Nitric oxide protects against the cytotoxic effects of reactive oxygen species

Inhibition of experimental gastric carcinogenesis, induced by N-methyl-N'-nitro-N-nitrosoguanidine in rats, by sodium nitroprusside, a nitric oxide generator

The effects of prolonged administration of sodium nitroprusside (SNP), a generator of nitric oxide (NO), on gastric carcinogenesis induced by N-methyl-N'-nitro-N-nitrosoguanidine (MNNG) and the labelling index of the gastric mucosa were investigated in male Wistar rats. The rats received intra-peritoneal injections of 2 or 4 mg/kg body weight of SNP every other day after 25 weeks' oral treatment with the carcinogen. Prolonged administration of SNP at 4 mg/kg body weight, but not at 2 mg/kg body weight, significantly decreased the incidence of gastric cancers in experimental week 52. However, it did not affect the histological types or depths of involvement of gastric cancers. SNP at 4 mg/kg body weight, but not at 2 mg/kg body weight, also significantly decreased the bromodeoxyuridine labelling index of the antral epithelial cells. These findings indicate that SNP inhibits gastric carcinogenesis and suggest that this effect may be related to the suppression of proliferation of the antral epithelial cells.

The cytotoxicity of nitroxyl: possible implications for the pathophysiological role of NO

In addition to the broad repertoire of regulatory functions nitric oxide (NO) serves in mammalian physiology, the L-arginine:NO pathway is also involved in numerous pathophysiological mechanisms. While NO itself may actually protect cells from the toxicity of reactive oxygen radicals in some cases, it has been suggested that reactive nitrogen oxide species formed from nitric oxide synthase (NOS) can be cytotoxic. In addition to NO, the one electron reduction product NO- has been proposed to be formed from NOS. We investigated the potential cytotoxic role of nitroxyl (NO-), using the nitroxyl donor Angelis's salt, (AS; sodium trioxodinitrate, Na2N2O3) as the source of NO-. As was found to be cytotoxic to Chinese hamster V79 lung fibroblast cells over a concentration range of 2-4 mM. The presence of equimolar ferricyanide (Fe(III)-(CN6)3-), which converts NO- to NO, afforded dramatic protection against AS-mediated cytotoxicity. Treatment of V79 cells with L-buthionine sulfoximine to reduce intracellular glutathione markedly enhanced AS cytotoxicity, which suggests that GSH is critical for cellular protection against the toxicity of NO-. Further experiments showed that low molecular weight transition metal complexes associated with the formation of reactive oxygen species are not involved in AS-mediated cytotoxicity since metal chelators had no effect. However, under aerobic conditions, AS was more toxic than under hypoxic conditions, suggesting that oxygen dramatically enhanced AS-mediated cytotoxicity. At a molecular level, AS exposure resulted in DNA double strand breaks in whole cells, and this effect was completely prevented by coincubation of cells with ferricyanide or Tempol. The data in this study suggest that nitroxyl may contribute to the cytotoxicity associated with an enhanced expression of the L-arginine:NO pathway under different biological conditions.

Effects of inhaled nitric oxide in patients with acute respiratory distress syndrome: results of a randomized phase II trial. Inhaled Nitric Oxide in ARDS Study Group

OBJECTIVES

To evaluate the safety and physiologic response of inhaled nitric oxide (NO) in patients with acute respiratory distress syndrome (ARDS). In addition, the effect of various doses of inhaled NO on clinical outcome parameters was assessed.

DESIGN

Prospective, multicenter, randomized, double-blind, placebo-controlled study.

SETTING

Intensive care units of 30 academic, teaching, and community hospitals in the United States.

PATIENTS

Patients with ARDS, as defined by the American-European Consensus Conference, were enrolled into the study if the onset of disease was within 72 hrs of randomization.

INTERVENTIONS

Patients were randomized to receive placebo (nitrogen gas) or inhaled NO at concentrations of 1.25, 5, 20, 40, or 80 ppm.

