
Eur J Heart Fail, March 1, 2003; 5(2): 147 - 154.
[Abstract] [Full Text] [PDF]


Home page
J. Biol. Chem.Home page
S. Kloss, H. Furneaux, and A. Mulsch
Post-transcriptional Regulation of Soluble Guanylyl Cyclase Expression in Rat Aorta
J. Biol. Chem., January 17, 2003; 278(4): 2377 - 2383.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
U. Landmesser, S. Spiekermann, S. Dikalov, H. Tatge, R. Wilke, C. Kohler, D. G. Harrison, B. Hornig, and H. Drexler
Vascular Oxidative Stress and Endothelial Dysfunction in Patients With Chronic Heart Failure: Role of Xanthine-Oxidase and Extracellular Superoxide Dismutase
Circulation, December 10, 2002; 106(24): 3073 - 3078.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
T. Munzel, I. B. Afanas'ev, A. L. Kleschyov, and D. G. Harrison
Detection of Superoxide in Vascular Tissue
Arterioscler Thromb Vasc Biol, November 1, 2002; 22(11): 1761 - 1768.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
P.a. Pacher, L. Liaudet, J. G. Mabley, K. Komjati, and C. Szabo
Pharmacologic inhibition of poly(adenosine diphosphate-ribose) polymerase may represent a novel therapeutic approach in chronic heart failure
J. Am. Coll. Cardiol., September 4, 2002; 40(5): 1006 - 1016.
[Abstract] [Full Text] [PDF]


Home page
DiabetesHome page
M. Christ, J. Bauersachs, C. Liebetrau, M. Heck, A. Gunther, and M. Wehling
Glucose Increases Endothelial-Dependent Superoxide Formation in Coronary Arteries by NAD(P)H Oxidase Activation: Attenuation by the 3-Hydroxy-3-Methylglutaryl Coenzyme A Reductase Inhibitor Atorvastatin
Diabetes, August 1, 2002; 51(8): 2648 - 2652.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
K. Fukuo, J. Yang, O. Yasuda, M. Mogi, T. Suhara, N. Sato, T. Suzuki, S. Morimoto, and T. Ogihara
Nifedipine Indirectly Upregulates Superoxide Dismutase Expression in Endothelial Cells via Vascular Smooth Muscle Cell-Dependent Pathways
Circulation, July 16, 2002; 106(3): 356 - 361.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
U. Landmesser and H. Drexler
Allopurinol and Endothelial Function in Heart Failure: Future or Fantasy?
Circulation, July 9, 2002; 106(2): 173 - 175.
[Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
J. H. Traverse, Y. Chen, M. Hou, and R. J. Bache
Inhibition of NO production increases myocardial blood flow and oxygen consumption in congestive heart failure
Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2278 - H2283.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
M. Ahmad, Y. Zhang, Y. Zhang, C. Papharalambus, and R. W. Alexander
Role of Isoprenylcysteine Carboxyl Methyltransferase in Tumor Necrosis Factor-{alpha} Stimulation of Expression of Vascular Cell Adhesion Molecule-1 in Endothelial Cells
Arterioscler Thromb Vasc Biol, May 1, 2002; 22(5): 759 - 764.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
L. Sanchez de Miguel, M. a M. Arriero, J. Farre, P. Jimenez, A. Garcia-Mendez, T. de Frutos, A. Jimenez, R. Garcia, F. Cabestrero, J. Gomez, et al.
Nitric oxide production by neutrophils obtained from patients during acute coronary syndromes: expression of the nitric oxide synthase isoforms
J. Am. Coll. Cardiol., March 6, 2002; 39(5): 818 - 825.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. Bauersachs, M. Heck, D. Fraccarollo, S. K. Hildemann, G. Ertl, M. Wehling, and M. Christ
Addition of spironolactone to angiotensin-converting enzyme inhibition in heart failure improves endothelial vasomotor dysfunction: Role of vascular superoxide anion formation and endothelial nitric oxide synthase expression
J. Am. Coll. Cardiol., January 16, 2002; 39(2): 351 - 358.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
J. A. Wagner, K. Hu, J. Bauersachs, J. Karcher, M. Wiesler, S. K. Goparaju, G. Kunos, and G. Ertl
Endogenous cannabinoids mediate hypotension after experimental myocardial infarction
J. Am. Coll. Cardiol., December 1, 2001; 38(7): 2048 - 2054.
[Abstract] [Full Text] [PDF]


