Advances in the clinical applications of exhaled nitric oxide measurements

This article focuses on recent data which highlight the clinical settings in which exhaled nitric oxide (F(E)NO) is potentially helpful, or not, as a clinical tool. It is becoming clearer that, selectively applied, F(E)NO measurements can provide reliable clinical guidance, particularly when values are low. Such values are associated with high negative predictive values (>90%). Increased F(E)NO levels are associated with much more modest positive predictive values (75%-85%) and these are less reliable. These general principles apply when diagnosing steroid responsiveness in relation to asthma, chronic cough, and COPD. Although randomised trials do not support routine use of exhaled NO measurements in uncomplicated bronchial asthma, there is evidence that in patients with difficult asthma, or asthma associated with pregnancy, F(E)NO enhances overall management, and the decision to commence or increase inhaled steroid therapy (yes/no) may be made more accurately. Exhaled NO is potentially relevant in the assessment of occupational asthma (serial measurements) and also in diagnosing bronchiolitis obliterans in lung transplant patients.     

Characterization of nitric oxide release by nebivolol and its metabolites

BACKGROUND: Nebivolol is a selective beta(1)-adrenergic receptor antagonist that causes a direct vasodilator effect attributed to the action on vascular nitric oxide (NO). This study aimed to investigate whether nebivolol or its metabolites induces NO production and to explore the mechanisms underlying this pharmacologic effect. METHODS: Conductance and resistance arteries from Wistar-Kyoto rats (WKY) (n = 33) incubated with the fluorescent probe diaminofluorescein-2 (DAF-2) were stimulated with increasing concentrations of nebivolol or its enantiomers and metabolites, and NO release was histologically evaluated. RESULTS: Nebivolol induced a dose-dependent increase in NO levels in the endothelium of both arteries. Levels of NO were significantly increased at 10(-6)mol/L and reached a plateau state at 10(-5)mol/L. Induction of NO is not a general action of beta-adrenoceptor antagonists, as atenolol had no effects. Nebivolol action on NO release was mainly caused by the D-isomer. Moreover NO production is also maintained after hepatic metabolism, as the three main metabolites of nebivolol were able to induce a significant increase in endothelial NO release. Finally, nebivolol-activated calcium mobilization is crucial to NO production. CONCLUSION: Our study shows the effects of D-nebivolol and its metabolites on endothelial NO production in both conductance and resistance arteries, and clarifies that this effect is realized through a calcium-dependent mechanism.     

Hepatopulmonary syndrome: role of nitric oxide and clinical aspects.

Hepatopulmonary syndrome is defined by oxygenation impairment due to abnormal intrapulmonary vascular dilatations in patients with liver disease. The implication of enhanced pulmonary production of nitric oxide in the pathogenesis of intrapulmonary vascular dilatations has been demonstrated both in murine models and in human hepatopulmonary syndrome. The diagnosis of hepatopulmonary syndrome in chronic liver disease is of paramount importance, considering the fact that severe hypoxemia related to hepatopulmonary syndrome may occur in patients with well compensated liver disease and that survival is reduced in patients with hepatopulmonary syndrome relative to non hepatopulmonary syndrome patients. Priority for liver transplantation, which is presently the only cure, has been recently increased in patients with advanced hepatopulmonary syndrome.     

一氧化氮及其合酶在哮喘发病机制中的作用

探讨一氧化氮及其合酶在哮喘发病机制中的作用。方法 采用哮喘豚鼠模型，将豚鼠分为４组；１．哮喘组，用１０％卵白蛋白腹腔注射１ｍｌ致敏，２周后用１％卵白蛋白超声雾化吸入致其哮喘发作．２；肾上腺皮质激素预防组；诱喘同哮喘组，在每次诱喘前腹腔滴注地塞米松０．５ｍｇ／ｋｇ。３．硝基精氨酸甲酯预防组；诱喘同哮喘组，每次诱喘产腹腔注射ＬＮＮＡ０．４ｍｇ／ｋｇ。４．正常对照组；用生理盐水代替诱喘剂。每组分别测定其     

The role of nitric oxide

When studying the impact of endothelins (ETs) on physiology and pathophysiology, this needs to be done in the context of nitric oxide (NO) synthesis and action, since these two are closely intertwined in their action. Here, we will review the work demonstrating the crosstalk between endothelin-1 (ET-1) and NO, and the recent developments regarding the role of these two mediators in inflammatory processes. Moreover, we will discuss the role of NO in pro-inflammatory diseases and the potential mechanisms of the anti-inflammatory activity of ET receptor antagonism.     

