Left ventricular dysfunction and extravascular fluid in the lung: physiological basis for symptoms

The essential feature of left ventricular dysfunction is an increase in left atrial pressure and pulmonary venous congestion leading to a fluid flux across the pulmonary microvasculature. Small acute increases (< 10 mmHg) in left atrial pressure enhance the extravascular fluid volume in the airways and activate the rapidly adapting receptors (RAR). With larger increases in left atrial pressure (approximately 25 mmHg) both the RAR and the C-fiber receptors in the airways and the alveoli are activated. Activation of RAR causes a reflex increase in respiratory rate, tracheal tone and mucus secretion from the airways. It appears that small increases in extravascular fluid volume of the airways also cause a reflex diuresis which is mediated by activation of neuronal nitric oxide synthase in the renal medulla. In contrast, when left atrial pressure is elevated chronically, further small increments in extravascular fluid volume of the airways no longer stimulate the RAR. The reflex diuresis is also not evident under these circumstances. However, the RAR continue to be activated by increments in left atrial pressure in excess of 25 mmHg. It is suggested that the RAR of the airways play a significant role in monitoring changes in the extravascular fluid volume of the airways and mediate the reflexes which are associated with the symptomatology of acute left ventricular dysfunction.     

Myocardial reperfusion injury in neuronal nitric oxide synthase deficient mice

BACKGROUND: A substantial amount of data suggesting that endothelial cell nitric oxide synthase (eNOS) plays a cardioprotective role in animal models of ischemia-reperfusion injury has amassed. We have previously demonstrated that eNOS-deficient (-/-) mice exhibit significantly larger myocardial infarcts than do wild-type mice. Few investigations have examined the neuronal form of nitric oxide synthase in the heart. The two constitutive isoforms have been demonstrated to play differing roles in studies of cerebral ischemia-reperfusion. OBJECTIVE: To characterize the role of neuronal nitric oxide synthase (nNOS) in myocardial ischemia-reperfusion injury. METHODS: Wild-type and nNOS -/- mice were subjected to 20 min of coronary artery occlusion and 120 min of reflow. RESULTS: We found no significant difference between the two groups in terms of infarct size. Microscopic cross-sections from both groups were examined for infiltration of polymorphonuclear leukocyte. Hearts of nNOS -/- mice exhibited significantly (P < 0.05) more polymorphonuclear leukocytes than did hearts of wild-type mice. CONCLUSION: Despite the fact that eNOS plays a cardioprotective role in the ischemic-reperfused myocardium, we observed no change in size of myocardial infarcts when nNOS was genetically disrupted.     

Distribution of constitutive nitric oxide synthase in the jejunum of adult rat

AIM：To study the distribution of the constitutive nitric oxide synthase(NOS) in the jejunom of adult rat.METHODS:The distribution of endothelial NOS(eNOS) was detected by immunohistochemistry.Immunofluorescence histochemical dual stainging technique were used for studying the distribution of neuronal NOS( nNOS) and eNOS,The dual stained slides were observed under a confocal laser scanning microscope.RESULTS:Positive neuronal NOS(nNOS) and endothelial NOS(eNOS) cells were found to be distributed in lamina propria of villi,and the epithelial cell was not stained,eNOS was mainly located in submucosal vascular endothelia while nNOS was mainly sityated in myenteric plexus.Some cells in the villi had both nNOS and eNOS.More than 80% of the cells were positive for both nNOS and eNOS,the rest cells were positive either for nNOS or for eNOS.CONCLUSION:The two constitutive nitric oxide synthases are distributed differently in the jejunum of rat.nNOS distributed in myenteric plexus is a neurotransmitter in the non-adrenergic non-cholinergic(NANC)inhibitory nerves eNOS distributed in endothelial and smooth muscle cells of blood vessels plays vasodilator role .eNOS and nNOS are coexpressed in some cells of lamina propria of villi.NO genearted y those NOS is very important in the physiological and pathological process of small intestine.     

