Analysis of nitric oxide activity in prevention of reperfusion injury

Modulation of Nitric Oxide Bioavailability Attenuates Ischemia-Reperfusion Injury in Type II Diabetes

BACKGROUND

Diabetes mellitus increases the susceptibility of free tissue transplantations to ischemia-reperfusion injury. The aim of this study was to enhance nitric oxide (NO) bioavailability through exogenous NO synthase and the substrate L-arginine to attenuate ischemia reperfusion-induced alterations in a type 2 diabetes rodent model.

MATERIAL AND METHODS

Sixty-four Wistar rats were divided into 8 experimental groups. Type 2 diabetes was established over 3 months with a combination of a high-fat diet and streptozotocin. A vascular pedicle isolated rat skin flap model that underwent 3 h of ischemia was used. At 30 min before ischemia, normal saline, endothelial NOSs (eNOSs), inducible NOSs, neuronal NOSs (1 and 2 IU), and L-arginine (50 mg/kg body weight) were administered by intravenous infusion alone or in combination. Ischemia-reperfusion-induced alterations were measured 5 days after the operation.

RESULTS

The three isoforms of NOS significantly increased the flap vitality rate (VR) between 20% and 28% as compared to the control group (3%). Sole L-arginine administration increased the VR to 33%. The combination of L-arginine with NOS resulted in a further increase in flap VRs (39%-50%). Best results were achieved with the combination of eNOS and L-arginine (50%). An increase in enzyme dosage led to decreased VRs in all NOS isoforms alone and even in combination with L-arginine.

CONCLUSION

Modulation of NO bioavailability through the exogenous application of NOSs and L-arginine significantly attenuated ischemia-reperfusion-induced alterations in a type 2 diabetic skin flap rat model. The combination of enzyme and substrate result in the highest VRs. Higher enzyme dosage seems to be less effective. This pharmacological preconditioning could be an easy and effective interventional strategy to support the conversion of L-arginine to NO in ischemic and in type 2 diabetic conditions.

Pharmaceutical Preconditioning With Nitric Oxide Synthase and L-Arginine in Ischemic Tissues

BACKGROUND

Nitric oxide (NO) is a multifunctional signaling molecule involved in regulating vascular tone and tissue oxygenation. It is also an important cytoprotective agent against ischemia-reperfusion injury (IRI). Enhancing NO bioavailability via exogenous NO synthases (NOSs) and L-arginine promotes conversation to NO, circumventing the problem of nonfunctioning NOSs under hypoxic and acidic conditions. In this study, the authors evaluated the therapeutic efficacy of neuronal, inducible, and endothelial NOS and L-arginine on reperfusion-induced skin flap alterations.

METHODS

The vascular pedicle isolated rat skin flap model was used and underwent 3 hours of ischemia. At 30 minutes before ischemia, normal saline, endothelial-, inducible-, and neuronal NOSs (1/2 IU) and L-arginine (100 mg/kg body weight) were administered by means of intravenous infusion. The IRI-induced alterations were measured 5 days after the operation.

RESULTS

The 3 isoforms of NOS increased the flap vitality rate (VR) from 10% to 23% compared with the control group. L-Arginine treatment also increased the VR by approximately 15%. The combination of L-arginine with NOS resulted in even higher flap VRs. The best results could be achieved with the combination of endothelial NOS (2 IU) and L-arginine.

CONCLUSIONS

Modulation of NO bioavailability via exogenous application of NOSs and L-arginine significantly improved VRs in a skin flap rat model. This pharmacologic preconditioning has the potential to attenuate IRI-induced alterations in skin flaps.

Effect of aminoguanidine on sciatic functional index, oxidative stress, and rate of apoptosis in an experimental rat model of ischemia-reperfusion injury

This study was conducted to investigate the potential protective effects of aminoguanidine (AG) on sciatic functional index (SFI), oxidative stress status, and apoptosis index using a rat model of experimental sciatic nerve ischemia-reperfusion injury (I/R). Treatment groups received 150 mg AG/kg body mass, 24 h after the induction of ischemia. After reperfusion for 2, 4, 7, 14, and 28 days, we evaluated measured SFI, plasma antioxidant enzymes, total antioxidant capacity (TAC), malondialdehyde (MDA), and index of apoptosis. SFI was significantly improved on the 7th and 14th day of reperfusion in the AG-treated groups. AG treatment resulted in the significant reduction of MDA levels on the 7th and 14th day of reperfusion. TAC was only increased after 7 days of reperfusion compared with the untreated group. SOD activity was decreased in both the untreated and AG-treated groups by comparison with the control, but did not show a significant change. GPx activity decreased only after 7 days of reperfusion. The maximal rate of apoptosis occurred on the 7th day of reperfusion. Treatment with AG significantly reduced this enhancement. AG exhibits positive effects against sciatic nerve I/R injury, possibly in part because of the protective effects of AG against apoptosis and I/R-induced oxidative stress.

