Rapid clearance of supplemented tetrahydrobiopterin is driven by high-capacity transporters in the kidney.

Tetrahydrobiopterin (BH(4)) is an essential cofactor of aromatic amino acid hydroxylases and NO synthase. Supplementation of BH(4) potentially targets cardiovascular dysfunction as well as inherited BH(4) deficiencies and BH(4)-responsive phenylketonuria. However, the high cost/effect ratio of the recommended daily dose of BH(4) supplementation acts against further popularization of this therapy. The aim of this study was to attenuate urinary excretion with the intention of improving efficacy of BH(4) supplementation. The rapid excretion of BH(4) in the urine was confirmed to be the major route of supplemented BH(4) loss. In addition to glomerular filtration into the urine, a dominant rapid exclusion by renal secretion was observed in rats (T((1/2))=16 min) when the plasma BH(4) was higher than about 1 nmol/mL (more than 10 times higher than normal), due to BH(4) supplementation. The rapidity of the process was slowed by prior administration of cyclosporin A, a representative anti-excretory drug, and the excretion decelerated to a moderate rate (T((1/2))=53 min). By the combined administration of BH(4) plus cyclosporin A, the blood BH(4) levels were dramatically elevated. It was hypothesized that the drug interfered with kidney excretion of BH(4) rather than by attenuating organ tissue distribution by inhibiting biopterin uptake from the plasma. Consistent with this hypothesis, biopterin levels after BH(4) administration were elevated in major organs in the presence of anti-excretory drugs without notable change in their BH(4) fraction which was consistently 95% or higher regardless of combined administration with the drugs. Targeting these putative transporters would be a promising approach for improving the efficiency of BH(4) supplementation therapy.

Accumulated BH4 in mouse liver caused by administration of either 6R- or 6SBH4 consisted solely of the 6R-diastereomer: evidence of oxidation to BH2 and enzymic reduction.

Mice were given (i.p.) L-erythro-(6S)-tetrahydrobiopterin (6SBH4) or 6RBH4 and the increase in liver BH4 in both groups was almost the same. The C6-chirality of liver BH4 was determined by HPLC. After administration of 6SBH4, the liver BH4 consisted mainly of 6RBH4 (>95%). These findings show that the exogenous BH4 was oxidized to 7,8BH2 which was then taken up and enzymically reduced back to BH4 in the liver.

Cellular accumulation of tetrahydrobiopterin following its administration is mediated by two different processes; direct uptake and indirect uptake mediated by a methotrexate-sensitive process.

In our previous study on tetrahydrobiopterin (BH4) accumulation in organs of mice administered with 6RBH4, it was demonstrated that the intestinal mucosa was able to take up BH4 directly but that the liver could accomplish this only indirectly via a pathway involving the dihydrofolate reductase reaction. This observation was largely based on the fact that BH4 deposition in the liver was completely inhibited by prior treatment with methotrexate whereas deposition in the intestinal mucosa was only partially inhibited. To investigate the distinctive features of BH4 uptake in these organs, Caco-2 of intestinal epithelial origin and isolated hepatocytes were analyzed for cellular BH4 uptake in vitro. Both cell types exhibited a similar profile of BH4 accumulation but their response to methotrexate differed; the accumulation of BH4 in the hepatocytes was almost completely inhibited by methotrexate, whereas no inhibition was observed in Caco-2 cells, suggesting that the process of BH4 accumulation in Caco-2 cells, unlike hepatocytes, did not involve enzymic reduction by dihydrofolate reductase. Furthermore, 6SBH4, a synthetic diastereomer of BH4, was loaded into Caco-2 cells and the accumulated BH4 was identified as 6SBH4. These results provided strong evidence that BH4 had directly accumulated in Caco-2 cells. The distinctive features of BH4 deposition in the intestinal mucosa and liver reflected the means by which Caco-2 cells or hepatocytes, both representative cells of these tissues, took up extracellular BH4, i.e., in a direct or indirect manner, respectively.