MEASUREMENTS AND MAIN RESULTS

Acute increases in PaO2, decreases in mean pulmonary arterial pressure, intensity of mechanical ventilation, and oxygenation index were examined. Clinical outcomes examined were the dose effects of inhaled NO on mortality, the number of days alive and off mechanical ventilation, and the number of days alive after meeting oxygenation criteria for extubation. A total of 177 patients were enrolled over a 14-month period. An acute response to treatment gas, defined as a PaO2 increase > or =20%, was seen in 60% of the patients receiving inhaled NO with no significant differences between dose groups. Twenty-four percent of placebo patients also had an acute response to treatment gas during the first 4 hrs. The initial increase in oxygenation translated into a reduction in the FIO2 over the first day and in the intensity of mechanical ventilation over the first 4 days of treatment, as measured by the oxygenation index. There were no differences among the pooled inhaled NO groups and placebo with respect to mortality rate, the number of days alive and off mechanical ventilation, or the number of days alive after meeting oxygenation criteria for extubation. However, patients receiving 5 ppm inhaled NO showed an improvement in these parameters. In this dose group, the percentage of patients alive and off mechanical ventilation at day 28 (a post hoc analysis) was higher (62% vs. 44%) than the placebo group. There was no apparent difference in the number or type of adverse events reported among those patients receiving inhaled NO compared with placebo. Four patients had methemoglobin concentrations >5%. The mean inspired nitrogen dioxide concentration in inhaled NO patients was 1.5 ppm.

CONCLUSIONS

From this placebo-controlled study, inhaled NO appears to be well tolerated in the population of ARDS patients studied. With mechanical ventilation held constant, inhaled NO is associated with a significant improvement in oxygenation compared with placebo over the first 4 hrs of treatment. An improvement in oxygenation index was observed over the first 4 days. Larger phase III studies are needed to ascertain if these acute physiologic improvements can lead to altered clinical outcome.

Nitric oxide enhances hydrogen peroxide-mediated endothelial permeability in vitro

The objective of this study was to evaluate the effects of nitric oxide (NO) on H2O2-mediated endothelial permeability. H2O2 (0.1 mM) increased permeability at 90 min to 298% of baseline. Spermine NONOate (SNO), an NO donor, at 0.1 or 1 mM did not alter permeability. However, 0.1 mM H2O2 + 1 mM SNO increased permeability to 764%, twice that of 0.1 mM H2O2 alone. These treatments were not directly toxic to endothelial cells. This NO effect was concentration dependent, inasmuch as 0.1 mM SNO did not significantly change H2O2-mediated permeability. The NO-enhanced, H2O2-dependent permeability required the simultaneous presence of NO and H2O2, inasmuch as preincubation with SNO for 30 min followed by 0.1 mM H2O2 did not alter permeability. Staining of endothelial junctions showed widening of the intercellular space only in junctions of cells exposed to H2O2 (0.1 mM) + SNO (1 mM). Furthermore, NO did not affect H2O2 metabolism by endothelial cells but significantly depleted intracellular glutathione. This reduction of cell glutathione produced by NO exposure recovered 15-30 min after removal of the NO donor. NO-enhanced permeability was completely blocked by methionine (1 mM), a scavenger of reactive oxygen species, and by the iron chelator desferrioxamine (0.1 mM). These results suggest that NO may exacerbate the effects of H2O2-dependent increase in endothelial monolayer permeability via the iron-catalyzed formation of reactive oxygen metabolites.

Nitric oxide synergistically enhances DNA strand breakage induced by polyhydroxyaromatic compounds, but inhibits that induced by the Fenton reaction

