日本臨床麻酔学会 vol.32

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1 835 日本臨床麻酔学会第 31 回大会招待講演日臨麻会誌 Vol.32 No.7, , 2012 一酸化窒素と循環器病 : 遺伝子改変動物から得られた新知見 * 筒井正人 [ 要旨 ] 一酸化窒素合成酵素 (nitric oxide synthase:nos) には, 神経型 NOS, 誘導型 NOS, 内皮型 NOSの3 種類のアイソフォームが存在する. 従来, 生体内におけるNOS 系の役割が, NOS 阻害薬を用いて薬理学的に広く検討されてきた. しかし,NOS 阻害薬はさまざまな非特異的作用を有するため,NOS 系の真の役割は, いまだ十分に解明されていない. この点を検討するために, 著者らは,NOS 系完全欠損マウスを世界に先駆けて開発した. 興味深いことに, このマウスには, 高度の冠動脈硬化を伴う自然発症の急性心筋梗塞が認められた. さらに, このマウスには, 代謝症候群, 高脂血症, 拡張期心不全の病態も見出された. 以上より,NOS 系が多彩な循環器病の成因に重要な役割を果たしていることが示唆された. キーワード : 一酸化窒素, 一酸化窒素合成酵素, 循環器病, 心筋梗塞, 遺伝子改変マウスはじめに nitric oxide NO 1 4 NO NOS NOS nnos NOS inos NOS enos NO Ⅰ enos 遺伝子治療 Zvonimir S. Katusic enos enos recombinant enos 5 12 図 1 Ⅱ nnos の血管保護作用 nnos enos inos nnos nnos nnos

2 836 Vol.32 No.7/Nov 図 1 血管外膜を標的とした生体内内皮型 NOS(eNOS) 遺伝子治療法の確立 enos 図 2 1 nnos enos inos nnos NOS Ⅲ NOS 系完全欠損マウスの開発 NOS L- NAME L-NMMA NOS NOS NOS NOS NO 図 3 16, 17 NOS NOS NOS triple nnos/ inos/enos 図 4 3, 18 Ⅳ NOS 系完全欠損マウスに見られた急性心筋梗塞 NOS 図 5 図 6 NOS 2, 19 NOS 1 AT1

3 837 図 2 神経型 NOS(nNOS) の血管保護作用の解明 enos inos nnos NOSs 図 3 NOS 阻害薬の NO 非依存性長期血管作用の解明 NOS NOS NO NOS

4 838 Vol.32 No.7/Nov 図 4 NOS 系完全欠損マウスの樹立 3 Single NOS 3 Double NOSs 3 Triple NOSs 図 5 Single,Double,Triple NOSs 欠損マウスにおける生存率 11 NOS NOS Single Double Triple Triple NOSs 11 8

5 839 図 6 死亡した Triple NOSs 欠損マウスに認められた急性心筋梗塞 Triple NOSs AT1 2, 19 Ⅴ NOS 系完全欠損マウスの研究ツールとしての有用性 enos enos NOS enos nnos NOS NOS 20, 21 Ⅵ NOS 系完全欠損マウスにおける多彩な循環器病 NOS 2, 19 NOS 22 NOS 23 おわりに NOS NOS NOS NOS 参考文献 1) Tsutsui M:Neuronal nitric oxide synthase as a novel anti-atherogenic factor. J Atheroscler Thromb 11: 41-48, 2004