Plasma nitric oxide level and its role in slow coronary flow phenomenon

Previous studies have suggested that microvascular abnormalities and endothelial dysfunction cause slow coronary flow (SCF). The objective of this study was to assess the plasma nitric oxide (NO) level and determine its role in the pathogenesis of SCF phenomenon. Thirty-six patients with SCF (group 1) and otherwise patent coronary arteries and 34 subjects with normal coronary flow (group 2) were included in the study. Coronary flow was quantified according to the TIMI Frame Count (TFC) method. Brachial artery endothelium-dependent flow-mediated dilatation (FMD) and nitroglycerin (NTG)-induced endothelium-independent dilatation were studied in both groups. In addition, plasma NO levels were measured and their contribution to FMD was determined. The sex, age, body mass index, arterial blood pressure, and heart rate distributions were similar in both groups. TFC was significantly higher in group 1 compared to group 2 for each artery. The plasma NO level was lower in patients with SCF than in control subjects (18.4 +/- 4.4 versus 25.2 +/- 6.3 micromol/L P = 0.001). FMD was significantly smaller in group 1 than in group 2 (4.0 +/- 3.2% versus 10.6 +/- 5.8%, P = 0.0001). The percent NTG-induced dilatation was similar in the two groups (16.8 +/- 1.1% versus 17.1 +/- 1.1%, P = 0.42). In group 1, the plasma NO level was correlated with percent of FMD. Also, the plasma NO level was inversely correlated with TFC for each artery. Reduced NO bioactivity as well as impaired FMD support the presence of endothelial damage in the pathogenesis of SCF phenomenon.     

一氧化氮在砷中毒中作用的研究

目的探讨砷对机体ＮＯ的影响及ＮＯ在砷中毒发病中的作用。方法采用动物实验和人群调查方法。结果慢性染砷实验中,小鼠血清、肾脏ＮＯ２－／ＮＯ３－含量中、高剂量组显著降低,肝脏、心脏ＮＯ２－／ＮＯ３－含量各剂量组显著降低,且呈剂量—效应关系。全血ＧＳＨ含量低剂量组显著升高,中、高剂量组显著降低,肝脏、心脏ＧＳＨ含量各剂量组均显著下降,肾脏ＧＳＨ含量中、高剂量组显著降低。红细胞、心脏ＳＯＤ活性中、高剂量组显著下降,肝脏ＳＯＤ活性低剂量组显著升高,中、高剂量组显著下降,肾脏各剂量组未见显著差异。人群调查,砷病区病人血中ＮＯ２－／ＮＯ３－、ＧＳＨ含量显著低于非病区健康人,且二者呈正相关,红细胞ＳＯＤ活性未见显著差异。结论砷可导致ＮＯ含量的下降。砷可导致ＧＳＨ含量和ＳＯＤ活性的变化,进而影响ＮＯ合成和代谢     

Characterization of the nitric oxide reductase from Thermus thermophilus

Nitrous oxide (N₂O) is a powerful greenhouse gas implicated in climate change. The dominant source of atmospheric N₂O is incomplete biological dentrification, and the enzymes responsible for the release of N₂O are NO reductases. It was recently reported that ambient emissions of N₂O from the Great Boiling Spring in the United States Great Basin are high, and attributed to incomplete denitrification by Thermus thermophilus and related bacterial species [Hedlund BP, et al. (2011) Geobiology 9(6)471–480]. In the present work, we have isolated and characterized the NO reductase (NOR) from T. thermophilus. The enzyme is a member of the cNOR family of enzymes and belongs to a phylogenetic clade that is distinct from previously examined cNORs. Like other characterized cNORs, the T. thermophilus cNOR consists of two subunits, NorB and NorC, and contains a one heme c, one Ca²⁺, a low-spin heme b, and an active site consisting of a high-spin heme b and Fe_B. The roles of conserved residues within the cNOR family were investigated by site-directed mutagenesis. The most important and unexpected result is that the glutamic acid ligand to Fe_B is not essential for function. The E211A mutant retains 68% of wild-type activity. Mutagenesis data and the pattern of conserved residues suggest that there is probably not a single pathway for proton delivery from the periplasm to the active site that is shared by all cNORs, and that there may be multiple pathways within the T. thermophilus cNOR.     

