Tetrahydrobiopterin increases NO-dependent vasodilation in hypercholesterolemic human skin through eNOS-coupling mechanisms

Alexander LM, Kutz JL, Kenney WL. Tetrahydrobiopterin increases NO-dependent vasodilation in hypercholesterolemic human skin through eNOS-coupling mechanisms. Am J Physiol Regul Integr Comp Physiol 304: R164-R169, 2013. First published November 28, 2012; doi:10.1152/ajpregu.00448.2012.-Localized exogenous R-tetrahydrobiopterin (R-BH4) corrects the deficit in local heat-induced vasodilation (VD) in hypercholesterolemic (HC) human skin through one of two plausible mechanisms: by serving as an essential cofactor to stabilizing endothelial nitric oxide (NO) synthase (eNOS) or through generalized antioxidant effects. We used the stereoisomer S-BH4, which has the same antioxidant properties but does not function as an essential NOS cofactor, to elucidate the mechanism by which R-BH4 restores cutaneous VD in HC humans. Intradermal microdialysis fibers were placed in 20 normocholesterolemic (NC), 13 midrange cholesterolemic (MC), and 18 HC (LDL: 94 +/- 3, 124 +/- 3 and 179 +/- 6 mg/dl, respectively) men and women to perfuse Ringer (control site) and R-BH4. In 10 NC, 13 MC, and 9 HC subjects (LDL: 94 +/- 3, 124 +/- 3, 180 +/- 10 mg/dl), S-BH4 was perfused at a third microdialysis site. Skin blood flow was measured during a standardized local heating protocol to elicit eNOS-dependent VD. After cutaneous vascular conductance (CVC = LDF/MAP) plateaued, NO-dependent VD was quantified by perfusing N-G-nitro-L-arginine methyl ester (L-NAME). Data were normalized as %CVCmax. Fully expressed VD (NC: 97.9 +/- 2.3 vs. MC: 85.4 +/- 5.4, HC: 79.9 +/- 4.2%CVCmax) and the NO-dependent portion (NC: 62.1 +/- 3 vs. MC: 45.8 +/- 3.9, HC: 35.7 +/- 2.8%CVCmax) were reduced in HC (both P < 0.01 vs. NC), but only the fully expressed VD was reduced in MC (P < 0.01 vs. NC). R-BH4 increased the fully expressed (93.9 +/- 3.4%CVCmax; P < 0.01) and NO-dependent VD (52.1 +/- 5.1%CVCmax; P < 0.01) in HC but not in NC or MC. S-BH4 increased full-expressed VD in HC (P < 0.01) but did not affect NO-dependent VD in HC or MC. In contrast S-BH4 attenuated NO-dependent VD in NC (control: 62.1 +/- 3 vs. S-BH4: 41.6 +/- 7%CVCmax; P < 0.001). Exogenous R-BH4 restores NO-dependent VD in HC human skin predominantly through NOS coupling mechanisms but increases full expression of the local heating response through generalized antioxidant properties.