Nebivolol:: A third-generation β-blocker that augments vascular nitric oxide release endothelial β2-adrenergic receptor-mediated nitric oxide production

Background-Nebivolol is a beta-selective adrenergic receptor antagonist with proposed nitric oxide (NO)-mediated vasodilating properties in humans. In this study, we explored whether nebivolol indeed induces NO production and, if so, by what mechanism. We hypothesized that not nebivolol itself but rather its metabolites augment NO production. Methods and Results-Mouse thoracic aorta segments were bathed in an organ chamber. Administration of nebivolol did not affect NO production. When nebivolol was allowed to metabolize in vivo in mice, addition of plasma of these mice caused a sustained 2-fold increase in NO release. Interestingly, coadministration of a selective beta(2)-adrenergic receptor antagonist (butoxamine) prevented the response. Immunohistochemistry and Western blot analysis demonstrated the presence of beta(2)- but not beta(1)-adrenergic receptors on endothelial cells. In the absence of calcium, metabolized nebivolol failed to increase NO production, suggesting a role for calcium-dependent NO synthase. With digital fluorescence imaging, a rapid and sustained rise in endothelial cytosolic free Ca2+ concentration was observed after administration of metabolized nebivolol, which also was abrogated by butoxamine pretreatment. Conclusions-In vivo metabolized nebivolol increases vascular NO production. This phenomenon involves endothelial Pz-adrenergic receptor ligation, with a subsequent rise in endothelial free [Ca2+], and endothelial NO synthasedependent NO production. This may be an important mechanism underlying the nebivolol-induced, NO-mediated arterial dilation in humans.