Reactive oxygen and nitrogen species play an important role in many human diseases including cancer. We have found that incubation of pBR322 plasmid DNA with a nitric oxide (NO)-releasing compound such as diethylamine NONOate and a polyhydroxyaromatic compound such as catechol, 1,4-hydroquinone, or pyrogallol caused synergistic induction of single-strand breakage, whereas either compound alone induced much less breakage. Phenol, resorcinol, or guaiacol (O-methylcatechol) did not exhibit this synergistic effect of DNA damage with NO. The strand breakage induced by NO with pyrogallol was prevented by excess superoxide dismutase, carboxy-PTIO (an NO-trapping agent), or anti-oxidants (urate, ascorbate). Possible mechanisms for the induction of this synergistic effect of NO and polyhydroxyaromatic compounds on the strand breakage are proposed, including involvement of peroxynitrite formed from NO and O2.- derived from autooxidation of polyhydroxyaromatics. This pathway for generation of reactive species from NO and catechol-type compounds (e.g., L-dopa, catechol-estrogen) may be important in many pathological conditions, because both compounds are concurrently formed or present in vivo. On the other hand, NO dose-dependently inhibited the strand breakage mediated by 1,4-hydroquinone plus Cu2+ or Fenton reaction (H2O2, iron or copper). This inhibition could be due to formation of a complex between NO and a metal ion, inhibiting generation of reactive species from H2O2. Our results can account for contrasting activities of NO reported in relation to tissue injury. NO can play both detrimental and beneficial roles in DNA damage, depending on the type and amounts of reactive oxygen species and metal ions concurrently present.

In vitro and in vivo cytotoxic effects of nitric oxide on metastatic cells

It has been reported that nitric oxide (NO) is tumoricidal in vitro and inhalation of NO is effective for the therapy of pulmonary hypertension. However, little attention has been addressed to the effects of inhaled NO on tumors in the lung. In the present study cytotoxic effects of NO have been investigated both in vitro and in vivo using metastatic cell lines. Viabilities of both B16 melanoma and Lewis lung carcinoma cells were decreased in the presence of S-nitroso-N-acetyl-DL-penicillamine (SNAP) in vitro and the cytotoxicity of SNAP was reduced dose-dependently by NO radical scavenger, oxyhemoglobin. To examine in vivo tumoricidal activity of NO, mice were exposed to 10-80 ppm NO gas after intravenous injection of both tumor cell lines. Intravenous injection of both cell lines produced metastatic tumor colonies in the mouse lung. However, inhaled NO did not reduce the tumor colony formation in the lung. The increase in NO concentration was accompanied by elevation of concomitant nitric dioxide concentration in exposure chambers and exposure to higher concentration of NO appeared to enhance tumor colony formation in the lung.

Sensitivity of human hepatocytes in culture to reactive nitrogen intermediates

The cytotoxic effects of 3-morpholinosydnonimine (Sin-1) and S-nitroso-N-acetylpenicillamine-amine (SNAP) on replicatively active human hepatocyte cells in culture was determined as a function of oxidant type. Both Sin-1 which yields nitric oxide and peroxynitrite following the generation of superoxide anion plus nitric oxide, and SNAP which generates nitric oxide, induced dose dependent decreases in the colony forming capabilities of the human hepatocytes. Sin-1 was much more cytotoxic (LD50 = 400 microM) than SNAP (LD50 = 1250 microM). Comparatively, both compounds were much less cytotoxic than H2O2 (LD50 = 96 microM). Sin-1 induced 4-fold higher levels of cellular nitrite than that generated by the chemical in cell free medium. Nitrotyrosine, a marker of peroxynitrite formation in cells, was immunohistochemically detected in hepatocytes treated with both Sin-1 and SNAP. The formation of 3-nitrotyrosine by hepatocytes incubated with SNAP, suggests that hepatocytes generate intracellular superoxide which reacts with the exogenous nitric oxide derived from SNAP to produce intracellular peroxynitrite, resulting in the SNAP cytotoxicity. The enhanced levels of Sin-1 cytotoxicity on the hepatocytes is suggested to be due both to the chemical generation of peroxynitrite and superoxide anion by Sin-1. These data indicate that peroxynitrite is formed in cultured human hepatocytes inhibiting their replication, and that peroxynitirite may play a significant role in the pathogenesis of liver disease.

Low-dose nitric oxide inhalation during initial reperfusion enhances rat lung graft function

BACKGROUND

In ischemia-reperfusion injury, the production of nitric oxide by dysfunctional endothelium falls rapidly within minutes of the onset of reperfusion. Replenishment during this critical early period using inhaled nitric oxide may benefit lung grafts through modulation of vascular tone, endothelial permeability, neutrophil and platelet function, and availability of reactive oxygen species.

