NOx and R-NOx: effects on drug metabolism

A family of three nitric oxide synthase 1(NOS) isoforms produces nitric oxide (NO*) and L-citrulline via a stepwise oxidation of the guanidinium nitrogen of L-arginine. Akin to cytochrome P450 (P450)-catalyzed monoxygenations, the NOS reactions are dependent on both molecular oxygen and NADPH. Although all three NOS isoforms (two constitutively-expressed isoforms; neuronal (nNOS) and endothelial (eNOS), and one inducible isoform; (iNOS)) produce identical products, the function of the NO* varies widely in terms of physiological functions due to the varied localization of the isoforms within different cell populations of the body. The NOS isoforms are homo-dimeric, bi-domain enzymes. Each monomer consisting of a flavin-containing reductase domain linked to a heme-containing oxygenase domain by a calmodulin (CaM)-binding sequence located between the two domains. The reductase domains of the NOS isoforms not only possess close sequence and structural homology to NADPH-cytochrome P450 oxidoreductase (CPOR), but also, owing to the flavins, resemble CPOR in function in that the reductase permits the passage of electrons from a NADPH-derived hydride, one at a time, to the NOS oxygenase domain. Although possessing very little structural resemblance to P450, the oxygenase domain of NOS is referred to as being "P450-like" due to the presence of iron protoporphyrin IX (heme), linked axially by a cysteine to the NOS protein, which carries out "P450-like" mono-oxygenation reactions. Considering the importance of NO* in regulating many physiological functions, the NOS isoforms are important drug targets. Modulators (both inhibitors as well as possible activators) of enzymatic function are needed to either decrease or increase NO* production, respectively, in various disease states. In addition to the widely known beneficial processes where NO* plays a role (i.e. neurotransmission, blood pressure regulation, immunomodulation), under certain conditions production of NO* (as well as other NOS-derived oxidants) can be detrimental by altering enzyme activity; for example P450-mediated drug metabolism. Furthermore, because of the close structural and functional similarities between NOS reductase and CPOR, many of the same redox-cycling and reductive reactions that occur with CPOR can also occur with NOS. The final focus of this review article is the less-well-recognized reactions mediated by NOS, which have recently begun to receive the attention they deserve. We hope to highlight reasons for concern regarding both altered drug metabolism as well as extra-hepatic, and target-organ toxicities in response to both altered NO* production as well as the detrimental interaction of NOS with certain xenobiotics.