Immunosupression and infection after major surgery: a nutritional deficiency

T cell dysfunction significantly increases susceptibility to infections and organ failure after trauma or surgery (physical injury). This coincides with a persistent drop in arginine availability, a necessary amino acid for normal T cell function. Recent data led to the identification of a novel mechanism of T cell suppression caused by the depletion of arginine through the induction of arginase 1 (ARG1) in a specialized group of immature myeloid cells, now named myeloid-derived suppressor cells (MDSC). In addition to T cell dysfunction, arginine depletion leads to the decrease in nitric oxide (NO) production. Dietary therapy containing arginine at supraphysiologic concentrations along with other components such as omega-3 fat acids, antioxidants, nucleotides, and vitamin A is associated with improvement in T cell function, NO production, and a significant decrease in infection rates. The authors propose that a pathologic decrease in arginine availability is an identifiable nutrition deficiency syndrome that worsens outcomes if left untreated.

Nature of myeloid cells expressing arginase 1 in peripheral blood after trauma

BACKGROUND

Myeloid cells that express arginase 1 are upregulated by different stimuli, including trauma, and are capable of depleting arginine from the surrounding environment. Through arginine depletion, myeloid cells are capable of regulating T-cell function. We have previously reported increased arginase 1 expression in the peripheral blood mononuclear cells (PBMCs) after injury. The nature of the cells expressing arginase in humans after trauma is unknown and is the focus of this article.

METHODS

PBMCs were isolated using a Ficoll-Hypaque gradient. Arginase activity was measured by conversion of arginine to ornithine, and arginase 1 protein expression was measured by Western blot. The percent CD16 granulocytes and phenotypical analysis of the cells present in PBMCs were determined by flow cytometry. Magnetic microbeads were used for isolation and exclusion of specific cell subpopulations.

RESULTS

Trauma patients exhibited a dramatic increase in arginase activity (p < 0.05) and an increased percentage of CD16 granulocytes in the PBMC layer (p < 0.05) compared with control volunteers. Increased arginase activity in the PBMC layer was due to the contamination of this layer by granulocytes, as their exclusion decreased arginase activity back to baseline (p < 0.05). Granulocytes isolated from the PBMC layer expressed increased CD11b (p < 0.05) and CD66b (p < 0.05), markers of granulocyte activation. Furthermore, these granulocytes were significantly more swollen and degranulated compared with noncontaminating granulocytes.

CONCLUSION

In humans, increased arginase 1 expression after trauma observed in the PBMC layer seems to be exclusively the result of an increased number of activated granulocytes.

Intra-arterial infusion of nitric oxide (NO) - first animal trial

OBJECTIVE

Nitric oxide (NO) is an important signaling molecule that acts in many tissues to regulate a diverse range of physiological processes. NO has been implicated in a number of cardiovascular diseases. Reduced basal NO synthesis or function may lead to: vasoconstriction, elevated blood pressure and thrombus formation. By contrast, overproduction of NO results in vasodilatation, hypotension, vascular leakage, and disruption of cell metabolism. The purpose of this study was to determine the effects of NO gas directly infused into the arteries.

METHODS

The study was performed on 28 rabbits and 10 pigs. We developed a device that enables quantitatively controlled infusion of NO gas, directly into the arteries.

RESULTS

We found that administration of NO gas via arteries caused widening of the blood vessels as well as increasing blood flow in the extremity. It emerges that. These effects persist up to 2-3 h after the NO infusion ceased. Although the NO breaks down when diffused in blood, its influence commences rapidly and continues for a relatively long time.

CONCLUSIONS

Our findings indicate that, administration of NO into blood vessels causes a long lasting vasodilatation and enhanced blood flow. Despite the fact that NO is broken down rapidly.