Neuronal nitric oxide synthase is associated with airway obstruction in BALB/c mice exposed to ozone

BACKGROUND: The functional role of nitric oxide (NO) and the various nitric oxide synthase (NOS) isoforms in asthma is controversial. OBJECTIVE: To investigate the role of NO in mice exposed to ozone, three known isoforms of NOS [inducible NOS (iNOS), neuronal NOS (nNOS), and endothelial NOS (eNOS)] were studied. METHODS: The expression of iNOS, nNOS, and eNOS was determined in lung by Western blot analysis after exposure to filtered air and ozone (0.12, 0.5, 1 or 2 ppm) for 3 h. Using barometric whole-body plethysmography and increase in enhanced pause (P(enh)) as an index of airway obstruction, we measured airway responses to ozone exposure. Bronchoalveolar lavage (BAL) was performed. Nitrate and nitrite were measured using a modified Griess reaction. RESULTS: The nitrate concentration in BAL fluid, which indicates the in vivo generation of NO in airways, from the ozone-exposed group was significantly greater than that from the group exposed to filtered air (631.0 +/- 86.4 vs. 152.1 +/- 16.9 micromol/l, p < 0.05). The nitrate concentration in BAL fluid was increased more in mice exposed to 2-ppm ozone than that in mice exposed to filtered air or 0.12-, 0.5-, or 1-ppm ozone. Increases in P(enh) after exposure to ozone or filtered air were significantly higher in the ozone-exposed groups than in the group exposed to filtered air (p < 0.01). Increases in P(enh) were dependent on the ozone concentration. Although the protein levels of eNOS and iNOS determined were within normal levels, the amount of nNOS protein was markedly elevated in airway tissue homogenates of the group exposed to 2-ppm ozone. CONCLUSION: These findings demonstrate that the nNOS isoform may be involved in airway obstruction in mice exposed to ozone.     

Increased nitric oxide release and expression of endothelial and inducible nitric oxide synthases in mildly changed porcine mitral valve leaflets

BACKGROUND AND AIM OF THE STUDY: Little is known of the local role of nitric oxide (NO) in heart valves in relation to heart valve diseases. The study aim was to examine NO release and the expression of both endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) in relation to early local changes in porcine mitral valves. METHODS: A histological evaluation of mitral valve leaflets from slaughter pigs and sows was made, and the expression of eNOS and iNOS protein measured using immunohistochemistry. Furthermore, mRNA levels of eNOS and iNOS were measured using real-time RT-PCR. A calibrated NO-specific electrode was used to measure local NO release in specific regions of the anterior mitral leaflet from slaughter pigs and sows interchordally at the tip of the leaflet (region A), at the chordal insertion (region B), and at the center of the leaflet (region C). RESULTS: Leaflets from sows had an increased accumulation of mucopolysaccharides (MPS) compared to those from slaughter pigs. Furthermore, mRNA levels of eNOS and iNOS were significantly increased in region C due to very high levels of expression in some sow leaflets. NO release in the sow mitral valve leaflet was increased in regions B and C compared to that in region A. CONCLUSION: The relative distribution of NO release is increased in regions of porcine mitral valve leaflets with deposition of MPS and defraction of the valve structure, which may reflect changes in both eNOS and iNOS expression.     

Increased neuronal nitric oxide synthase-derived NO production in the failing human heart

Experimental data suggest that nitric oxide (NO) generated from neuronal NO synthase (nNOS) modulates the myocardial inotropic state. To assess the contribution of NO, derived from endothelial and neuronal isoforms, to the pathophysiology of congestive heart failure in human beings, we compared expression, localisation, and specific activity of NOS isoforms in myocardium from patients with dilated cardiomyopathy with those in controls who had died from head trauma or intracranial bleeds. Diseased hearts had a significant increase in nNOS mRNA and protein expression, and activity associated with the translocation of nNOS to the sarcolemma through interactions with caveolin 3. Enhanced nNOS activity counteracted a decrease in eNOS expression and activity. Our results provide evidence of increased nNOS-derived NO in the failing human heart. Such altered regulation may be important in the pathophysiology of cardiac dysfunction in human congestive heart failure.     

