[The main determinants of endothelial dysfunction]

Nitric oxide (NO) is produced from amino acid L-arginine via the catalytic action of NO synthases, which use dioxygen and NADH or NADPH as cofactor. This simple molecule acts at nanomolar concentrations and demonstrates a wide spectrum of physiological effects, a primary of which is vasodilatation. The production of NO in endothelium cells is induced by mechanical action (increased blood-vessels wall tension) and chemical agents (catecholamines, acetylcholine, bradykinin, histamine). The endothelium-released NO easily diffuses to the underlying smooth muscles and triggers their relaxation by increasing cyclic guanosine monophosphate level and subsequent opening of endothelial potassium channels (K(ATP), K(Ca)). NO on the endothelium surface inhibits adhesion and aggregation of platelets, regulates the main functions of myocardium, modulates the permeability of endothelium, and weakens the interaction of endothelium cells and leukocytes by reducing the expression of adhesion-stimulating proteins. Direct evidence suggests that free radicals and related reactive oxygen species mostly as O2-, HO-, ONOO-, ROO- are associated with an endothelium dysfunction, which manifests itself as an impairment of endothelium-dependent vasorelaxation. Though reactive oxygen species in a small amount are produced constantly, the decreased metabolic turnover of homocysteine, poor performance of antioxidants or high level of angiotensin II alters the balance between production of free radicals and their neutralization. Such events decrease NO bioavailability and thus condition the development of various diseases like arteriosclerosis, hypertension, diabetes, heart and renal failure. Agents increasing NO bioavailability and depressing the endothelial dysfunction would be the most useful for the treatment above-mentioned pathologies.