Distribution of nitric oxide synthase and secretory role of exogenous nitric oxide in the isolated rat pancreas.

BACKGROUND: Pancreatic production and in vivo effects of nitric oxide (NO) have been shown by several studies. In order to examine the direct actions of the NO donor sodium nitroprusside (SNP), this study used in vitro specimens of the rat pancreas where the distribution of neuronal nitric oxide synthase (NOS) and the secretory effects of SNP and the cyclic GMP (cGMP) analog 8-bromo cyclic GMP (8-Br cGMP) were investigated. METHODS: NO containing pancreatic nerves were visualized by NOS immunohistochemistry. Basal and stimulated amylase output from rat pancreatic segments was measured by an on-line fluorimetric method. Stimulation was achieved by either acetylcholine (ACh) or electrical field stimulation (EFS). Intracellular free calcium concentration ([Ca2+]i) was measured in dispersed pancreatic acinar cells. RESULTS: NOS containing nerves were demonstrated in the vicinity of pancreatic acini and blood vessels. SNP and 8-Br cGMP inhibited both basal and EFS evoked amylase output but failed to inhibit ACh induced amylase output. Basal [Ca2+]i was decreased by both SNP and 8-Br cGMP but neither SNP nor 8-Br cGMP influenced the ACh evoked increase in [Ca2+]i. CONCLUSION: NO is well distributed in the rat exocrine pancreas. Exogenous nitric oxide may have a dual action in the isolated rat pancreas: Inhibition of basal amylase secretion in acinar cells and inhibition of ACh release from intrinsic nerve terminals. Both effects seem to be calcium dependent and possibly mediated by cGMP.     

大鼠组织一氧化氮含量变化及其调节在衰老过程中的作用

目的　揭示大鼠组织一氧化氮 ( NO)含量和一氧化氮合酶 ( NOS)活性变化与衰老的相关关系 ,并通过调节 NO合成 ,探讨 NO在衰老过程中的作用。　方法　对不同月龄大鼠采用铜离子活化镉还原法测定组织 NO含量 ,应用血红蛋白氧化法测定组织 NOS的活性 ,采用硫代巴比妥酸染色法测定组织丙二醛 ( MDA)含量。　结果　与青年组相比 ,老年组 ( 2 0～ 2 2月龄 )心脑肾组织 NO降低有显著性 ( P<0 .0 1 ) ,而中年组仅肾组织 NO含量降低有显著性 ( P<0 .0 5) ;老年组较中年组仅心脏组织 NO含量降低有显著性 ( P<0 .0 1 )。中年组心脑组织 NOS活性较青年组降低 ( P<0 .0 5) ;而老年组组织 NOS活性较中年组增高 ,仅脑组织 NOS增高有显著性 ( P<0 .0 5)。与老年对照组比较 ,β-雌二醇组心肝肾脑组织 NO含量明显增高 ( P<0 .0 1 ) ,而心脑肾组织 MDA下降有显著性 ( P<0 .0 1 ) ;L-硝基精氨酸甲酯组肝组织 NO降低有显著性 ( P<0 .0 5) ,而 MDA下降仅在脑组织有显著性 ( P<0 .0 5)。　结论　大鼠组织 NO含量与衰老之间存在一定的相关关系。     

The role of nitric oxide in osteoarthritis

Elevated levels of markers of nitric oxide (NO) production are found in osteoarthritic joints suggesting that NO is involved in the pathogenesis of osteoarthritis (OA). In OA, NO mediates many of the destructive effects of interleukin-1 (IL-1) and tumour necrosis factor-alpha (TNF-alpha) in the cartilage, and inhibitors of NO synthesis have demonstrated retardation of clinical and histological signs and symptoms in experimentally induced OA and other forms of arthritis. As an important factor in cartilage, the regulation of inducible nitric oxide synthase (iNOS) expression and activity, and the effects of NO are reviewed, especially in relation to the pathogenesis of OA.     