METHODS

Rat lung grafts were flushed with 60 mL/kg cold University of Wisconsin solution and were reperfused either immediately (group I, n = 5) or after 24-hour 4 degrees C storage (groups II and III, n = 5 each), for 60 minutes in an ex vivo model incorporating a support animal. Graft ventilation was with room air. In group III, 20 parts per million inhaled nitric oxide was added during the initial 10 minutes of reperfusion, whereas in groups I and II, equivalent flows of nitrogen were added to standardize oxygen concentration.

RESULTS

Compared with group I, graft function in group II was poor, with reductions in oxygenation and blood flow and elevations of mean pulmonary artery pressure, peak airway pressure, and wet to dry weight ratio. In contrast, during nitric oxide inhalation in group III, graft function improved to control levels. This improvement was subsequently sustained throughout the reperfusion period.

CONCLUSIONS

Low-dose inhaled nitric oxide administration in the early phase of reperfusion of stored lung grafts can yield sustained improvement in function. There may be a role for inhaled nitric oxide in the prevention of reperfusion injury in transplanted lungs.

Attenuation of lung graft reperfusion injury by a nitric oxide donor

OBJECTIVE

One of the primary features of ischemia-reperfusion injury is reduced production of protective autocoids, such as nitric oxide, by dysfunctional endothelium. Administration of a nitric oxide donor during reperfusion of lung grafts may therefore be beneficial through modulation of vascular tone and leukocyte and platelet function.

METHODS

Rat lung grafts were flushed with University of Wisconsin solution and reperfused for 1 hour in an ex vivo model incorporating a support animal. Group I grafts (n = 6) were reperfused immediately after explantation, group II (n = 6) and III (n = 5) grafts after 24 hours of storage at 4 degrees C. In group III, glyceryl trinitrate, a nitric oxide donor, was administered during the first 10 minutes of reperfusion at a rate of 200 micrograms/min. In an additional group (n = 5), 200 micrograms/min hydralazine was administered instead, to assess the effect of vasodilation alone.

RESULTS

Graft function in group II deteriorated compared with that in group I, with significant reduction of graft effluent oxygen tension and blood flow and elevation of pulmonary artery pressure, peak airway pressure, and wet/dry weight ratio. In contrast, in group III, glyceryl trinitrate treatment improved graft function to baseline levels in all these parameters. Administration of hydralazine, meanwhile, produced mixed results with only two out of five grafts functioning at control levels.

CONCLUSIONS

In this model, administration of glyceryl trinitrate to supplement the nitric oxide pathway in the early phase of reperfusion has a sustained beneficial effect on lung graft function after 24-hour hypothermic storage, probably through mechanisms beyond vasodilation alone.

Nitric oxide and some nitric oxide donor compounds enhance the cytotoxicity of cisplatin

A major emphasis in cancer therapy research is finding mechanisms to enhance the effectiveness of clinically used chemotherapeutic agents. In this report, we show the effects of direct NO exposure or NO delivery agents such as NONOate NO donors, DEA/NO ((C2H5)2N[N(O)NO]-Na+) and PAPA/ NO (NH2(C3H6)(N[N(O)NO]C3H7)), or S-nitrosothiol NO donors (GSNO, S-nitrosoglutathione, and SNAP, S-nitroso-N-acetylpenicillamine) on the cytotoxicity of cisplatin with Chinese hamster V79 lung fibroblast cells. Cells pretreated with bolus NO or NO delivered from NONOate NO donors were markedly sensitized to subsequent cisplatin treatment, whereas S-nitrosothiol NO donors exerted little effect. The enhancement in cisplatin cytotoxicity from pretreatment with DEA/NO and PAPA/ NO persisted for approximately 180 and 240 min, respectively; thereafter cytotoxicity returned to a level consistent with cisplatin treatment alone. Pretreatment of cells with GSNO or SNAP did not enhance cisplatin cytotoxity. To discern why there were differential effects among the different NO donors, formation of NO over the time course of the experiment was assessed by the nitrosation of 2,3-diaminonaphthylene. Bolus NO, DEA/NO, and PAPA/NO produced more reactive nitrogen oxide species (RNOS) than did treatment with GSNO or SNAP. Previously reported electrochemical studies revealed that temporal NO concentrations measured from DEA/NO and PAPA/NO (1 mM) were greater than 5 microM. It appears that the flux of NO, as well as the amount of RNOS, is important in the NO-mediated enhancement of cisplatin cytotoxicity. Our results demonstrate the importance of NO delivery systems in the enhancement of cisplatin cytotoxicity and may provide insights into strategies for participation of NO donors and nitric oxide synthase with cisplatin therapy.