Home page
Eur J Heart FailHome page
M. de Lorgeril, P. Salen, M. Accominotti, M. Cadau, J.-P. Steghens, F. Boucher, and J. de Leiris
Dietary and blood antioxidants in patients with chronic heart failure. Insights into the potential importance of selenium in heart failure
Eur J Heart Fail, December 1, 2001; 3(6): 661 - 669.
[Abstract] [Full Text] [PDF]


Home page
J. Am. Soc. Nephrol.Home page
M. Marques, I. Millas, A. Jimenez, E. Garcia-Colis, J. A. Rodriguez-Feo, S. Velasco, A. Barrientos, S. Casado, and A. Lopez-Farre
Alteration of the Soluble Guanylate Cyclase System in the Vascular Wall of Lead-Induced Hypertension in Rats
J. Am. Soc. Nephrol., December 1, 2001; 12(12): 2594 - 2600.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
R. Nakamura, K. Egashira, K. Arimura, Y. Machida, T. Ide, H. Tsutsui, H. Shimokawa, and A. Takeshita
Increased inactivation of nitric oxide is involved in impaired coronary flow reserve in heart failure
Am J Physiol Heart Circ Physiol, December 1, 2001; 281(6): H2619 - H2625.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
G. Wiemer, G. Itter, T. Malinski, and W. Linz
Decreased Nitric Oxide Availability in Normotensive and Hypertensive Rats With Failing Hearts After Myocardial Infarction
Hypertension, December 1, 2001; 38(6): 1367 - 1371.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
G. F. Mitchell, J.-C. Tardif, J. M. O. Arnold, G. Marchiori, T. X. O'Brien, M. E. Dunlap, and M. A. Pfeffer
Pulsatile Hemodynamics in Congestive Heart Failure
Hypertension, December 1, 2001; 38(6): 1433 - 1439.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
S. M. Wildhirt, M. Weis, C. Schulze, N. Conrad, S. Pehlivanli, G. Rieder, G. Enders, W. von Scheidt, and B. Reichart
Expression of Endomyocardial Nitric Oxide Synthase and Coronary Endothelial Function in Human Cardiac Allografts
Circulation, September 18, 2001; 104 (2009): I-336 - I-343.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
J. Bauersachs, I. Fleming, D. Fraccarollo, R. Busse, and G. Ertl
Prevention of endothelial dysfunction in heart failure by vitamin E: Attenuation of vascular superoxide anion formation and increase in soluble guanylyl cyclase expression
Cardiovasc Res, August 1, 2001; 51(2): 344 - 350.
[Abstract] [Full Text] [PDF]


Home page
J Am Coll CardiolHome page
P. V. Ennezat, S. L. Malendowicz, M. Testa, P. C. Colombo, A. Cohen-Solal, T. Evans, and T. H. LeJemtel
Physical training in patients with chronic heart failure enhances the expression of genes encoding antioxidative enzymes
J. Am. Coll. Cardiol., July 1, 2001; 38(1): 194 - 198.
[Abstract] [Full Text] [PDF]


Home page
Eur. J. Cardiothorac. Surg.Home page
S. M. Wildhirt, M. Weis, C. Schulze, N. Conrad, S. Pehlivanli, G. Rieder, G. Enders, W. von Scheidt, and B. Reichart
Coronary flow reserve and nitric oxide synthases after cardiac transplantation in humans
Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 840 - 847.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
A. Mulsch, M. Oelze, S. Kloss, H. Mollnau, A. Topfer, A. Smolenski, U. Walter, J.-P. Stasch, A. Warnholtz, U. Hink, et al.
Effects of In Vivo Nitroglycerin Treatment on Activity and Expression of the Guanylyl Cyclase and cGMP-Dependent Protein Kinase and Their Downstream Target Vasodilator-Stimulated Phosphoprotein in Aorta
Circulation, May 1, 2001; 103(17): 2188 - 2194.
[Abstract] [Full Text] [PDF]


Home page
Journal of Renin-Angiotensin-Aldosterone SystemHome page
L. J Wagenaar, H. Buikema, Y. M Pinto, and W. H van Gilst
Improvement of endothelial dysfunction in experimental heart failure by chronic RAAS-blockade: ACE-inhibition or AT1-receptor blockade?
Journal of Renin-Angiotensin-Aldosterone System, March 1, 2001; 2(1_suppl): S64 - S69.
[Abstract] [PDF]