Co-expression and modulation of neuronal and endothelial nitric oxide synthase in human endothelial cells

Despite originally identified in neurones, the neuronal type of nitric oxide synthase (nNOS) is present also in cardiac and skeletal myocytes. Whether nNOS is functionally expressed in human endothelial cells--as the endothelial enzyme (eNOS)--is unknown. Human umbilical vein endothelial cells (HUVEC) were studied under control culture conditions and after 48 h treatment with cytomix (human tumour necrosis factor-alpha, interferon-gamma and E. coli endotoxin). We tested: (i) localisation and expression of nNOS and eNOS proteins by immunostaining and immunoblotting; (ii) activity of nNOS and eNOS by measuring L-arginine to L-citrulline conversion with 1-(2-trifluoromethylphenyl)imidazole (TRIM), a specific nNOS antagonist, in sub-cellular fractions; (iii) intracellular cGMP levels, as a marker for nitric oxide production, after TRIM pre-treatment, by radioimmunoassay. nNOS protein was expressed in the cytosolic fraction and immunolocalised in cultured HUVEC, and co-localised with the eNOS protein in frozen sections of the human umbilical cord. nNOS protein contributed to total L-citrulline production as TRIM selectively and dose-dependently reduced L-citrulline synthesis in the cytosolic but not particulate fraction of HUVEC. Similarly, TRIM reduced intracellular cGMP content both at baseline and after stimulation with a calcium ionophore. Cytomix down-regulated the expression and function of both nNOS and eNOS while no inducible NOS (iNOS) was detected. In conclusion, a functional neuronal type of NOS is co-expressed with the endothelial NOS type in HUVEC, suggesting a possible role for nNOS in regulation of blood flow.     

一氧化氮能神经调节异常在腹泻型肠易激综合征患者中的作用

目的　探讨一氧化氮 (NO)在肠易激综合征 (IBS)发病机制中的作用 ,并从基因水平揭示NO含量改变的原因。方法　 (1)应用电子气压泵及灌注导管测压仪研究 2 5例腹泻型IBS患者及 15例正常志愿者的肛门、直肠压力、直肠顺应性、乙状结肠和直肠运动指数以及直肠对容量刺激的感觉阈值 ;(2 )应用硝酸还原酶法测定两组肠黏膜NO的含量 ;(3)NADPH黄递酶组化法和计算机图像分析系统对两组肠黏膜肌层一氧化氮合酶 (NOS)阳性神经纤维作定量分析 ;(4)采用荧光定量PCR(FQ PCR)方法对神经型一氧化氮合酶 (nNOS)的基因表达进行定量分析。结果　 (1)肠道测压 :IBS患者的直肠静息压、肛管上部静息压、收缩压、松弛压、肛管下部静息压、收缩压、松弛压和直肠顺应性与正常人比较 ,差异无显著性 (P >0 .0 5 ) ;患者乙状结肠和直肠运动指数明显高于正常人 (P <0 .0 5 ) ;(2 )直肠内脏感觉阈值 :最低感觉阈值、排便阈值和疼痛阈值明显低于正常人 (P <0 .0 5 ) ;(3)肠黏膜NO含量 :患者结肠黏膜NO含量显著低于正常人 ,并且患者的NO含量与运动指数成负相关 ,与感觉阈值、排便阈值、疼痛阈值呈正相关 (P <0 .0 5 ) ;(4)NADPH组化染色 :IBS患者黏膜肌层NOS阳性神经纤维的面积和平均吸光度较正常人显著减少 (P <0 .0 5 ) ;(5 )NOS mRNA     

Acupuncture reduces experimental renovascular hypertension through mechanisms involving nitric oxide synthases

OBJECTIVE: To test the hypothesis that acupuncture on stomach 36 point (ST-36) reduces hypertension by activating nitric oxide synthase signaling mechanisms. METHODS: The authors used the two-kidney, one-clip renal hypertension (2K1C) hamster model with electroacupuncture treatment. RESULTS: Thirty-minute daily electroacupuncture treatment for 5 days reduced mean arterial pressure from 160.0 +/- 7.6 to 128.0 +/- 4.3 mmHg (mean +/- SEM), compared to 115.0 +/- 7.2 mmHg in sham-operated hamsters. Electroacupuncture increased periarteriolar NO concentration from 309.0 +/- 21.7 nM to 417.9 +/- 20.9 nM in the 2K1C hamster cheek pouch microcirculation when measured with NO-sensitive microelectrodes. Hypertension reduced endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) proteins relative to the sham-operated control, as measured by Western blotting. Electroacupuncture prevented the reduction of eNOS and nNOS associated with hypertension and showed even higher eNOS and nNOS expressions than sham-operated control in stomach and cheek pouch tissues, which are on the stomach meridian. Analysis of liver tissue, a non-stomach-meridian organ, indicated that electroacupuncture did not have a significant benefit in terms of enhanced expressions of eNOS and nNOS in the treated 2K1C hypertensive group. CONCLUSIONS: Activation of eNOS and nNOS is one of the mechanisms through which ST-36 electroacupuncture reduces blood pressure; this reduction works through the stomach meridian.     

