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(Circulation. 2002;105:1170.)
© 2002 American Heart Association, Inc.

Clinical Investigation and Reports

Functional and Biochemical Analysis of Endothelial (Dys)function and NO/cGMP Signaling in Human Blood Vessels With and Without Nitroglycerin Pretreatment

Eberhard Schulz, MD; Nikolaus Tsilimingas, MD; Ruth Rinze, BS; Beate Reiter, MD; Maria Wendt, PhD; Mathias Oelze, PhD; Silke Woelken-Weckmüller, MD; Ulrich Walter, MD; Hermann Reichenspurner, MD; Thomas Meinertz, MD; Thomas Münzel, MD

From the University Hospital Eppendorf, Division of Cardiology (E.S., R.R., M.W., M.O., T. Meinertz, T. Münzel) and Department of Cardiovascular Surgery (N.T., B.R., S.W.W., H.R.), Hamburg, and the Institute of Clinical Biochemistry and Pathobiochemistry (U.W.), University Würzburg, Germany.

Correspondence to Thomas Münzel, MD, Universitätskrankenhaus Eppendorf, Abteilung für Kardiologie, Martinistraße 52, 20246 Hamburg, Germany. E-mail muenzel{at}uke.uni-hamburg.de

Background— In experimental animal models, long-term in vivo treatment with nitroglycerin (NTG) induces both endothelial dysfunction and tolerance to nitrates. However, it is still controversial whether nitrate tolerance in humans is associated with both endothelial dysfunction and impaired vascular response to nitrovasodilator-derived NO.

Methods and Results— Patients undergoing elective bypass surgery were randomized to receive 48 hours of continuous NTG infusion (NTG group) or no nitrate therapy (control group). Segments of surgically removed arteria mammaria, vena saphena, and arteria radialis not required for the bypass procedure were used to examine (1) the vascular responsiveness to NTG and the endothelium-dependent vasodilator acetylcholine; (2) the expression of the NO target, the soluble guanylyl cyclase; (3) the expression of the soluble guanylyl cyclase/cGMP effector target, the cGMP-dependent protein kinase (cGK); and (4) the cGK activity as assessed by the phosphorylation state of its vascular substrate, the vasodilator-stimulated phosphoprotein at serine²³⁹ (P-VASP). NTG treatment caused a marked degree of nitrate tolerance in all 3 vessel types studied and a significant cross-tolerance to the endothelium-dependent vasodilator acetylcholine in A. mammaria and A. radialis. Although soluble guanylyl cyclase, cGK-I, and VASP expression levels were not modified by NTG treatment, a marked decrease of P-VASP, a surrogate parameter for in-vivo cGK-I activity, was observed.

Conclusions— We conclude that long-term NTG treatment induces endothelial dysfunction and impaired vascular NO/cGMP signaling in humans, which can be monitored by measuring P-VASP levels.

Key Words: nitroglycerin • endothelium • nitric oxide • bypass

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