Dose-Dependent Effects of a Nitric Oxide Donor in a Rat Flap Model

Previous studies have proven the effectiveness of nitric oxide (NO) donors to enhance flap survival in experimental models. The purpose of this study was to determine the ideal dose of the NO donor spermine/nitric oxide complex (Sper/NO) with respect to flap survival and hemodynamic side effects. Additionally, the influence of the type of application (systemically versus intra-arterial into the flap artery) was observed.Seventy-two male Wistar rats were divided into 9 experimental groups. An extended epigastric adipocutaneous flap (6 x 10 cm) based on the left superficial epigastric artery and vein was raised in each animal. The average percentage of flap necrosis was 69.8% in the control group with ischemia and 29.8% in the non ischemic controls. The average necrosis areas in the 3 groups after preischemic intravenous (i.v.) application of Sper/NO (250, 500, and 750 nmol/kg body weight) were 63.5%, 33.8%, and 38.4%, respectively. The application of similar doses into the flap artery resulted in 63.5%, 72.3%, and 64.3% flap necrosis; 52.7% average flap loss was observed in an additional group receiving Sper/NO adjusted to flap weight (500 nmol/kg flap weight). Only the intravenous application of 500 and 750 nmol/kg resulted in a significant reduction of flap necrosis compared with the ischemic controls (P < 0.01). The drop in mean arterial pressure was less after i.v. application of 500 nmol/kg Sper/NO compared with 750 nmol. Our data show that the preischemic intravenous application of 500 nmol/kg Sper/NO achieved the best results with acceptable side effects. A dose of 250 nmol/kg i.v., as well as the application of Sper/NO into the flap artery, was demonstrated to be ineffective.

Protective effects of some antineoplastic agents on ischemia-reperfusion injury in epigastric island skin flaps

Neutrophil depletion has a beneficial effect on ischemic myocardium and skeletal muscle upon reperfusion. Antineoplastic agents reduce blood neutrophils effectively, and lead to neutrophil depletion. The purpose of this study was to investigate the effects of four antineoplastic agents in low doses (cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil) on ischemia-reperfusion injury, using an epigastric island skin-flap model in rats. Fifty male Sprague-Dawley rats, weighing 250-300 g, were randomly divided into five groups, each consisting of 10 rats: control, cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil groups. Epigastric island skin flaps (measuring 3.5 x 4 cm) were raised and subjected to 10 h of in situ ischemia, followed by 7-day reperfusion and evaluation. Treatment with antineoplastic agents (cyclophosphamide, cisplatinum, mitomycin-C, and 5-fluorouracil) was used to introduce neutropenia. Complete blood counts, cutaneous bleeding time, and skin-flap survival were evaluated. Additionally, levels of malonyldialdehyde (MDA), nitric oxide (NO), glutathione (GSH), glutathione peroxidase (GSH-Px), and superoxide dismutase (SOD) were measured from extracted skin tissue. Numbers of leukocytes and platelets were decreased in all experimental groups. However, neutropenia and thrombocytopenia were not seen. Cutaneous bleeding activity was prolonged in all experimental groups, but not above the normal value. MDA and NO levels were found to be lower in all four antineoplastic agent groups than in the control group, while GSH, GSH-Px, and SOD enzyme activities were significantly higher (P < 0.05). However, MDA and NO levels were significantly decreased in the cyclophosphamide and 5-fluorouracil groups, as compared to the cisplatinum and mitomycin-C groups (P < 0.01). Also, GSH, GSH-Px, and SOD enzyme activities were significantly increased in the cyclophosphamide and 5-fluorouracil groups, compared to the other two antineoplastic agent groups (P < 0.01). We conclude that antineoplastic agents have beneficial effects on ischemia-reperfusion injuries when their doses are carefully adjusted, by decreasing the number of leukocytes and platelets, and altering the activity of free oxygen radicals.

The effects of exogenous nitric oxide donor on motor functional recovery of reperfused peripheral nerve

PURPOSE

To investigate the effects of the nitric oxide donor S-nitroso-N-acetylcysteine (SNAC) on motor functional recovery of reperfused rat sciatic nerve.

METHODS

Seventy-eight rats were divided into groups treated with SNAC (100 nmol/100 g/min), methylprednisolone 30 mg/kg/h for 15 minutes, 45-minute pause, 5.4 mg/kg/h for 1.5 h), and phosphate-buffered saline 0.2 mL/100 g/h). A 1-cm segment of sciatic nerve had 2 hours of ischemia and the results were evaluated after various reperfusion periods using a walking track test, muscle contractile testing, muscle weight, and histology.

