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Kim DJK, Gao Z, Luck JC, Brandt K, Miller AJ, Kim-Shapiro D, Basu S, Leuenberger U, Gardner AW, Muller MD, Proctor DN. Effects of short-term dietary nitrate supplementation on exercise and coronary blood flow responses in patients with peripheral artery disease. Front Nutr 2024; 11:1398108. [PMID: 39027664 PMCID: PMC11257697 DOI: 10.3389/fnut.2024.1398108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Background Peripheral arterial disease (PAD) is a prevalent vascular disorder characterized by atherosclerotic occlusion of peripheral arteries, resulting in reduced blood flow to the lower extremities and poor walking ability. Older patients with PAD are also at a markedly increased risk of cardiovascular events, including myocardial infarction. Recent evidence indicates that inorganic nitrate supplementation, which is abundant in certain vegetables, augments nitric oxide (NO) bioavailability and may have beneficial effects on walking, blood pressure, and vascular function in patients with PAD. Objective We sought to determine if short-term nitrate supplementation (via beetroot juice) improves peak treadmill time and coronary hyperemic responses to plantar flexion exercise relative to placebo (nitrate-depleted juice) in older patients with PAD. The primary endpoints were peak treadmill time and the peak coronary hyperemic response to plantar flexion exercise. Methods Eleven PAD patients (52-80 yr.; 9 men/2 women; Fontaine stage II) were randomized (double-blind) to either nitrate-rich (Beet-IT, 0.3 g inorganic nitrate twice/day; BRnitrate) or nitrate-depleted (Beet-IT, 0.04 g inorganic nitrate twice/day, BRplacebo) beetroot juice for 4 to 6 days, followed by a washout of 7 to 14 days before crossing over to the other treatment. Patients completed graded plantar flexion exercise with their most symptomatic leg to fatigue, followed by isometric handgrip until volitional fatigue at 40% of maximum on day 4 of supplementation, and a treadmill test to peak exertion 1-2 days later while continuing supplementation. Hemodynamics and exercise tolerance, and coronary blood flow velocity (CBV) responses were measured. Results Although peak walking time and claudication onset time during treadmill exercise did not differ significantly between BRplacebo and BRnitrate, the diastolic blood pressure response at the peak treadmill walking stage was significantly lower in the BRnitrate condition. Increases in CBV from baseline to peak plantar flexion exercise after BRplacebo and BRnitrate showed a trend for a greater increase in CBV at the peak workload of plantar flexion with BRnitrate (p = 0.06; Cohen's d = 0.56). Conclusion Overall, these preliminary findings suggest that inorganic nitrate supplementation in PAD patients is safe, well-tolerated, and may improve the coronary hyperemic and blood pressure responses when their calf muscles are most predisposed to ischemia.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT02553733.
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Affiliation(s)
- Danielle Jin-Kwang Kim
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Zhaohui Gao
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Jonathan C. Luck
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Kristen Brandt
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Amanda J. Miller
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Daniel Kim-Shapiro
- Department of Physics, Wake Forest University, Winston-Salem, NC, United States
| | - Swati Basu
- Department of Physics, Wake Forest University, Winston-Salem, NC, United States
| | - Urs Leuenberger
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
| | - Andrew W. Gardner
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Matthew D. Muller
- School of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - David N. Proctor
- Penn State Heart and Vascular Institute, Penn State College of Medicine, Hershey, PA, United States
- Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA, United States
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Lee KH, Song MY, Lee S, Park J, Kang JH, Cho H, Kim KB, Son SJ, Cheng XW, Lee YJ, Lee GJ, Shin JH, Kim W. Nitric oxide releasing nanofiber stimulates revascularization in response to ischemia via cGMP-dependent protein kinase. PLoS One 2024; 19:e0303758. [PMID: 38768136 PMCID: PMC11104631 DOI: 10.1371/journal.pone.0303758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Nitric oxide (NO) promotes angiogenesis via various mechanisms; however, the effective transmission of NO in ischemic diseases is unclear. Herein, we tested whether NO-releasing nanofibers modulate therapeutic angiogenesis in an animal hindlimb ischemia model. Male wild-type C57BL/6 mice with surgically-induced hindlimb ischemia were treated with NO-releasing 3-methylaminopropyltrimethoxysilane (MAP3)-derived or control (i.e., non-NO-releasing) nanofibers, by applying them to the wound for 20 min, three times every two days. The amount of NO from the