An endothelium-derived 21-residue vasoconstrictor peptide, endothelin, has been isolated, and shown to be one of the most potent vasoconstrictors known. Cloning and sequencing of preproendothelin complementary DNA shows that mature endothelin is generated through an unusual proteolytic processing, and regional homologies to a group of neurotoxins suggest that endothelin is an endogenous modulator of voltage-dependent ion channels. Expression of the endothelin gene is regulated by several vasoactive agents, indicating the existence of a novel cardiovascular control system.

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A novel potent vasoconstrictor peptide produced by vascular endothelial cells.

The discovery that mammalian cells have the ability to synthesize the free radical nitric oxide (NO) has stimulated an extraordinary impetus for scientific research in all the fields of biology and medicine. Since its early description as an endothelial-derived relaxing factor, NO has emerged as a fundamental signaling device regulating virtually every critical cellular function, as well as a potent mediator of cellular damage in a wide range of conditions. Recent evidence indicates that most of the cytotoxicity attributed to NO is rather due to peroxynitrite, produced from the diffusion-controlled reaction between NO and another free radical, the superoxide anion. Peroxynitrite interacts with lipids, DNA, and proteins via direct oxidative reactions or via indirect, radical-mediated mechanisms. These reactions trigger cellular responses ranging from subtle modulations of cell signaling to overwhelming oxidative injury, committing cells to necrosis or apoptosis. In vivo, peroxynitrite generation represents a crucial pathogenic mechanism in conditions such as stroke, myocardial infarction, chronic heart failure, diabetes, circulatory shock, chronic inflammatory diseases, cancer, and neurodegenerative disorders. Hence, novel pharmacological strategies aimed at removing peroxynitrite might represent powerful therapeutic tools in the future. Evidence supporting these novel roles of NO and peroxynitrite is presented in detail in this review.

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Nitric Oxide and Peroxynitrite in Health and Disease

Nitric oxide contrasts with most intercellular messengers because it diffuses rapidly and isotropically through most tissues with little reaction but cannot be transported through the vasculature due to rapid destruction by oxyhemoglobin. The rapid diffusion of nitric oxide between cells allows it to locally integrate the responses of blood vessels to turbulence, modulate synaptic plasticity in neurons, and control the oscillatory behavior of neuronal networks. Nitric oxide is not necessarily short lived and is intrinsically no more reactive than oxygen. The reactivity of nitric oxide per se has been greatly overestimated in vitro because no drain is provided to remove nitric oxide. Nitric oxide persists in solution for several minutes in micromolar concentrations before it reacts with oxygen to form much stronger oxidants like nitrogen dioxide. Nitric oxide is removed within seconds in vivo by diffusion over 100 microns through tissues to enter red blood cells and react with oxyhemoglobin. The direct toxicity of nitric oxide is modest but is greatly enhanced by reacting with superoxide to form peroxynitrite (ONOO-). Nitric oxide is the only biological molecule produced in high enough concentrations to out-compete superoxide dismutase for superoxide. Peroxynitrite reacts relatively slowly with most biological molecules, making peroxynitrite a selective oxidant. Peroxynitrite modifies tyrosine in proteins to create nitrotyrosines, leaving a footprint detectable in vivo. Nitration of structural proteins, including neurofilaments and actin, can disrupt filament assembly with major pathological consequences. Antibodies to nitrotyrosine have revealed nitration in human atherosclerosis, myocardial ischemia, septic and distressed lung, inflammatory bowel disease, and amyotrophic lateral sclerosis.

Nitric oxide, superoxide, and peroxynitrite: the good, the bad, and ugly.

Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis

Accumulating evidence suggests that oxidant stress alters many functions of the endothelium, including modulation of vasomotor tone. Inactivation of nitric oxide (NO(.)) by superoxide and other reactive oxygen species (ROS) seems to occur in conditions such as hypertension, hypercholesterolemia, diabetes, and cigarette smoking. Loss of NO(.) associated with these traditional risk factors may in part explain why they predispose to atherosclerosis. Among many enzymatic systems that are capable of producing ROS, xanthine oxidase, NADH/NADPH oxidase, and uncoupled endothelial nitric oxide synthase have been extensively studied in vascular cells. As the role of these various enzyme sources of ROS become clear, it will perhaps be possible to use more specific therapies to prevent their production and ultimately correct endothelial dysfunction.