RESULTS

During reperfusion there was a significant overall improvement in sciatic functional index measurement and isometric titanic contractile force for the SNAC-treated group compared with the methylprednisolone- and phosphate-buffered saline- treated groups. The SNAC group had significantly earlier improvement in the sciatic functional index measurement between days 7 and 28. Restoration of the contractile force and muscle weight of the extensor digitorum longus muscle began earlier in the SNAC group--after day 11--whereas the other 2 groups showed progressive atrophy until day 21, with a significant difference between the SNAC group and the other 2 groups. Histologic examination showed that SNAC-treated rats had less severe degeneration and earlier regeneration of axons than the others. Although methylprednisolone-treated rats showed earlier recovery than phosphate-buffered saline-treated rats in all parameters there were no significant differences between these 2 groups.

CONCLUSIONS

Supplementation of nitric oxide is effective in promoting motor functional recovery of the reperfused peripheral nerve and has potential to replace or augment steroids as therapeutic agents in treatment of nervous system ischemia/reperfusion injury.

The effect of single administration of vascular endothelial growth factor or L-arginine on necrosis and vasculature of the epigastric flap in the rat model

OBJECTIVES

Vascular endothelial growth factor (VEGF) and nitric oxide (NO) produce vasodilation, induce angiogenesis, and improve survival of surgical flaps. We used the rat epigastric skin flap to study the effect of a single intra-arterial dose of VEGF or L-arginine, a substrate for NO production, on flap regional necrosis and pedicle dependence of flap perfusion.

METHODS

In 30 Sprague-Dawley rats an 8 x 8 cm2 skin flap, consisting of four vertical zones marked A through D (right to left), based on the proximal right inferior epigastric vessels was raised. Subsequently, 1 ml of either saline (control, n =10), 5 microg VEGF (VEGF, n = 10), or 50 mg of L-arginine (L-arginine, n = 10) was injected into the arterial pedicle by cannulating the right saphenous artery, and the flap was resutured in place. After 8 days, the animals were perfused systemically with 15 microm coloured fluorescent microspheres before (blue) and after (yellow-green) ligation of the right inferior epigastric vascular pedicle. After sacrifice, the area of flap necrosis was measured in each zone by templates and weight-to-surface ratio, and the flap zones were harvested and processed for determination of fluorescence and blood flow.

RESULTS

Administration of VEGF or L-arginine resulted in decreased total and regional (zone D) flap necrosis (ANOVA <0.001). The total and regional flap shrinkage was greater in the experimental groups (ANOVA <0.02). While VEGF and L-arginine decreased the percentage of necrosis in the zone most distal to the pedicle (ANOVA <0.01) only L-arginine diminished percentage of total flap necrosis (p = 0.04). In the VEGF group, total and regional flap perfusion did not change after pedicle ligation, but perfusion decreased significantly in zones B through D in the L-arginine treated rats.

CONCLUSION

Single intra-pedicle administration of VEGF or L-arginine decreased necrosis of the epigastric skin flap at 8 days postoperatively, but flap shrinkage also increased in the zone with the greatest degree of necrosis. Perfusion data suggest that beneficial effects of VEGF and L-arginine on flap survival may be based on different mechanisms.

Oral Administration of L-Arginine Decreases Necrosis of the Epigastric Skin Flap in the Rat

BACKGROUND

We investigated the effect of prolonged oral arginine administration on tissue necrosis and perfusion in the rat skin flap.

METHODS

Twenty-five Sprague-Dawley rats had an 8 x 8 - cm epigastric skin flap elevated and were divided in 2 groups, l-Arginine and Control, which respectively received oral 6% l-arginine solution or water for 8 days postoperatively. On postoperative day 8, area of flap necrosis was measured, and the animals were perfused systemically with 15-microm colored fluorescent microspheres before (blue) and after (yellow-green) ligation of the flap pedicle.

RESULTS

l-Arginine reduced total flap necrosis (6.53 +/- 3.76 cm versus 11.91 +/- 4.12 cm; P < 0.01). After pedicle ligation, total flap perfusion remained unchanged in Control but diminished in the l-Arginine group (Control: 0.47 +/- 0.23 and 0.42 +/- 0.06; P = nonsignificant versus l-Arginine: 0.58 +/- 0.29 and 0.27 +/- 0.19; P < 0.01). Serum levels of l-arginine were higher in the l-arginine-treated animals (504 +/- 154 versus 152 +/- 34 micromol/l; P < 0.0001).