nanofiber into tissues was assessed by NO fluorometric assay. The activity of cGMP-dependent protein kinase (PKG) was determined by western blot analysis. Perfusion ratios were measured 2, 4, and 14 days after inducing ischemia using laser doppler imaging. On day 4, Immunohistochemistry (IHC) with F4/80 and gelatin zymography were performed. IHC with CD31 was performed on day 14. To determine the angiogenic potential of NO-releasing nanofibers, aorta-ring explants were treated with MAP3 or control fiber for 20 min, and the sprout lengths were examined after 6 days. As per either LDPI (Laser doppler perfusion image) ratio or CD31 capillary density measurement, angiogenesis in the ischemic hindlimb was improved in the MAP3 nanofiber group; further, the total nitrate/nitrite concentration in the adduct muscle increased. The number of macrophage infiltrations and matrix metalloproteinase-9 (MMP-9) activity decreased. Vasodilator-stimulated phosphoprotein (VASP), one of the major substrates for PKG, increased phosphorylation in the MAP3 group. MAP3 nanofiber or NO donor SNAP (s-nitroso-n-acetyl penicillamine)-treated aortic explants showed enhanced sprouting in an ex vivo aortic ring assay, which was partially abrogated by KT5823, a potent inhibitor of PKG. These findings suggest that the novel NO-releasing nanofiber, MAP3 activates PKG and promotes therapeutic angiogenesis in response to hindlimb ischemia.
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Affiliation(s)
- Kyung Hye Lee
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
- Department of Biotechnology, Cha University, Pocheon, Korea
| | - Min-Young Song
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Sora Lee
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - JinSun Park
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hee Kang
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Haneul Cho
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Ki-Bum Kim
- Department of Chemistry, Kwangwoon University, Seoul, Korea
| | - Soo Ji Son
- Department of Chemistry, Kwangwoon University, Seoul, Korea
| | - Xian Wu Cheng
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
- Department of Cardiology and Hypertension, Jilin Provincial Key Laboratory of Stress and Cardiovascular Diseas, Yanbian University Hospital, Yanji, China
| | - Young Ju Lee
- Department of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Gi-Ja Lee
- Department of Biomedical Engineering, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Ho Shin
- Department of Chemistry, Kwangwoon University, Seoul, Korea
| | - Weon Kim
- Department of Internal Medicine, Division of Cardiovascular, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
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Wong SA, Drovandi A, Jones R, Golledge J. Effect of Dietary Supplements Which Upregulate Nitric Oxide on Walking and Quality of Life in Patients with Peripheral Artery Disease: A Meta-Analysis. Biomedicines 2023; 11:1859. [PMID: 37509499 PMCID: PMC10376856 DOI: 10.3390/biomedicines11071859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
This systematic review pooled evidence from randomised controlled trials (RCTs) on the effectiveness of dietary upregulators of nitric oxide (NO) in improving the walking and quality of life of patients with peripheral artery disease (PAD). RCTs examining the effect of dietary upregulators of NO in patients with PAD were included. The primary outcome was the maximum walking distance. Secondary outcomes were the initial claudication distance, the six-minute walking distance, quality of life, the ankle-brachial pressure index (ABI), adverse events and risk of mortality, revascularisation or amputation. Meta-analyses were performed using random effects models. The risk of bias was assessed using Cochrane's ROB-2 tool. Leave-one-out and subgroup analyses were conducted to assess the effect of individual studies, the risk of bias and intervention type on pooled estimates. Thirty-four RCTs involving 3472 participants were included. Seven trials tested NO donors, nineteen tested antioxidants, three tested NO synthase inducers and five tested enhancers of NO availability. Overall, the dietary supplements significantly improved the initial claudication (SMD 0.34; 95%CI 0.04, 0.64; p = 0.03) but not maximum walking (SMD 0.13; 95%CI -0.17, 0.43; p = 0.39) distances. Antioxidant supplements significantly increased both the maximum walking (SMD 0.36; 95%CI 0.14, 0.59; p = 0.001) and initial claudication (SMD 0.58; 95%CI 0.26, 0.90; p < 0.001) distances. The dietary interventions did not improve the physical function domain of the Short Form-36 (SMD -0.16; 95%CI -0.32, 0.00; p = 0.38), ABI or risk of adverse events, mortality, revascularisation or amputation. Dietary NO upregulators, especially antioxidants, appear to improve the initial claudication distance in patients with PAD. Larger high-quality RCTs are needed to fully examine the benefits and risks of these treatments. PROSPERO Registration: CRD42022256653.
