Induced nitric oxide impairs relaxation but not contraction in endotoxin-exposed rat pulmonary arteries

Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS

Objective

Pulmonary hypertension is a characteristic feature of acute respiratory distress syndrome (ARDS) and contributes to mortality. Administration of sildenafil in ambulatory patients with pulmonary hypertension improves oxygenation and ameliorates pulmonary hypertension. Our aim was to determine whether sildenafil is beneficial for patients with ARDS.

Design

Prospective, open-label, multicenter, interventional cohort study.

Setting

Medical-surgical ICU of two university hospitals.

Patients

Ten consecutive patients meeting the NAECC criteria for ARDS.

Interventions

A single dose of 50 mg sildenafil citrate administered via a nasogastric tube.

Main results

Administration of sildenafil in patients with ARDS decreased mean pulmonary arterial pressure from 25 to 22 mmHg (P = 0.022) and pulmonary artery occlusion pressure from 16 to 13 mmHg (P = 0.049). Systemic mean arterial pressures were markedly decreased from 81 to 75 mmHg (P = 0.005). Sildenafil did not improve pulmonary arterial oxygen tension, but resulted in a further increase in the shunt fraction.

Conclusion

Although sildenafil reduced pulmonary arterial pressures during ARDS, the increased shunt fraction and decreased arterial oxygenation render it unsuitable for the treatment of patients with ARDS.

Electronic supplementary material

The online version of this article (doi:10.1007/s00134-010-1754-3) contains supplementary material, which is available to authorized users.

Essential role of nitric oxide in sepsis-induced impairment of endothelium-derived hyperpolarizing factor-mediated relaxation in rat pulmonary artery

Both endothelial nitric oxide (NO) and endothelium-derived hyperpolarizing factor (EDHF) are important vasodilators in pulmonary circulation. Sepsis is known to impair endothelium-dependent dilation in the pulmonary vasculature, but the mechanisms are incompletely understood. We have examined the relative contribution of EDHF/NO to the attenuated endothelium-dependent relaxation of pulmonary artery in sepsis, and the role of inducible nitric oxide synthase (iNOS)-derived NO in this mechanism. Sepsis was induced in male adult Wistar rats by caecal ligation and puncture. At 18h after surgery, left and right branches of pulmonary arteries were isolated for tension recording, NO/cyclic guanosine monophosphate (cGMP) measurements, mRNA and protein expressions. Despite a marked decrease in the arterial endothelial nitric oxide synthase (eNOS) mRNA and phosphorylated-eNOS (p-eNOS) protein expressions in sepsis, endothelium-dependent relaxation to acetylcholine (ACh) mediated by NO, acetylcholine-stimulated NO release and tissue cGMP levels were moderately inhibited. Sepsis however abolished the N(G)-Nitro-l-arginine methyl ester (L-NAME)/indomethacin-resistant arterial relaxation (EDHF response) to acetylcholine in this vessel. In vitro treatment of the arterial rings from septic rats with 1400W, a selective inhibitor of iNOS restored the EDHF response, but had no effect on the acetylcholine-induced relaxation mediated by endothelial NO. The functional role of iNOS-derived NO in impairing EDHF-mediated relaxation was coincident with an increased basal NO production, iNOS mRNA and protein expressions in the rat pulmonary artery. In conclusion, the loss of the EDHF response may be primarily responsible for the endothelial dysfunction in sepsis, and its restoration by a selective iNOS inhibitor may improve pulmonary vasodilation.

Voltage-independent calcium channels mediate lipopolysaccharide-induced hyporeactivity to endothelin-1 in the rat aorta

The roles of intracellular calcium concentration ([Ca(2+)](i)) and Ca(2+) sensitization in lipopolysaccharide (LPS)-induced vascular smooth muscle (VSM) hyporesponsiveness are incompletely understood. To investigate these roles, contraction responses to endothelin-1 (ET-1) and 80 mM KCl; relaxation responses to nifedipine; the expression levels of mRNAs of ET-1 and its receptors (ET(A) or ET(B)); the expression levels of protein kinase C (PKC) and phosphorylation of Rho kinase (ROKalpha), CPI-17, and myosin phosphatase target subunit-1 (MYPT1); and changes in aortic VSM cell [Ca(2+)](i) were measured in LPS-treated aortic rings from male Wistar rats (250-300 g). LPS (10 mug/ml, 20 h) decreased contraction induced by ET-1 (0.3-100 nM) or 80 mM KCl. LPS-induced hypocontractility was not observed in the absence of external Ca(2+), but LPS-treated aorta remained hypocontractile on subsequent stepwise restoration of extracellular Ca(2+) (0.01-10 mM). Vascular relaxation to nifedipine; mRNA expression levels of ET-1, ET(A), or ET(B); protein expression levels of PKC; and phosphorylation levels of ROKalpha, CPI-17, and MYPT1 were not affected by LPS. In isolated aortic VSM cells, ET-1 caused a transient initial increase in [Ca(2+)](i), followed by a maintained tonic increase in [Ca(2+)](i), which was decreased by LPS pretreatment and was dependent on external Ca(2+). Subsequent restoration of extracellular Ca(2+) increased [Ca(2+)](i), but this increase was lower in the LPS-treated group. This difference in response to extracellular Ca(2+) addition was not affected by diltiazem, but was abolished by SKF-96365. Therefore, LPS induces hyporeactivity to ET-1 in rat aorta that depends on external Ca(2+) influx through non-voltage-operated Ca(2+) channels, but not on ET-1 receptor expression or Ca(2+) sensitization.

Role of protein kinase G in nitric oxide deficiency-induced supersensitivity to nitrovasodilator in rat pulmonary artery

The aim of the present study was to examine the role of protein kinase G (G-kinase) in the mechanism of endogenous nitric oxide (NO) deficiency-induced supersensitivity to the nitrovasodilator sodium nitroprusside (SNP) in isolated rat pulmonary artery. Tension experiments and cGMP measurements were carried out on isolated rat pulmonary artery to assess the influence of NO deficiency, caused by either N-nitro-L-arginine methyl ester (L-NAME) treatment or endothelium removal on the vasodilator potency of SNP. Sodium nitroprusside was more potent (pD2; 8.21 +/- 0.04) in relaxing arterial rings treated with 100microM L-NAME or denuded of the endothelium (pD2; 8.44 +/- 0.11) compared with the endothelium-intact controls (pD2; 7.61 +/- 0.05). Similarly, the tissue sensitivity to 8-Br-cGMP, a G-kinase activator, was significantly (P < 0.05) greater after L-NAME treatment (pD2; 5.04 +/- 0.09) or endothelium removal (pD2; 5.28 +/- 0.11) in comparison with the controls (pD2; 4.22 +/- 0.17). On the other hand, dibutyryl cAMP, an activator of protein kinase A, was equipotent in dilating control (pD2; 4.14 +/- 0.04) and L-NAME-treated (pD2 4.21 +/- 0.05) vessels. Further, L-NAME treatment significantly (P < 0.05) decreased the basal cGMP but enhanced SNP (1 microM)-stimulated increase in the tissue cyclic nucleotide levels (271.8 +/- 39.93 pmol/mg protein versus control: 66.19 +/- 7.18 pmol/mg protein), indicating sensitization of soluble guanylyl cyclase to NO. The increased sensitivity of G-kinase to cGMP observed in the present study suggests a novel mechanism of supersensitivity in vascular smooth muscle to nitrovasodilators in acute NO deficiency. Further, it explains the influence of ambient cGMP in determining the sensitivity of G-kinase in vascular smooth muscle.