CONCLUSIONS

Postoperative oral administration of l-arginine decreased flap necrosis in the rat epigastric skin flap. Flap perfusion following oral l-arginine was more dependent on the main vascular pedicle.

Modulating effects of L-arginine on cytokine-stimulated lymphocyte migration in vitro

Elective microsurgical transplants have become routine. Yet there remains a 1-5% rate of complete flap necrosis among these surgical reconstructions. This rate is much higher in emergent replantations. Despite technically accurate surgery, perfusion fails in this group. This lack of perfusion, or no-reflow, has been attributed to ischemic-reperfusion injury. The exact nature of this phenomenon remains poorly characterized, though it is clear that significant changes occur in such situations at the endothelial vascular interface. In an effort to understand the biomolecular events involved in ischemic-reperfusion injury we investigated the modulation of leukocyte transendothelial migration. Using a chemotactic chamber model with a cytokine stimulate mono-layer of umbilical vein endothelium, we evaluated the migration rate of peripheral blood mononuclear cells in the presence of exogenous L-arginine and/or the nitric oxide synthase inhibitor L-NAME. Levels of INF-gamma and TNF-alpha production were also determined. It was found that in the face of cytokine pre-stimulation and L-arginine, mononuclear cell trans-endothelial migration increased dramatically. There were also parallel increases in inflammatory cytokine output. These responses were sharply decreased by L-NAME. The results of this study suggest that in vitro nitric oxide augments transendothelial migration of inflammatory cells. Modulation of this response may provide a clinically useful method of minimizing ischemic-reperfusion injury.

Inhibition of nitric oxide synthase (NOS) conversion of L-arginine to nitric oxide (NO) decreases low density mononuclear cell (LD MNC) trans-endothelial migration and cytokine output

BACKGROUND

Biochemical, molecular, and cellular events at the micro-vascular endothelial interface determine the integrity of the vascular system. Disruption of these events has been described to occur in accordance with ischemic/reperfusion injury leading to inflammation, cell adhesion, and endothelial permeability changes. It has also been suggested that nitric oxide (NO) participates in these events. However, the manner in which it does is debated. The purpose of this study was to investigate the effects of exogenous L-arginine, an NO precursor, and L-N (G) nitroarginine methyl ester (L-NAME), a nitric oxide synthase (NOS) inhibitor, upon inflammatory events at the endothelial interface.

MATERIAL AND METHODS

Fresh cultures of human umbilical vein endothelial cells were established and used to seed Transwell chemotaxic chambers, and then grown to confluence. Whole blood was obtained from the same healthy volunteer and processed for light density mononuclear cells. Following per-stimulation of the endothelial monolayer with IL-1beta or antigen-antibody complex, known numbers of mononuclear cells were seeded to the endothelium. Incubation with and without exogenous L-arginine or L-NAME for 48 h was done. Lower chamber supernatant was then collected, cell numbers and viability determined and levels of inflammatory cytokines TNF-alpha and INF-lambda determined via ELISA assay.

RESULTS

Tran-endothelial cellular migration was nil lacking pre-stimulation, regardless of the addition of exogenous L-arginine. With pre-stimulation trans-endothelial migration increased significantly, a response that was greatly enhanced by L-arginine. With the further addition of L-NAME cellular migration decreased substantially. Pro-inflammatory cytokine levels of TNF-alpha and INF-lambda followed levels of cellular migration.

CONCLUSIONS

In vitro there was little to no trans-endothelial migration of inflammatory cells across an unstimulated monolayer of vascular endothelium. Pre-stimulation of the same endothelial monolayer with either a cytokine or antigen-antibody complex resulted in a significant trans-endothelial migration of inflammatory cells. This latter response was associated with a concurrent increase in the secretion of the pro-inflammatory cytokines TNF-alpha and INF-gamma. The presence of the NO precursor L-arginine greatly enhanced the observed inflammatory response. Conversely, L-NAME, an inhibitor of NOS, depressed the inflammatory response.

