Release and hemodynamic influence of nitro-glycerine-derived nitric oxide in endotoxemic rats

Pathological Impact of the Interaction of NO and CO with Mitochondria in Critical Care Diseases

The outcome of patients with critical care diseases (CCD) such as sepsis, hemorrhagic shock, or trauma is often associated with mitochondrial dysfunction. In turn, mitochondrial dysfunction is frequently induced upon interaction with nitric oxide (NO) and carbon monoxide (CO), two gaseous messengers formed in the body by NO synthase (NOS) and heme oxygenase (HO), respectively. Both, NOS and HO are upregulated in the majority of CCD. A multitude of factors that are associated with the pathology of CCD exert a potential to interfere with mitochondrial function or the effects of the gaseous messengers. From these, four major factors can be identified that directly influence the effects of NO and CO on mitochondria and which are defined by (i) local concentration of NO and/or CO, (ii) tissue oxygenation, (iii) redox status of cells in terms of facilitating or inhibiting reactive oxygen species formation, and (iv) the degree of tissue acidosis. The combination of these four factors in specific pathological situations defines whether effects of NO and CO are beneficial or deleterious.

EPR analysis of extra- and intracellular nitric oxide in liver biopsies

PURPOSE

To develop an assay that can enable the quantification of intra- and extracellular nitric oxide (NO) levels in liver biopsies without application of potentially harmful exogenous NO traps.

THEORY

Electron paramagnetic resonance (EPR) spectroscopy is currently the most appropriate method of measuring NO in biological samples due to the outstanding specificity resulting from the interaction of NO with exogenous NO traps. Because such traps are not allowed in clinical settings, we tested the reliability of endogenous NO traps for the determination of NO levels in blood and liver compartments.

METHODS

Rats were injected with 0-8 mg/kg lipopolysaccharide (LPS) to gradually induce a systemic inflammatory response. Specific features of NO-hemoglobin and NO-Fe EPR signals were quantified using a specifically developed calibration procedure.

RESULTS

Whereas both NO-hemoglobin (NO-Hb^{LIVER BLOOD} ) and NO-Fe (NO-Fe^LIVER ) complexes were detected in nonperfused liver tissue, only NO-Fe complexes were detected in perfused tissue and only NO-Hb complexes were detected in blood (NO-Hb^BLOOD ). The NO concentrations increased in the sequence NO-Hb^BLOOD  < NO-Fe^LIVER  < NO-Hb^{LIVER BLOOD} (9.4, 18.5, 27.9 nmol/cm³ , respectively at 2.5 mg/kg LPS). The detection limit of the method was 0.61 nmol/cm³ for NO-Hb and 0.52 nmol/cm³ for NO-Fe.

CONCLUSION

The assay reported here does not influence natural NO pathways and enables the quantification of NO distribution in two liver compartments using a single liver biopsy. Magn Reson Med 77:2372-2380, 2017. © 2016 International Society for Magnetic Resonance in Medicine.

Nitric oxide donors in sepsis: a systematic review of clinical and in vivo preclinical data

An abundant literature in the field of sepsis focuses on the role of NO. Inhibiting NO synthesis corrects certain hemodynamic parameters of septic shock but failed to improve outcome in patients. Conversely, administration of NO donors lowers blood pressure but restores microcirculatory flow in patients with sepsis. We undertook a systematic review of the literature to comprehensively summarize the results of studies exploring the effects of systemic NO donors in sepsis. We included both clinical and preclinical data. We described the details surrounding NO donor administration, and the results obtained in each study were regrouped in broad categories. In the case of animal research, we limited our data collection to in vivo protocols and described the sepsis model. Finally, we critically appraised all the studies included in the review. Overall, the reviewed publications aimed for physiopathological description rather than clinical relevance and did not meet the required criteria for extrapolation to clinical practice. With this reserve, NO donors usually improved the outcomes measured (e.g., mortality, pulmonary hypertension, tissue/organ perfusion, etc.) but also lowered blood pressure. We conclude that our findings warrant further animal experimentation designed to maximize clinical relevance.

Endotoxin causes pulmonary hypertension by upregulating smooth muscle endothelin type-B receptors: role of aldose reductase

Endothelin-1 (ET-1), a potent vasoconstrictor and mitogen, is upregulated in pulmonary tissue during endotoxemia and contributes markedly to endotoxin-induced pulmonary hypertension. It is, however, unknown whether the ET receptors, ET(A) and ET(B), are differentially regulated in endotoxemic pulmonary vasculature and how this may impact on pulmonary vascular tone. To investigate this topic, we used isolated perfused lungs, pulmonary endothelial cells (ECs), and pulmonary vascular smooth muscle cells (SMCs) of the rat. During a 6-h endotoxin exposure, isolated perfused lungs developed significant pulmonary hypertension that was markedly attenuated by antagonizing ET(A) or ET(B) receptors using subtype-selective or a mixed ET(A/B) receptor antagonist. Peptide levels of big ET-1 and ET-1 and gene expression of prepro-ET-1 were increased after endotoxin challenge in all tissues. In endotoxemic isolated perfused lungs and ECs, the significant rise of mature ET-1 seen in controls after ET(B) receptor or mixed antagonism disappeared completely. However, this effect was preserved in endotoxemic SMCs. In ECs, endotoxin markedly downregulated maximum ET(B) receptor sites and ET(B) mRNA levels, whereas in SMCs, it generated substantial ET(B) receptor upregulation and moderate ET(A) receptor downregulation. The aldose reductase inhibitors sorbinil and zopolrestat mitigated endotoxin-induced pulmonary hypertension, ET-1 stimulation, and differential ET(B) receptor regulation. We conclude that endotoxin-induced pulmonary hypertension in the rat results from a loss of endothelial and concomitant gain of vascular smooth muscle ET(B) receptors. These changes are at least partly mediated by aldose reductase.