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Affiliation(s)
- Shannon A Wong
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Rhondda Jones
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
| | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD 4811, Australia
- The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD 4814, Australia
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Keszler A, Lindemer B, Broeckel G, Weihrauch D, Gao Y, Lohr NL. In Vivo Characterization of a Red Light-Activated Vasodilation: A Photobiomodulation Study. Front Physiol 2022; 13:880158. [PMID: 35586710 PMCID: PMC9108481 DOI: 10.3389/fphys.2022.880158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/06/2022] [Indexed: 12/04/2022] Open
Abstract
Nitric oxide dependent vasodilation is an effective mechanism for restoring blood flow to ischemic tissues. Previously, we established an ex vivo murine model whereby red light (670 nm) facilitates vasodilation via an endothelium derived vasoactive species which contains a functional group that can be reduced to nitric oxide. In the present study we investigated this vasodilator in vivo by measuring blood flow with Laser Doppler Perfusion imaging in mice. The vasodilatory nitric oxide precursor was analyzed in plasma and muscle with triiodide-dependent chemiluminescence. First, a 5–10 min irradiation of a 3 cm2 area in the hind limb at 670 nm (50 mW/cm2) produced optimal vasodilation. The nitric oxide precursor in the irradiated quadriceps tissue decreased significantly from 123 ± 18 pmol/g tissue by both intensity and duration of light treatment to an average of 90 ± 17 pmol/g tissue, while stayed steady (137 ± 21 pmol/g tissue) in unexposed control hindlimb. Second, the blood flow remained elevated 30 min after termination of the light exposure. The nitric oxide precursor content significantly increased by 50% by irradiation then depleted in plasma, while remained stable in the hindlimb muscle. Third, to mimic human peripheral artery disease, an ameroid constrictor was inserted on the proximal femoral artery of mice and caused a significant reduction of flow. Repeated light treatment for 14 days achieved steady and significant increase of perfusion in the constricted limb. Our results strongly support 670 nm light can regulate dilation of conduit vessel by releasing a vasoactive nitric oxide precursor species and may offer a simple home-based therapy in the future to individuals with impaired blood flow in the leg.
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Affiliation(s)
- Agnes Keszler
- Departments of Medicine- Division of Cardiovascular Medicine, Milwaukee, WI, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Brian Lindemer
- Departments of Medicine- Division of Cardiovascular Medicine, Milwaukee, WI, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Grant Broeckel
- Departments of Medicine- Division of Cardiovascular Medicine, Milwaukee, WI, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Dorothee Weihrauch
- Departments of Medicine- Division of Cardiovascular Medicine, Milwaukee, WI, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Departments of Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Yan Gao
- Institute for Health and Equity- Division of Biostatistics, Milwaukee, WI, United States
| | - Nicole L. Lohr
- Departments of Medicine- Division of Cardiovascular Medicine, Milwaukee, WI, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, WI, United States
- Clement J Zablocki VA Medical Center, Milwaukee, WI, United States
- *Correspondence: Nicole L. Lohr,
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Qi X, Ricart K, Ahmed KA, Patel RP, Boulton ME. Supplemental nitrite increases choroidal neovascularization in mice. Nitric Oxide 2021; 117:7-15. [PMID: 34537345 DOI: 10.1016/j.niox.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/09/2021] [Accepted: 09/14/2021] [Indexed: 10/20/2022]
Abstract