Cardiac arrest induces decrease of nitric oxide synthase activity and increase of free radical generation in rat brain regions

Rats were subjected to 15 min cardiac arrest and sacrificed 1 h or 15-20 days after resuscitation. Homogenates of brain regions were assayed for nitric oxide synthase (NOS) activity (by measuring the mononitrosyl iron complex of NO with diethyl dithiocarbamate and endogenous brain Fe2+ using electron spin resonance spectroscopy) and generation of free radicals (FRG; by measuring H2O2-induced, luminol-dependent chemiluminescence). Cardiac arrest induced marked decrease of NOS activity and the increase of FRG, most prominent in cerebellum and less marked in cerebral cortex. Two groups of rats were revealed 15-20 days after cardiac arrest: with NOS activity significantly lower than control and not different from control. Positive linear inter-regional cross-correlations of both NOS activity and FRG (except of the group 1 h after resuscitation) as well as negative correlations between NOS and FRG were demonstrated.

Binge ethanol-induced brain damage in rats: effect of inhibitors of nitric oxide synthase

Testing the possible role of endogenous nitric oxide (NO) in the neurotoxicity of ethanol, we examined how two different NO synthase (NOS) inhibitors affected the extent cerebrocortical and olfactory neuronal damage in a modified "binge intoxication" rat model (Collins et al., Alcohol Clin. Exp. Res. 20:284-292, 1996). Male rats intragastrically fed ethanol (6.5 to 12 g/kg/day) in nutrient solution three times daily for 4 days also received NG-nitro-L-arginine methyl ester by chronic intracerebroventricular infusion or 7-nitro-indazole by daily intraperitoneal injection; control rats were given nutrient solution only and/or vehicles. Blood ethanol levels did not differ among the ethanol-treated groups. The amount of ethanol-dependent neuronal degeneration in the entorihinal cortex, dentate gyrus, and olfactory bulb glomeruli--visualized with the de Olmos cupric silver stain and quantitatively assessed in the binge-intoxicated rats--was either unchanged or significantly increased by the NOS inhibitors. Although the efficacies of the inhibitors cannot be directly compared because of various NOS forms were probably inhibited to differing extents, the results do not support the idea that endogenous NO is a neurotoxic mediator of ethanol's effects. Rather NO may have a modest neuroprotectant role in this model of early brain damage induced by ethanol. In addition, the NOS that is localized histochemically as NADPH diaphorase was present primarily in regions and/or cells not damaged by binge ethanol treatment. Assuming that NADPH diaphorase represents most of the NO forming enzyme(s) this suggests a transcellular mechanism for NO. A further observation was that hippocampal CA pyramidal neuron degeneration was extensive in rats infused centrally with NG-nitro-L-arginine methyl ester.

Interleukin-1-induced nitric oxide production modulates glutathione synthesis in cultured rat hepatocytes

In cultured rat hepatocytes, we have previously demonstrated that inhibition of interleukin-1 (IL-1)-mediated nitric oxide (NO) synthesis is associated with depletion of intracellular reduced glutathione (GSH) in toxin-mediated oxidative injury. To further examine NO's effects on GSH metabolism in rat hepatocytes, IL-1-mediated NO synthesis was examined in the context of 1) cysteine, cystine, and methionine uptake; 2) gene transcription and enzyme activities for gamma-glutamylcysteine synthetase, the rate-limiting enzyme in GSH synthesis, glutathione reductase, and glutathione peroxidase; and 3) GSH and oxidized glutathione (GSSG) levels. Inhibition of NO synthesis decreased the GSH content and GSH/GSSG ratio in a guanylyl cyclase-independent fashion. Enzyme activity and steady-state levels of mRNA for gamma-glutamylcysteine synthetase were also depressed. Nuclear run-on analysis demonstrated ablation of gamma-glutamylcysteine synthetase gene transcription. Hepatocellular uptake of cysteine, cystine, and methionine was not altered. Activity and steady-state mRNA levels for glutathione reductase and glutathione peroxidase were not affected. These results indicate that IL-1-mediated NO synthesis regulates hepatocyte GSH synthesis through a mechanism that is dependent on transcriptional regulation of the rate-limiting enzyme in GSH synthesis. In the setting of oxidative stress and IL-1 exposure, hepatocyte synthesis of NO may be protective through regulation of GSH synthesis.

