Pathogenetic role of eNOS uncoupling in cardiopulmonary disorders

Jan F. Gielis, Judy Y. Lin, Kirstin Wingler, Paul E. Y. Van Schil, Harald H. Schmidt, An L. Moens*

*Corresponding author for this work

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The homodimeric flavohemeprotein endothelial nitric oxide synthase (eNOS) oxidizes L-arginine to L-citrulline and nitric oxide (NO), which acutely vasodilates blood vessels and inhibits platelet aggregation. Chronically, eNOS has a major role in the regulation of blood pressure and prevention of atherosclerosis by decreasing leukocyte adhesion and smooth muscle proliferation. However, a disturbed vascular redox balance result:; in eNOS damage and uncoupling of oxygen activation from L-arginine conversion. Uncoupled eNOS monomerizes and generates reactive oxygen species (ROS) rather than NO. Indeed, eNOS uncoupling has been suggested as one of the main pathomechanisms in a broad range of cardiovascular and pulmonary disorders such as atherosclerosis, ventricular remodeling, and pulmonary hypertension. Therefore, modulating uncoupled eNOS, in particular eNOS-dependent ROS generation, is an attractive therapeutic approach to preventing and/or treating cardiopulmonary disorders, including protective effects during cardiothoracic surgery. This review provides a comprehensive overview of the pathogenetic role of uncoupled eNOS in both cardiovascular and pulmonary disorders. In addition, the related therapeutic possibilities such as supplementation with the eNOS substrate L-arginine, volatile NO, and direct NO donors as well as eNOS modulators such as the eNOS cofactor tetrahydrobiopterin and folic acid are discussed in detail.
Original languageEnglish
Pages (from-to)765-776
JournalFree Radical Biology and Medicine
Issue number7
Publication statusPublished - 1 Apr 2011


  • eNOS uncoupling
  • Superoxide
  • Tetrahydrobiopterin
  • eNOS modulators
  • Cardioprotection
  • Free radicals

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