Low doses of nitrite, close to physiological levels, increase blood flow in normal and ischemic tissues through a nitric oxide (NO) dependent mechanism. Given that nitrite therapy and dietary supplementation with vegetables high in nitrate (e.g. beets) are gaining popularity we decided to determine if low doses of nitrite impact the development of choroidal neovascularization (CNV), a key feature of wet age related macular degeneration (AMD). Sodium nitrite (at 50 mg/L, 150 mg/L, and 300 mg/L), nitrate (1 g/L) or water alone were provided in the drinking water of C57BL/6 J mice aged 2 or 12 months. Mice were allowed to drink ad libitum for 1 week at which time laser-induced choroidal neovascularization (L-CNV) was induced. The mice continued to drink the supplemented water ad libitum for a further 14 days at which point optical coherence tomography (OCT) was performed to determine the volume of the CNV lesion. Blood was drawn to determine nitrite and nitrate levels and eyes taken for histology. CNV volume was 2.86 × 107 μm3 (±0.4 × 107) in young mice on water alone but CNV volume more than doubled to >6.9 × 107 μm3 (±0.8 × 107) in mice receiving 300 mg/L nitrite or 7.34 × 107 μm3 (±1.4 × 107) in 1 g/L nitrate (p < 0.01). A similar trend was observed in older mice. CNV volume was 5.3 × 107 μm3 (±0.5 × 107) in older mice on water alone but CNV volume almost doubled to approximately 9.3 × 107 μm3 (±1.1 × 107) in mice receiving 300 mg/L nitrite or 8.7 × 107 μm3 (±0.9 × 107) 1 g/L nitrate (p < 0.01). Plasma nitrite levels were highest in young mice receiving 150 mg/L in the drinking water with no changes in plasma nitrate observed. In older mice, drinking water nitrite did not significantly change plasma nitrite, but plasma nitrate was increased. Plasma nitrate was elevated in both young and old mice provided with nitrate supplemented drinking water. Our data demonstrate that the CNV lesion is larger in older mice compared to young and that therapeutic levels of oral nitrite increase the volume of CNV lesions in both young and older mice. Therapeutic nitrite or nitrate supplementation should be used with caution in the elderly population prone to CNV.
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Affiliation(s)
- Xiaoping Qi
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, 35294, USA
| | - Karina Ricart
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, AL, 35294, USA
| | - Khandaker A Ahmed
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, AL, 35294, USA
| | - Rakesh P Patel
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, AL, 35294, USA.
| | - Michael E Boulton
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, AL, 35294, USA.
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Bahadoran Z, Mirmiran P, Carlström M, Ghasemi A. Inorganic nitrate: A potential prebiotic for oral microbiota dysbiosis associated with type 2 diabetes. Nitric Oxide 2021; 116:38-46. [PMID: 34506950 DOI: 10.1016/j.niox.2021.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/07/2021] [Accepted: 09/05/2021] [Indexed: 11/29/2022]
Abstract
Oral microbiota dysbiosis, concomitant with decreased abundance of nitrate (NO3-)-reducing bacteria, oral net nitrite (NO2-) production, and reduced nitric oxide (·NO) bioactivity, is associated with the development of cardiometabolic disorders. Therefore, restoring the oral microbiome to a health-associated state is suggested as a therapeutic approach to potentiate the NO3--NO2--·NO pathway and provide a backup resource for insufficient NO production in conditions including cardiovascular disease and type 2 diabetes mellitus (T2DM). The current review discusses how inorganic NO3- can improve the oral microbial community in patients with T2DM and act as a prebiotic. Both animal and human experiments indicated that inorganic NO3- modulates the oral microbiome by increasing the abundance of health-associated NO3--reducing bacteria (e.g., Neisseria and Rothia) and decreasing the plenty of species Prevotella and Veillonella, leading to oral NO2- accumulation and improved systemic ·NO availability. Supplementation with NO3- reduces caries- and periodontitis-associated bacteria and the pathogenic genus related to insulin resistance and glucose intolerance. In addition, inorganic NO3- may provide a more optimal environment for NO3- reductase activity in the oral cavity, as it increases salivary flow rate and prevents decreased pH by inhibiting acid-producing bacteria.
