Relationship: 952



Decrease, GTPCH-1 leads to Decrease, Tetrahydrobiopterin

Upstream event


Decrease, GTPCH-1

Downstream event


Decrease, Tetrahydrobiopterin

Key Event Relationship Overview


AOPs Referencing Relationship


AOP Name Adjacency Weight of Evidence Quantitative Understanding
Peptide Oxidation Leading to Hypertension adjacent High High

Taxonomic Applicability


Term Scientific Term Evidence Link
Homo sapiens Homo sapiens High NCBI
Bos taurus Bos taurus High NCBI
Mus musculus Mus musculus High NCBI
Rattus norvegicus Rattus norvegicus High NCBI

Sex Applicability


Sex Evidence
Unspecific High

Life Stage Applicability


Term Evidence
All life stages High

Key Event Relationship Description


Guanosine triphosphate cyclohydrolase-1 (GTPCH-1) is the rate-limiting enzyme in the de novo biosynthesis of BH4, which is an essential cofactor for eNOS and NO generation (Wang et al., 2008). Oxidative stress can disrupt and decrease GTPCH-1 activity, leading to decreased BH4 levels and subsequent uncoupling of eNOS.

Evidence Supporting this KER


Biological Plausibility


As GTPCH-1 is required for BH4 biosynthesis, there is strong biological plausibility for this relationship.

Many studies demonstrated that deletion of GTPCH-1 led to the deficiency of BH4 in endothelial cells. In the hph-1 mouse model, cardiac GTPCH-1 enzymatic activity was reduced by 90% compared to wild-type mice, which led to 60% reduction in BH4 levels (Adlam et al., 2012). In another mouse model of endothelial-targeted deletion of GTPCH-1, BH4 levels in lung, heart and aorta were significantly decreased compared to wild-type mice (Chuaiphichai et al., 2014). GTPCH-1 siRNA significantly reduced GTPCH-1 enzyme activity and BH4 levels in murine sEnd.1 and aortic endothelial cells (Crabtree et al., 2009; Tatham et al., 2009; Wang et al., 2008). The selective GTPCH-1 inhibitor diaminohydroxypyrimidine (DAHP) reduced levels of BH4 in bovine aortic endothelial cells (BAECs) (Wang et al., 2008). Also, transgenic overexpression of GTPCH-1 increased BH4 protein levels in murine hearts and aortas, leading to enhanced eNOS activity (Alp et al., 2003; Carnicer et al., 2012).

Empirical Evidence


Include consideration of temporal concordance here

Exposure to a wide range of stimuli led to a decrease in both GTPCH-1 expression and activity and a decrease in BH4 levels, indicating strong empirical support between these two key events. An assumption that a decrease in GTPCH-1 expression and activity also results in a decrease in BH4 levels was made for these studies. 

After myocardial reperfusion, GTPCH-1 activity decreased from 100% to 50% and arterial BH4 levels was reduced by 32% (Jayaram et al., 2015).

IL6/TNF/LPS (4 ng/mL, 10 nmol/L, 80 ng/mL) stimulation for 24 hours induced a 3-fold upregulation of GTPCH-1 gene expression and 3- to 4-fold increase in vascular BH4 (Antoniades et al., 2011). For this evidence, an assumption that a change in GTPCH-1 gene expression would affect GTPCH-1 enzyme activity was made.

Cigarette smoke extract (CSE, 5%) exposure for 4 hours significantly decreased BH4 levels from 100% to 50% and GTPCH-1 expression from 100% to 51%, while a lower concentration of 2.5% CSE did not cause a significant change in bovine aortic endothelial cells (Abdelghany et al., 2017).

In BAECs, stimulation with 25 μM 4-hydroxy-2-nonenal decreased BH4 levels from 10 pmol/mg protein to 6.1 pmol/mg protein and GTPCH-1 activity from 27 pmol/hr/mg protein to 23 pmol/hr/mg protein (Whitsett et al., 2007).

In a rat hypertensive model, the decrease in GTPCH-1 protein expression (via densitometry of western blot band intensity, 0.089 control to 0.0087) and BH4 (33.71±3.318 pmol control to 17.144±2.251 pmol) induced by aortic coarctation was attenuated by clofibrate treatment (GTPCH-1: 0.088±0.022 band intensity, BH4: 32.534±5.809 pmol) (Cervantes-Pérez et al., 2012).

Uncertainties and Inconsistencies


There are no uncertainties or inconsistencies.

Quantitative Understanding of the Linkage


Is it known how much change in the first event is needed to impact the second? Are there known modulators of the response-response relationships? Are there models or extrapolation approaches that help describe those relationships?

Based on the relationship between GTPCH-1 and BH4, it would be possible that any change in GTPCH-1 activity would affect BH4 biosynthesis. The studies above showed that there are many modulators of the response-response relationships including cardiac reperfusion (Jayaram et al., 2015), cytokines (Antoniades et al., 2011), CSE (Abdelghany et al., 2017), and 4-hydroxy-2-nonenal (Whitsett et al., 2007).

