The effects of modulating eNOS activity and coupling in ischemia/reperfusion (I/R)

Kerry Anne A. Perkins, Sailesh Pershad, Qian Chen, Sloane McGraw, Jovan S. Adams, Christopher Zambrano, Samuel Krass, Jeffrey Emrich, Brandon Bell, Michael Iyamu, Catherine Prince, Helen Kay, Jane Chun Wen Teng, Lindon H. Young

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21 Scopus citations


The in vivo role of endothelial nitric oxide synthase (eNOS) uncoupling mediating oxidative stress in ischemia/reperfusion (I/R) injury has not been well established. In vitro, eNOS coupling refers to the reduction of molecular oxygen to l-arginine oxidation and generation of l-citrulline and nitric oxide NO synthesis in the presence of an essential cofactor, tetrahydrobiopterin (BH 4). Whereas uncoupled eNOS refers to that the electron transfer becomes uncoupled to l-arginine oxidation and superoxide is generated when the dihydrobiopterin (BH 2) to BH 4 ratio is increased. Superoxide is subsequently converted to hydrogen peroxide (H 2O 2). We tested the hypothesis that promoting eNOS coupling or attenuating uncoupling after I/R would decrease H 2O 2/increase NO release in blood and restore postreperfused cardiac function. We combined BH 4 or BH 2 with eNOS activity enhancer, protein kinase C epsilon (PKC ε) activator, or eNOS activity reducer, PKC ε inhibitor, in isolated rat hearts (ex vivo) and femoral arteries/veins (in vivo) subjected to I(20 min)/R(45 min). When given during reperfusion, PKC ε activator combined with BH 4, not BH 2, significantly restored postreperfused cardiac function and decreased leukocyte infiltration (p < 0.01) while increasing NO (p < 0.05) and reducing H 2O 2 (p < 0.01) release in femoral I/R veins. These results provide indirect evidence suggesting that PKC ε activator combined with BH 4 enhances coupled eNOS activity, whereas it enhanced uncoupled eNOS activity when combined with BH 2. By contrast, the cardioprotective and anti-oxidative effects of the PKC ε inhibitor were unaffected by BH 4 or BH 2 suggesting that inhibition of eNOS uncoupling during reperfusion following sustained ischemia may be an important mechanism.

Original languageEnglish (US)
Pages (from-to)27-38
Number of pages12
JournalNaunyn-Schmiedeberg's Archives of Pharmacology
Issue number1
StatePublished - Jan 2012
Externally publishedYes

Bibliographical note

Funding Information:
Acknowledgements Daniel Eskinazi (Philadelphia College of Osteopathic Medicine) assisted in the editing of this manuscript. Dr. Bruce Stouch assisted with statistical analysis of this manuscript. This study was supported by the National Heart, Blood and Lung Institute Grant 2R15HL-76235-02 and the Center for the Chronic Disorders of Aging at Philadelphia College of Osteopathic Medicine.


  • Hydrogen peroxide
  • Ischemia/reperfusion injury
  • Left ventricular developed pressure
  • Nitric oxide
  • PKC epsilon
  • eNOS uncoupling/coupling


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