The role of pre-ischaemic application of the nitric oxide donor spermine/nitric oxide complex in enhancing flap survival in a rat model

Spermine/nitric oxide complex (Sper/NO) is a new nitric oxide (NO) donor with a long half-life providing controlled biological release of NO in vivo. The purpose of this study was to determine whether flap survival could be improved by pre-ischaemic or post-ischaemic intravenous administration of Sper/NO. We divided 37 male Wistar rats into four experimental groups. An extended epigastric adipocutaneous flap was raised in each animal. The mean area of flap necrosis was assessed for all groups on the fifth postoperative day, using planimetry software. The average area of flap necrosis was mean +/- s.d. = 68.2%+/-18.1% in the control group, and 29.7% +/- 13.3% in the non-ischaemic controls. The group with pre-ischaemic application of Sper/NO demonstrated an average flap necrosis of mean+/-s.d. = 11.2%+/-5.9%, whereas this increased to 59.2%+/-14.4% in the group receiving Sper/NO 5 min prior to reperfusion. The group with pre-ischaemic application of Sper/NO showed a significantly lower area of flap necrosis than either of the control groups or the group receiving Sper/NO just prior to reperfusion (P < 0.05). The group receiving Sper/NO just prior to reperfusion demonstrated a significantly higher mean area of flap necrosis than the non-ischaemic controls (P < 0.05), but did not differ significantly from the control group. Our data show that pharmacological preconditioning and enhancement of flap survival can be achieved by intravenous administration of Sper/NO. The application of Sper/NO at the end of the ischaemia period or in the early reperfusion period provides no protection against ischaemia-reperfusion injury.

The effects of the nitric oxide donor SIN-1 on ischemia-reperfused cutaneous and myocutaneous flaps

Ischemia-reperfusion injury causes tissue damage that leads to a decrease in bioavailability of nitric oxide. The authors hypothesized that an exogenous supply of nitric oxide will have beneficial effects on survival of skin and skeletal muscle subjected to ischemia-reperfusion injury. By using the nitric oxide donor SIN-1 (3-morpholino-sydnonimine) the effects of direct intraarterial infusion of an exogenous source of nitric oxide in reperfused flaps was studied. Bilateral island buttock skin flaps and latissimus dorsi myocutaneous flaps were elevated in eight pigs, for a total of 32 flaps. Flaps were subjected to 6 hours of ischemia followed by 18 hours of reperfusion. Flaps on one side of each animal were randomized to be treated with the nitric oxide donor (treatment group). The contralateral side was treated with an equivalent volume of saline vehicle (infusion control) SIN-1, or saline was administered as a continuous direct intraarterial infusion at the onset of reperfusion and continued during the observation period. Outcomes measured were tissue neutrophil accumulation by using myeloperoxidase assay and tissue survival (intravenous fluorescein and nitroblue tetrazolium for skin and muscle, respectively). In both skin and myocutaneous flaps, SIN-1 treatment caused a significant improvement in survival and a decrease in neutrophil accumulation. Nitric oxide may play an important role in the pathophysiologic process of ischemia-induced reperfusion injury in skin and skeletal muscle. Nitric oxide donors may be a promising family of therapeutic agents for the prevention of ischemia-induced reperfusion injury in cutaneous and myocutaneous flaps.

Effects of in vivo myocardial ischemia and reperfusion on interstitial nitric oxide metabolites

BACKGROUND

There have been numerous studies examining the role of nitric oxide (NO) in myocardial ischemia-reperfusion injury; however, few studies have included measurements of NO or related reactive nitrogen species. The purpose of this study was to determine the effects of in vivo regional myocardial ischemia on interstitial fluid (ISF) reactive nitrogen species.

METHODS

Open chest pigs were submitted to one of three protocols: (1) 15 minutes coronary occlusion and 2 hours reperfusion, (2) 60 minutes coronary occlusion and 2 hours reperfusion, or (3) two-cycle ischemic preconditioning (IPC) followed by prolonged ischemia and 2 hours reperfusion. The stable NO metabolites, nitrite plus nitrate (NOx), in cardiac microdialysis samples were measured by ozone chemiluminescence.

RESULTS

NOx concentration decreased 40% +/- 6% (p < 0.05) during brief ischemia but returned to baseline during reperfusion. Dialysate NOx levels decreased further after 60 minutes ischemia (60% +/- 3% of baseline, p < 0.01) but reperfusion dialysate NOx concentration increased 34% +/- 9% above baseline (p < 0.05). Preconditioning did not increase dialysate NOx but did accelerate the ischemia-induced decrease in NOx levels (p < 0.05). Reperfusion NOx levels in preconditioned pigs were significantly lower than in nonpreconditioned pigs (p < 0.05).

CONCLUSIONS

These results suggest that ischemia is associated with decreased ISF NOx concentration. Reperfusion NOx levels are increased after prolonged ischemia, an effect that is significantly blunted by ischemic preconditioning.