Response-response Relationship




Known modulating factors


Known Feedforward/Feedback loops influencing this KER


Domain of Applicability


The relationship between GTPCH-1 and BH4 is supported in humans (Jayaram et al., 2015), cows (Abdelghany et al., 2017; Whitsett et al., 2007, Wang et al., 2008), mice (Adlam et al., 2012; Chuaiphichai et al., 2014; Crabtree et al., 2009; Tatham et al., 2009; Wang et al., 2008) and rats (Cervantes-Pérez et al., 2012).



AbdelGhany, T., Ismail, R., Elmahdy, M., Mansoor F, Zweier J, Lowe, F., and Zweier, JL. (2017). Cigarette Smoke Constituents Cause Endothelial Nitric Oxide Synthase Dysfunction and Uncoupling due to Depletion of Tetrahydrobiopterin with Degradation of GTP Cyclohydrolase.  Nitric Oxide (Under review).

Adlam, D., Herring, N., Douglas, G., De Bono, J.P., Li, D., Danson, E.J., Tatham, A., Lu, C.-J., Jennings, K.A., Cragg, S.J., et al. (2012). Regulation of β-adrenergic control of heart rate by GTP-cyclohydrolase 1 (GCH1) and tetrahydrobiopterin. Cardiovasc. Res. 93, 694–701.

Alp, N.J., Mussa, S., Khoo, J., Cai, S., Guzik, T., Jefferson, A., Goh, N., Rockett, K.A., and Channon, K.M. (2003). Tetrahydrobiopterin-dependent preservation of nitric oxide-mediated endothelial function in diabetes by targeted transgenic GTP-cyclohydrolase I overexpression. J. Clin. Invest. 112, 725–735.

Antoniades, C., Cunnington, C., Antonopoulos, A., Neville, M., Margaritis, M., Demosthenous, M., Bendall, J., Hale, A., Cerrato, R., Tousoulis, D., et al. (2011). Induction of vascular GTP-cyclohydrolase I and endogenous tetrahydrobiopterin synthesis protect against inflammation-induced endothelial dysfunction in human atherosclerosis. Circulation 124, 1860–1870.

Carnicer, R., Hale, A.B., Suffredini, S., Liu, X., Reilly, S., Zhang, M.H., Surdo, N.C., Bendall, J.K., Crabtree, M.J., Lim, G.B.S., et al. (2012). Cardiomyocyte GTP cyclohydrolase 1 and tetrahydrobiopterin increase NOS1 activity and accelerate myocardial relaxation. Circ. Res. 111, 718–727.

Cervantes-Pérez, L.G., Ibarra-Lara, M. de la L., Escalante, B., Del Valle-Mondragón, L., Vargas-Robles, H., Pérez-Severiano, F., Pastelín, G., and Sánchez-Mendoza, M.A. (2012). Endothelial nitric oxide synthase impairment is restored by clofibrate treatment in an animal model of hypertension. Eur. J. Pharmacol. 685, 108–115.

Chen, C.-A., Lin, C.-H., Druhan, L.J., Wang, T.-Y., Chen, Y.-R., and Zweier, J.L. (2011). Superoxide induces endothelial nitric-oxide synthase protein thiyl radical formation, a novel mechanism regulating eNOS function and coupling. J. Biol. Chem. 286, 29098–29107.

Chuaiphichai, S., McNeill, E., Douglas, G., Crabtree, M.J., Bendall, J.K., Hale, A.B., Alp, N.J., and Channon, K.M. (2014). Cell-autonomous role of endothelial GTP cyclohydrolase 1 and tetrahydrobiopterin in blood pressure regulation. Hypertension 64, 530–540.

Crabtree, M.J., Tatham, A.L., Al-Wakeel, Y., Warrick, N., Hale, A.B., Cai, S., Channon, K.M., and Alp, N.J. (2009). Quantitative regulation of intracellular endothelial nitric-oxide synthase (eNOS) coupling by both tetrahydrobiopterin-eNOS stoichiometry and biopterin redox status: insights from cells with tet-regulated GTP cyclohydrolase I expression. J. Biol. Chem. 284, 1136–1144.

Jayaram, R., Goodfellow, N., Zhang, M.H., Reilly, S., Crabtree, M., De Silva, R., Sayeed, R., and Casadei, B. (2015). Molecular mechanisms of myocardial nitroso-redox imbalance during on-pump cardiac surgery. Lancet Lond. Engl. 385 Suppl 1, S49.

Tatham, A.L., Crabtree, M.J., Warrick, N., Cai, S., Alp, N.J., and Channon, K.M. (2009). GTP cyclohydrolase I expression, protein, and activity determine intracellular tetrahydrobiopterin levels, independent of GTP cyclohydrolase feedback regulatory protein expression. J. Biol. Chem. 284, 13660–13668.

Wang, S., Xu, J., Song, P., Wu, Y., Zhang, J., Chul Choi, H., and Zou, M.-H. (2008). Acute inhibition of guanosine triphosphate cyclohydrolase 1 uncouples endothelial nitric oxide synthase and elevates blood pressure. Hypertension 52, 484–490.

Whitsett, J., Picklo, M.J., and Vasquez-Vivar, J. (2007). 4-Hydroxy-2-nonenal increases superoxide anion radical in endothelial cells via stimulated GTP cyclohydrolase proteasomal degradation. Arterioscler. Thromb. Vasc. Biol. 27, 2340–2347.