Home page
Cardiovasc ResHome page
A.C. Mendes Ribeiro, T.M.C. Brunini, J.C. Ellory, and G.E. Mann
Abnormalities in L-arginine transport and nitric oxide biosynthesis in chronic renal and heart failure
Cardiovasc Res, March 1, 2001; 49(4): 697 - 712.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
H. Cai and D. G. Harrison
Endothelial Dysfunction in Cardiovascular Diseases: The Role of Oxidant Stress
Circ. Res., November 10, 2000; 87(10): 840 - 844.
[Abstract] [Full Text] [PDF]


Home page
Arterioscler. Thromb. Vasc. Bio.Home page
K. M. Channon, H. Qian, and S. E. George
Nitric Oxide Synthase in Atherosclerosis and Vascular Injury : Insights From Experimental Gene Therapy
Arterioscler Thromb Vasc Biol, August 1, 2000; 20(8): 1873 - 1881.
[Abstract] [Full Text] [PDF]


Home page
Cardiovasc ResHome page
J. Bauersachs, D. Fraccarollo, P. Galuppo, J. Widder, and G. Ertl
Endothelin-receptor blockade improves endothelial vasomotor dysfunction in heart failure
Cardiovasc Res, July 1, 2000; 47(1): 142 - 149.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
A. B. Driss, C. Devaux, D. Henrion, M. Duriez, C. Thuillez, B. I. Levy, and J.-B. Michel
Hemodynamic Stresses Induce Endothelial Dysfunction and Remodeling of Pulmonary Artery in Experimental Compensated Heart Failure
Circulation, June 13, 2000; 101(23): 2764 - 2770.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
T. J. Guzik, N. E. J. West, E. Black, D. McDonald, C. Ratnatunga, R. Pillai, and K. M. Channon
Vascular Superoxide Production by NAD(P)H Oxidase : Association With Endothelial Dysfunction and Clinical Risk Factors
Circ. Res., May 12, 2000; 86 (9): e85 - e90.
[Abstract] [Full Text] [PDF]


Home page
HypertensionHome page
R. P. Brandes, D.-y. Kim, F.-H. Schmitz-Winnenthal, M. Amidi, A. Godecke, A. Mulsch, and R. Busse
Increased Nitrovasodilator Sensitivity in Endothelial Nitric Oxide Synthase Knockout Mice : Role of Soluble Guanylyl Cyclase
Hypertension, January 1, 2000; 35(1): 231 - 236.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
T. Munzel and D. G. Harrison
Increased Superoxide in Heart Failure : A Biochemical Baroreflex Gone Awry
Circulation, July 20, 1999; 100(3): 216 - 218.
[Full Text] [PDF]


Home page
J. Biol. Chem.Home page
H.-Y. Sohn, M. Keller, T. Gloe, H. Morawietz, U. Rueckschloss, and U. Pohl
The Small G-protein Rac Mediates Depolarization-induced Superoxide Formation in Human Endothelial Cells
J. Biol. Chem., June 16, 2000; 275(25): 18745 - 18750.
[Abstract] [Full Text] [PDF]


Home page
Am. J. Physiol. Heart Circ. Physiol.Home page
D. B. Haitsma, D. Merkus, J. Vermeulen, P. D. Verdouw, and D. J. Duncker
Nitric oxide production is maintained in exercising swine with chronic left ventricular dysfunction
Am J Physiol Heart Circ Physiol, June 1, 2002; 282(6): H2198 - H2209.
[Abstract] [Full Text] [PDF]


Home page
Circ. Res.Home page
G. D. Thomas, W. Zhang, and R. G. Victor
Impaired Modulation of Sympathetic Vasoconstriction in Contracting Skeletal Muscle of Rats With Chronic Myocardial Infarctions : Role of Oxidative Stress
Circ. Res., April 27, 2001; 88(8): 816 - 823.
[Abstract] [Full Text] [PDF]


This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Bauersachs, J.
Right arrow Articles by Ertl, G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Bauersachs, J.
Right arrow Articles by Ertl, G.
Right arrowPubmed/NCBI databases
*Compound via MeSH
*Substance via MeSH
Medline Plus Health Information
*Heart Attack
Hazardous Substances DB
*PHENYLEPHRINE
Related Collections
Right arrow Heart failure - basic studies
Right arrow Oxidant stress
Right arrow Endothelium/vascular type/nitric oxide