Nitric oxide-associated regulation of hepatocyte glutathione synthesis is a guanylyl cyclase-independent event

BACKGROUND

In a system of rat hepatocytes in primary culture, inhibition of cytokine-mediated nitric oxide (NO) production has been shown to be protective in states of oxidative stress. In the absence of oxidative injury, inhibition of NO synthesis has been associated with decreased intracellular levels of reduced glutathione.

METHODS

To further characterize the role of NO in hepatocyte glutathione metabolism, cytokine-mediated NO synthesis was inhibited by addition of a competitive substrate inhibitor. Reduced glutathione, NO metabolites, and enzyme activity and steady-state mRNA levels of the rate-limiting enzyme for reduced glutathione (GSH) synthesis, gamma-glutamylcysteine synthetase, were determined in the presence and absence of the substrate inhibitor. A diffusible cyclic guanosine monophosphate (cGMP) analog, 8-bromo-cGMP, was added in selected instances to determine the potential role of soluble guanylyl cyclase in glutathione metabolism.

RESULTS

Inhibition of cytokine-induced NO synthesis was associated with depletion of glutathione. These levels were restored in the presence of pharmacologic concentrations of a NO donor. Along with decreased glutathione levels, gamma-glutamylcysteine synthetase enzyme activity and steady state mRNA levels were also decreased with inhibition of NO synthesis. Addition of 8-bromo-cGMP did not alter glutathione content or gamma-glutamylcysteine synthetase enzyme activity and steady-state mRNA levels.

CONCLUSIONS

In this system of cultured rat hepatocytes, cytokine-mediated NO synthesis may be protective in states of oxidative stress through regulation of glutathione synthesis.

Evaluation of the relative contribution of nitric oxide and peroxynitrite to the suppression of mitochondrial respiration in immunostimulated macrophages using a manganese mesoporphyrin superoxide dismutase mimetic and peroxynitrite scavenger

Here we report that the cell-permeable superoxide dismutase mimetic Mn(III)tetrakis (4-benzoic acid) porphyrin (MnTBAP) inhibits the oxidation of dihydrorhodamine-123 by peroxynitrite, but does not scavenge nitric oxide (NO). MnTBAP protects against the suppression of mitochondrial respiration in J774 cells exposed to peroxynitrite or to NO donors. MnTBAP and N(G)-methyl-L-arginine provide additive protective effect against the suppression of respiration in immunostimulated cells. Our data suggest separate contributions of NO and peroxynitrite to the suppression of mitochondrial respiration and support the role of oxidative stress in the expression of the inducible isoform of NO synthase.

Nitric oxide (NO) protects against cellular damage by reactive oxygen species

Since the discovery of nitric oxide (NO) as an endogenously formed radical, its effect on numerous physiological processes has been intensively investigated. Some studies have suggested NO to be cytotoxic while others have demonstrated it protective under various biological conditions. Though NO shows minimal cytotoxicity to a variety mammalian cell cultures, it does modulate the toxicity of some agents such as reactive oxygen species. Often, NO is generated in the presence of these reactive oxygen species in response to foreign pathogens or under various pathophysiological conditions. We will show that NO can play a protective role under oxidative stress resulting from superoxide, hydrogen peroxide and alkyl peroxides. It was found by measuring the time-concentration profiles of NO released from various NO donor compounds that only microM levels of NO were required for protection against the toxicity of these reactive species. It was found that there are several chemical reactions which may account for these protective effects such as NO preventing heme oxidation, inhibition of Fenton-type oxidation of DNA, and abatement of lipid peroxidation. Taken together, NO at low concentrations clearly protects against peroxide-mediated toxicity.