Role of neuronal nitric oxide synthase and inducible nitric oxide synthase in intestinal injury in neonatal rats

AIM: To investigate the dynamic change and role of neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) in neonatal rat with intestinal injury and to define whether necrotizing enterocolitis (NEC) is associated with the levels of nitric oxide synthase (NOS) in the mucosa of the affected intestine tissue. METHODS: Wistar rats less than 24 h in age received an intraperitoneal injection with 5 mg/kg lipopolysaccharide (IPS). Ileum tissues were collected at 1, 3, 6, 12 and 24 h following LPS challenge for histological evaluation of NEC and for measurements of nNOS and iNOS. The correlation between the degree of intestinal injury and levels of NOS was determined. RESULTS: The LPS-injected pups showed a significant increase in injury scores versus the control. The expression of nNOS protein and mRNA was diminished after LPS injection. There was a negative significant correlation between the nNOS protein and the grade of median intestinal injury within 24 h. The expression of iNOS protein and mRNA was significantly increased in the peak of intestinal injury. CONCLUSION: nNOS and iNOS play different roles in LPS-induced intestinal injury. Caution should be exerted concerning potential therapeutic uses of NOS inhibitors in NEC.     

Diminished Expression of Constitutive Nitric Oxide Synthases in the Kidney of Spontaneously Hypertensive Rat

In kidney, nitric oxide (NO) synthesized by nitric oxide synthase (NOS) regulates sodium and water excretion, and renal medullary blood flow. The expression of constitutive NOS, endothelial NOS (eNOS) and neuronal NOS (nNOS), were assessed in kidney of the spontaneously hypertensive rat (SHR) and the normotensive Wistar Kyoto (WKY) rat by Western blot analysis and immunocytochemistry. Neuronal NOS expression was observed in the cortex and eNOS was detected only in the inner medulla of both WKY and SHR. In SHR, expression of eNOS was attenuated to 35.1 ± 10.8%, while expression of nNOS was only 57.5 ± 5.7% of the levels seen in WKY rat. Immunocytochemical studies revealed decreased staining of nNOS in the macula densa, collecting ducts and in the glomerulus of SHR compared to WKY rat. Endothelial NOS immunoreactivity was restricted to vascular structures of the inner intima cells and smooth muscle cells, and was markedly reduced in the vasculature of SHR. The decreased renal blood flow observed in SHR may be linked to a diminished expression of eNOS and nNOS, underscoring the importance of these enzymes in the pathophysiology and maintenance of genetic hypertension.     

Diminished expression of constitutive nitric oxide synthases in the kidney of spontaneously hypertensive rat

In kidney, nitric oxide (NO) synthesized by nitric oxide synthase (NOS) regulates sodium and water excretion, and renal medullary blood flow. The expression of constitutive NOS, endothelial NOS (eNOS) and neuronal NOS (nNOS), were assessed in kidney of the spontaneously hypertensive rat (SHR) and the normotensive Wistar Kyoto (WKY) rat by Western blot analysis and immunocytochemistry. Neuronal NOS expression was observed in the cortex and eNOS was detected only in theinner medulla of both WKY and SHR. In SHR, expression of eNOS was attenuated to 35.1 +/- 10.8%, while expression of nNOS was only 57.5 +/- 5.7% of the levels seen in WKY rat. Immunocytochemical studies revealed decreased staining of nNOS in the macula densa, collecting ducts and in the glomerulus of SHR compared to WKY rat. Endothelial NOS immunoreactivity was restricted to vascular structures of the inner intima cells and smooth muscle cells, and was markedly reduced in the vasculature of SHR. The decreased renal blood flow observed in SHR may be linked to a diminished expression of eNOS and nNOS, underscoring the importance of these enzymes in the pathophysiology and maintenance of genetic hypertension.     

