In-vivo- und Humanstudien Bestätigen das Antioxidative und Toleranzfreie Wirkprofil von PETN

Pentaerythritol tetranitrate (PETN) is a donor of nitric oxide (NO), which in addition to vasodilatory actions displays antioxidant and antiatherogenic properties. The latter effects are consequences of increased heme oxygen-ase-1 (HO-1) expression in endothelial cells under the influence of PETN and its metabolites, e.g. PETriN. Induction of HO-1 leads to enhanced heme degradation and the formation of carbon monoxide and bilirubin. These HO-1 products act as anti-inflammatory and antioxidant mediators. Another downstream effector of HO-1, ferritin, is a secondary antioxidant protein that is also induced by PETN. Treatment with PETN reduces the sensitivity of endothelial cells to oxidant injury. This effect is comparable to the direct cytoprotective action of bilirubin. Other long acting organic nitrates such as isosorbide dinitrate show little or no effect on HO-1 expression and related antioxidant pathways. It can be assumed that differences in NO release mechanisms and kinetics are responsible for this observation. PETN reduces oxidative stress not only in the vascular wall but also in macrophages. Studies in animals and humans have confirmed that PETN is free of tolerance and improves endothelial function. Most recent work has provided strong evidence that HO-1 induction and the virtual absence of tolerance in case of PETN are causally related. It is conceivable that activation of these cell and tissue protective pathways by PETN slows the progression of coronary artery disease.