Endothelial Dysfunction in Cardiovascular Diseases: The Role of Oxidant Stress

To analyze the potential mediator(s) involved in flow-induced endothelium-dependent vasodilation, we measured the wall tension of intraluminally perfused canine femoral artery segments and compared the content of 6-ketoprostaglandin F1 alpha (determined by radioimmunoassay) and the relaxing activity of the effluent (determined by bioassay on canine coronary artery rings). During perfusion at a steady flow of 2 ml/min the effluent contained 6-keto-prostaglandin F1 alpha and relaxed the bioassay rings. Sudden increase in steady flow rate to 4 ml/min, or the introduction of pulsatile flow, increased the release of 6-keto-prostaglandin F1 alpha and induced further relaxations of the bioassay ring. No relaxations were observed with the effluent passing through a femoral artery segment without endothelium. Indomethacin significantly depressed the release of 6-keto-prostaglandin F1 alpha during increases in flow but had no significant effect on the relaxing activity of the effluent. In the presence of indomethacin, increases in flow produced significant relaxation in the perfused femoral artery segments with endothelium. Superoxide dismutase restored the relaxing activity of the effluent during increases in flow at a transit time of 30 seconds. These data demonstrate that in addition to prostacyclin, flow triggers the release of another relaxing substance (or substances) from vascular endothelial cells that has characteristics similar to the endothelium-derived relaxing factor released by acetylcholine.

Flow-induced release of endothelium-derived relaxing factor

Experiments were designed to determine the effects of oxygen-derived free radicals on the production and biological activity of endothelium-derived relaxing factor or factors released by acetylcholine. Rings of canine coronary arteries without endothelium (bioassay rings) were superfused with solution passing through a canine femoral artery with endothelium. Superoxide dismutase caused maximal relaxation of the bioassay ring when infused upstream, but not downstream, of the femoral artery; this effect of superoxide dismutase was inhibited by catalase. Infusion of acetylcholine relaxed the bioassay rings because it released a labile relaxing factor (or factors) from the endothelium. When infused below the femoral artery, superoxide dismutase and, to a lesser extent, catalase augmented the relaxations to acetylcholine. Superoxide dismutase, but not catalase, doubled the half-life of the endothelium-derived relaxing factor(s). This protective effect of the enzyme was augmented fivefold by lowering the oxygen content of the perfusate from 95 to 10%. These data demonstrate that: superoxide anions inactivate the relaxing factor(s) released by acetylcholine from endothelial cells and hyperoxia favors the inactivation of endothelium-derived relaxing factor(s).

Superoxide anions and hyperoxia inactivate endothelium-derived relaxing factor.

The vascular endothelium is the layer of squamous epithelial cells that is in direct contact with the blood. In addition to its other important functions, which include capillary transport, regulation of plasma lipids, and participation in the control of hemostasis, it modulates the reactivity of vascular smooth muscle. This regulatory role is accomplished through several mechanisms: The layer (a) interposes a physical barrier between the vascular smooth muscle and hormones and other vasoactive substances circulating in blood; (b) it extracts or metaboli­ cally degrades vasoactive substances such as norepinephrine, serotonin, and kinins and thereby prevents or diminishes their activity in vascular smooth muscle; (c) it converts precursors (e.g. angiotensin I) into vasoactive products; (d) it secretes known vasoactive substances, primarily prostacyclin; and (e) it releases other still unidentified inhibitory and excitatory mediators in response to vasoactive stimuli. This review will summarize the evidence that the latter mechanism exists in mammalian blood vessels.

G. M. Rubanyi

Papers

Flow-induced release of endothelium-derived relaxing factor

Superoxide anions and hyperoxia inactivate endothelium-derived relaxing factor.

Modulation of vascular smooth muscle contraction by the endothelium.