Melatonin and its precursors scavenge nitric oxide

Nitric oxide (NO) scavenging activity of melatonin, N-acetyl-5-hydroxytryptamine, serotonin, 5-hydroxytryptophan and L-tryptophan was examined by the Griess reaction using flow injection analysis. 1-Hydroxy-2-oxo-3-(N-methyl-3-aminopropyl)-3-methyl-1-triazene (NOC-7) was used as NO generator. The Griess reagent stoichiometrically reacts with NO2-, which was converted by a cadmium-copper reduction column from the stable end products of NO oxidation. Except for tryptophan, all the compounds examined scavenged NO in a dose-dependent manner. Melatonin, which has a methoxy group in the 5-position and an acetyl side chain, exhibited the most potent scavenging activity among the compounds tested. Serotonin, N-acetyl-5-hydroxytryptamine, and 5-hydroxytryptophan, respectively, showed moderate scavenging activity compared to melatonin. Tryptophan, which has neither a methoxy nor a hydroxyl group in the 5-position, exhibited the least NO scavenging activity.     

Exhaled nitric oxide in the clinical management of asthma

Management of asthma has gradually evolved from the concept of controlling bronchial hyperresponsiveness to focusing on control of inflammation. The awareness of airway remodeling, and the emergence of data suggesting irreversibility of some of these changes, despite standard-of-care pharmacotherapies such as inhaled steroids, has highlighted the need for early detection; effective diagnosis and treatment; monitoring responses and adhering to treatment; and predicting exacerbations. Pre-clinical intervention strategies targeted toward picking up early suggestions of asthma before irreversible airway changes occur may open the door to primary prevention approaches. Although invasive methods, such as bronchial biopsy, remain the gold standard to understanding and treating asthma, there is a preference for noninvasive techniques for reasons of convenience, ease of use, and patient comfort. In this article, recent data that support the use of exhaled nitric oxide as a noninvasive biomarker of inflammation in clinical practice are reviewed.     

Possible role of nitric oxide in malarial immunosuppression

We have tested the hypothesis that nitric oxide may be responsible for the immunosuppression reported during malaria infections. We first showed that reactive nitrogen intermediates, which indicate nitric oxide generation, were increased in the plasma of Plasmodium vinckei-infected mice. We next found that Concanavalin A-induced proliferation of spleen cells from these mice was reduced compared with that observed in uninfected animals. The addition of N^G-methyl-L-arginine (L-NMMA) for the duration of the cultures restored the malarial proliferative response to normal. We then tested the effect of oral L-NMMA on the proliferative response of P. chabaudi-infected mice to a human red blood cell lysate. The secondary response to this antigen, measured as spleen cell proliferation in vitro ten days after immunization and when there was no discernible parasitaemia, remained normal in L-NMMA- treated P. chabaudi mice, but was decreased in the untreated infected mice. These results suggest a role for nitric oxide in malarial immunosuppression.     

The role of nitric oxide in endotoxin-induced cardiodepression

OBJECTIVE:

To determine the participation of inducible nitric oxide synthase (iNOS) in cardiodepressive phenomena during late preconditioning caused by subtoxic doses of lipopolysaccharide (LPS).

METHODS:

Spontaneously beating hearts isolated from male Wistar rats (350 g to 400 g), intact or preconditioned with LPS (0.25 mg/kg given intraperitoneally 18 h before heart excision), were used to measure contractile performance during 30 min of ischemia and 40 min of reperfusion in the Langendorff mode. For selective iNOS blockade, hearts were perfused with phenylene-1,3-bis(ethane-2-isothiourea) (50 nmol/L). Expression of iNOS (determined using Western blotting) and NOS activities were determined in frozen myocardial tissues.

RESULTS:

Subtoxic doses of LPS caused iNOS induction in the heart and depression of contractile function, but improved heart postischemic recovery. In all groups of animals, expression of iNOS was higher in the right than left ventricles. Ischemia and postischemic reperfusion of intact heart intensified production of nitric oxide (NO), predominantly by iNOS. The preconditioning led to iNOS activation during ischemia in the left ventricle and iNOS depression in the right ventricle, owing to feedback caused by the initially higher iNOS expression and activity in the right ventricle. Postischemic reperfusion diminished NOS activities in preconditioned myocardial tissues. Blockade of iNOS significantly slowed preconditioned heart recovery and partially restored left ventricular developed pressure, but only after 20 min of reperfusion.

CONCLUSIONS:

iNOS-produced NO plays a role in the development of delayed cardioprotection and cardiodepressive effects (in part) after extravasal administration of a minimal dose of endotoxin.