6 840 Vol.32 No.7/Nov ) Tsutsui M, Nakata S, Shimokawa H, et al.:spontaneous myocardial infarction and nitric oxide synthase. Trends Cardiovasc Med 18: , ) Tsutsui M, Shimokawa H, Morishita T, et al.:development of genetically engineered mice lacking all three nitric oxide synthases. J Pharmacol Sci 102: , ) Tsutsui M, Shimokawa H, Otsuji Y, et al.:nitric oxide synthases and cardiovascular diseases:insights from genetically modified mice. Circ J 73: , ) Chen AFY, Jiang SW, Crotty TB, et al.:effects of in vivo adventitial expression of recombinant endothelial nitric oxide synthase gene in cerebral arteries. Proc Natl Acad Sci U S A 94: , ) Tsutsui M, Chen AFY, O Brien T, et al.:adventitial expression of recombinant enos gene restores NO production in arteries without endothelium. Arterioscler Thromb Vasc Biol 18: , ) Tsutsui M, Milstien S, Katusic ZS:Effect of tetrahydrobiopterin on endothelial function in canine middle cerebral arteries. Circ Res 79: , ) Chen AFY, O Brien T, Tsutsui M, et al.:expression and function of recombinant endothelial nitric oxide synthase gene in canine basilar artery. Circ Res 80: , ) The World Health Report Reducing Risks, Promoting Healthy Life. World Health Organization, )Tsutsui M, Onoue H, Iida Y, et al.:adventitia-dependent relaxations of canine basilar arteries transduced with recombinant enos gene. Am J Physiol 276: H1846-H1852, )Tsutsui M, Onoue H, Iida Y, et al.:effects of recombinant enos gene expression on reactivity of small cerebral arteries. Am J Physiol Heart Circ Physiol 278: H420-H427, )Tsutsui M, Onoue H, Iida Y, et al.:b1 and B2 bradykinin receptors on adventitial fibroblasts of cerebral arteries are coupled to recombinant enos. Am J Physiol Heart Circ Physiol 278:H367-H372, )Morishita T, Tsutsui M, Shimokawa H, et al.:vasculoprotective roles of neuronal nitric oxide synthase. FASEB J 16: , )Nakata S, Tsutsui M, Shimokawa H, et al.:vascular neuronal NO synthase is selectively upregulated by platelet-derived growth factor:involvement of the MEK/ERK pathway. Arterioscler Thromb Vasc Biol 25: , )Nakata S, Tsutsui M, Shimokawa H, et al.:statin treatment upregulates vascular neuronal nitric oxide synthase through Akt/NF-kappaB pathway. Arterioscler Thromb Vasc Biol 27:92-98, )Suda O, Tsutsui M, Morishita T, et al.:long-term treatment with N(omega)-nitro-L-arginine methyl ester causes arteriosclerotic coronary lesions in endothelial nitric oxide synthase-deficient mice. Circulation 106: , )Suda O, Tsutsui M, Morishita T, et al.:asymmetric dimethylarginine produces vascular lesions in endothelial nitric oxide synthase-deficient mice:involvement of renin-angiotensin system and oxidative stress. Arterioscler Thromb Vasc Biol 24: , )Morishita T, Tsutsui M, Shimokawa H, et al.:nephrogenic diabetes insipidus in mice lacking all nitric oxide synthase isoforms. Proc Natl Acad Sci U S A 102: , )Nakata S, Tsutsui M, Shimokawa H, et al.:spontaneous myocardial infarction in mice lacking all nitric oxide synthase isoforms. Circulation 117: , )Takaki A, Morikawa K, Tsutsui M, et al.:crucial role of nitric oxide synthases system in endothelium-dependent hyperpolarization in mice. J Exp Med 205: , )Ulrich M, Petre A, Youhnovski N, et al.:post-translational tyrosine nitration of eosinophil granule toxins mediated by eosinophil peroxidase. J Biol Chem 283: , )Yatera Y, Shibata K, Furuno Y, et al.:severe dyslipidaemia, atherosclerosis, and sudden cardiac death in mice lacking all NO synthases fed a high-fat diet. Cardiovasc Res 87: , )Shibata K, Yatera Y, Furuno Y, et al.:spontaneous development of left ventricular hypertrophy and diastolic dysfunction in mice lacking all nitric oxide synthases. Circ J 74: , 2010

7 841 Nitric Oxide and Cardiovascular Disease: Novel Evidence Obtained from a Genetically Manipulated Animal Masato TSUTSUI Department of Pharmacology, Graduate School of Medicine, University of the Ryukyus Nitric oxide(no)is synthesized by three different NO synthase(nos)isoforms, including neuronal (nnos), inducible(inos), and endothelial NOS(eNOS). The roles of the NOS system in vivo have been extensively investigated in pharmacological studies with non-selective NOS inhibitors such as L-NAME and L-NMMA. However, because the NOS inhibitors possess multiple non-specific actions, the authentic roles of the NOS system in our body still remain to be fully elucidated. To address this important issue, we have successfully developed genetically manipulated mice in which all three NOS genes are totally disrupted. While the triply n/i/enos -/- mice were unexpectedly viable and appeared normal, their survival and fertility rates were markedly reduced as compared with wild-type mice. Intriguingly, the triply n/i/enos -/- mice spontaneously developed acute myocardial infarction accompanied by severe coronary arteriosclerotic lesions. Furthermore, the triply n/i/enos -/- mice manifested metabolic syndrome, dyslipidemia, and diastolic heart failure. These results provide the first evidence that genetic disruption of all NOS genes causes a variety of cardiovascular diseases in mice in vivo, demonstrating a critical role for the endogenous NOS system in the pathogenesis of cardiovascular disorders. Key Words : Nitric oxide, Nitric oxide synthase, Knockout mouse, Cardiovascular disease, Myocardial infarction The Journal of Japan Society for Clinical Anesthesia Vol.32 No.7, 2012

研究成果報告書

研究成果報告書 21 4 25 peroxynitrite angiotensin II ETA MEK/ERK pathway endothelin-1 EDHF (EDHF) EDHF EDHF EDHF 2 [phosphodiesterase 3 (PDE3) cilostazol metformin thromboxane A2 ozagrel eicosapentaenoic acid (EPA) angiotensin