Subcellular distribution of nitric oxide synthase isoforms in the rat duodenum

AIM:To study the cell-type specific subcellular distribution of the three isoforms of nitric oxide synthase(NOS) in the rat duodenum.METHODS:Postembedding immunoelectronmicroscopy was performed,in which primary antibodies for neuronal NOS(nNOS),endothelial NOS(eNOS),and inducible NOS(iNOS),were visualized with protein A-gold-conjugated secondary antibodies.Stained ultrathin sections were examined and photographed with a Philips CM10 electron microscope equipped with a MEGAVIEW II camera.The specificity of t...     

Expression of nitric oxide synthase in human gastric carcinoma and its relation to p53, PCNA

AIM: To investigate the expression of NOS in gastric carcinoma, and to explore the relationship between the expression of nitric oxide synthases (NOS) and p53, PCNA, pathological features and clinical staging of gastric cancer. METHODS: The activity of NOS protein was investigated in 85 samples of human gastric carcinoma and 25 samples of normal gastric mucosal tissue by biochemical assay. We then examined the expression of NOS, p53, PCNA in 85 samples of human gastric cancer was examined by immunohistochemistry, and NOS mRNA expression in 85 gastric cancer tissue specimens by In situ hybridization. RESULTS: Biochemical assay showed that the activity of NOS was significantly higher in gastric carcinoma than in normal gastric mucosal tissues (t=0.4161, P＜0.01). Immunohistochemistry revealed that endothelial nitric oxide synthase (eNOS) expressed in all samples of normal gastric mucosa, but only 6 cases of 85 gastric cancer specimens showed weak positive immunohistochemical reactions to eNOS (20%). Inducible nitric oxide synthase (iNOS) was expressed strongly in human gastric carcinoma (81.2%). In situ hybridization analysis showed that iNOS mRNA expression was significantly stronger than eNOS mRNA expression in gastric cancer tissue (X~2 = 10.23, P＜0.01). The expression of iNOS in gastric cancer was associated with differentiation, clinical stages or lymph node metastases (r=0.3426,P＜0.05). However, iNOS expression did not correlate with histological classifications and morphological types. The expression of iNOS was significantly correlated with p53 or PCNA expression (r=0.3612, P＜0.05). The expression of neuronal nitric oxide synthase (nNOS) was not examined by immunohistochemistry and in situ hybridization in gastric cancer specimens and normal gastric mucosa. CONCLUSION: In human gastric cancer, there is an enhanced expression of iNOS, but not of eNOS. NOS promotes the proliferation of tumor cells and plays an important role in gastric cancer spread. Inactivation of antioncogene p53 and overexpression of iNOS might play a synergetic role in the process of carcinogenesis of human gastric carcinoma.     

Effect of HMG-CoA reductase inhibition on endothelial dysfunction-inducing protein in hypercholesterolemic rabbits

INTRODUCTION AND OBJECTIVES: In our laboratory, we recently obtained evidence that cultured bovine endothelial cells contain cytosolic proteins that form complexes with the 3'-unstranslated region of endothelial nitric oxide synthase (eNOS) mRNA and are associated with its destabilization. The aim of this study was to determine the presence of such proteins and the level of eNOS expression in hypercholesterolemic rabbits as an in vivo model of endothelial dysfunction. METHODS AND RESULTS: Endothelium-dependent relaxation in response to acetylcholine was reduced in aortic segments from hypercholesterolemic rabbits compared with controls. Treatment of hypercholesterolemic rabbits with simvastatin (25 mg/kg body weight/day) restored endothelium-dependent relaxation. Aortic eNOS expression was reduced in hypercholesterolemic rabbits and was accompanied by enhanced binding activity of a 60-KDa cytosolic protein and reduced stability of eNOS mRNA. Simvastatin treatment upregulated eNOS expression and reduced the interaction of cytosolic protein with the 3'-untranslated region of eNOS mRNA. CONCLUSIONS: These results demonstrate the presence of a 60-KDa protein that binds to eNOS mRNA and reduces eNOS expression in the vascular wall.     

抗氧化剂PZ51对卒中易感型自发性高血压大鼠脑保护作用的探讨

目的探讨抗氧化剂PZ51对卒中易感型自发性高血压大鼠(SHRsp)高血压发展的慢性过程中的脑保护作用。方法22只SHRsp大鼠随机分为PZ51组和对照组,每组各11只,灌胃治疗6周。用分光光度计测大脑皮质匀浆丙二醛(MDA)、一氧化氮(NO)浓度;Westernblot检测大脑皮质内皮型一氧化氮合酶(eNOS)、神经元型一氧化氮合酶(nNOS)和诱导型一氧化氮合酶(iNOS)的蛋白表达;光镜检测颈动脉内膜中层厚度(IMT)。结果与对照组比较,PZ51组显著降低了大脑皮质匀浆MDA浓度[(2.09±0.62)nmolmg蛋白vs(4.11±0.45)nmolmg蛋白,P<0.001]和NO浓度[(0.82±0.19)μmolmg蛋白vs(1.24±0.28)μmolmg蛋白,P<0.001];PZ51抑制大脑皮质iNOS蛋白表达(P<0.01),对eNOS和nNOS无影响;光镜检查示PZ51组颈动脉IMT显著降低。结论PZ51显著降低了SHRsp大脑皮质MDA和NO浓度;抑制iNOS蛋白表达;降低了颈动脉IMT,从而发挥对SHRsp的脑保护作用。     

Elevated nitric oxide synthase activity concurrent with antigen-induced airway hyperresponsiveness in rats

To characterize the airway nitric oxide synthase (NOS) activities concurrent with airway hyperresponsiveness (AHR), a common feature of allergic asthma, the NOS activities of airway tissue homogenates from the antigen-induced AHR rats were determined by the ability of tissue homogenates to convert L-arginine to L-citrulline (Cit). A significantly higher level of total NOS activities was found in homogenates from the AHR rats (19.9 +/- 1.3 pmol Cit/min/mg protein) compared to those from sensitized control and normal control groups (9.8 +/- 1.2 and 8.8 +/- 1.2 pmol Cit/min/mg protein, respectively; P < .01). The nitrite concentration in bronchoalveolar lavage fluids, which indicates the in vivo generation of NO in airways, from the AHR rats (7.40 +/- 0.71 microM) was significantly greater than that from nonsensitized normal animals (1.45 +/- 1.12 microM, P < .01). Although the protein levels of endothelial (eNOS) and neuronal type NOS (nNOS) determined by immunoblotting were within normal levels, the amount of inducible NOS (iNOS) protein was markedly and significantly elevated in airway tissue homogenates from the AHR rats. Immunohistochemical staining of airway tissues with specific antibody against iNOS demonstrated a distinct localization of iNOS on epithelial cells and infiltrated inflammatory cells in the bronchi of the hyperresponsive rats, but only negligible staining of epithelia was observed in the nonsensitized normal group. No difference in constitutive NOS (eNOS and nNOS) localization was observed between groups. The present findings indicate that the NOS activities in airway tissues are elevated in antigen-induced AHR rats, which is mainly derived from the induction of iNOS in the airways. Downregulation of constitutive eNOS and nNOS is not found in this animal model of AHR.     

Vascular endothelial dysfunction in Duchenne muscular dystrophy is restored by bradykinin through upregulation of eNOS and nNOS

Little is known about the vascular function and expression of endothelial and neuronal nitric oxide synthases (eNOS and nNOS) in Duchenne muscular dystrophy (DMD). Bradykinin is involved in the regulation of eNOS expression induced by angiotensin-converting enzyme inhibitors. We characterized the vascular function and eNOS and nNOS expression in a canine model of DMD and evaluated the effects of chronic bradykinin treatment. Vascular function was examined in conscious golden retriever muscular dystrophy (GRMD) dogs with left ventricular dysfunction (measured by echocardiography) and in isolated coronary arteries. eNOS and nNOS proteins in carotid arteries were measured by western blot and cyclic guanosine monophosphate (cGMP) content was analyzed by radioimmunoassay. Compared with controls, GRMD dogs had an impaired vasodilator response to acetylcholine. In isolated coronary artery, acetylcholine-elicited relaxation was nearly absent in placebo-treated GRMD dogs. This was explained by reduced nNOS and eNOS proteins and cGMP content in arterial tissues. Chronic bradykinin infusion (1 μg/min, 4 weeks) restored in vivo and in vitro vascular response to acetylcholine to the level of control dogs. This effect was NO-mediated through upregulation of eNOS and nNOS expression. In conclusion, this study is the first to demonstrate that DMD is associated with NO-mediated vascular endothelial dysfunction linked to an altered expression of eNOS and nNOS, which can be overcome by bradykinin.