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Affiliation(s)
- Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Human Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mattias Carlström
- Department of Physiology and Pharmacology, Karolinska Institutet, Biomedicum 5B, Stockholm, SE-171 76, Sweden
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Miller L, Hébert CD, Grimes SD, Toomey JS, Oh JY, Rose JJ, Patel RP. Safety and toxicology assessment of sodium nitrite administered by intramuscular injection. Toxicol Appl Pharmacol 2021; 429:115702. [PMID: 34464673 PMCID: PMC8459319 DOI: 10.1016/j.taap.2021.115702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 07/02/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Intramuscular (IM) injection of nitrite (1-10 mg/kg) confers survival benefit and protects against lung injury after exposure to chlorine gas in preclinical models. Herein, we evaluated safety/toxicity parameters after single, and repeated (once daily for 7 days) IM injection of nitrite in male and female Sprague Dawley rats and Beagle dogs. The repeat dose studies were performed in compliance with the Federal Drug Administration's (FDA) Good Laboratory Practices Code of Federal Regulations (21 CFR Part 58). Parameters evaluated consisted of survival, clinical observations, body weights, clinical pathology, plasma drug levels, methemoglobin and macroscopic and microscopic pathology. In rats and dogs, single doses of ≥100 mg/kg and 60 mg/kg resulted in death and moribundity, while repeated administration of ≤30 or ≤ 10 mg/kg/day, respectively, was well tolerated. Therefore, the maximum tolerated dose following repeated administration in rats and dogs were determined to be 30 mg/kg/day and 10 mg/kg/day, respectively. Effects at doses below the maximum tolerated dose (MTD) were limited to emesis (in dogs only) and methemoglobinemia (in both species) with clinical signs (e.g. blue discoloration of lips) being dose-dependent, transient and reversible. These signs were not considered adverse, therefore the No Observed Adverse Effect Level (NOAEL) for both rats and dogs was 10 mg/kg/day in males (highest dose tested for dogs), and 3 mg/kg/day in females. Toxicokinetic assessment of plasma nitrite showed no difference between male and females, with Cmax occurring between 5 mins and 0.5 h (rats) or 0.25 h (dogs). In summary, IM nitrite was well tolerated in rats and dogs at doses previously shown to confer protection against chlorine gas toxicity.
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Affiliation(s)
- Lutfiya Miller
- Intertek Health Sciences, Inc., Pharmaceuticals & Healthcare, Mississauga, ON, Canada
| | | | | | - James S Toomey
- Southern Research, Birmingham, AL, United States of America
| | - Joo-Yeun Oh
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason J Rose
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rakesh P Patel
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, AL, USA.
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Bahadoran Z, Mirmiran P, Kashfi K, Ghasemi A. Lost-in-Translation of Metabolic Effects of Inorganic Nitrate in Type 2 Diabetes: Is Ascorbic Acid the Answer? Int J Mol Sci 2021; 22:4735. [PMID: 33947005 PMCID: PMC8124635 DOI: 10.3390/ijms22094735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/14/2022] Open
Abstract
Beneficial metabolic effects of inorganic nitrate (NO3-) and nitrite (NO2-) in type 2 diabetes mellitus (T2DM) have been documented in animal experiments; however, this is not the case for humans. Although it has remained an open question, the redox environment affecting the conversion of NO3- to NO2- and then to NO is suggested as a potential reason for this lost-in-translation. Ascorbic acid (AA) has a critical role in the gastric conversion of NO2- to NO following ingestion of NO3-. In contrast to AA-synthesizing species like rats, the lack of ability to synthesize AA and a lower AA body pool and plasma concentrations may partly explain why humans with T2DM do not benefit from NO3-/NO2- supplementation. Rats also have higher AA concentrations in their stomach tissue and gastric juice that can significantly potentiate gastric NO2--to-NO conversion. Here, we hypothesized that the lack of beneficial metabolic effects of inorganic NO3- in patients with T2DM may be at least in part attributed to species differences in AA metabolism and also abnormal metabolism of AA in patients with T2DM. If this hypothesis is proved to be correct, then patients with T2DM may need supplementation of AA to attain the beneficial metabolic effects of inorganic NO3- therapy.
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Affiliation(s)
- Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran; (Z.B.); (P.M.)
| | - Parvin Mirmiran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 1985717413, Iran; (Z.B.); (P.M.)
| | - Khosrow Kashfi
- Department of Molecular, Cellular and Biomedical Sciences, Sophie Davis School of Biomedical Education, City University of New York School of Medicine, New York, NY 10031, USA;
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran 19395-4763, Iran
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Chen J, Hamm LL, Bundy JD, Kumbala DR, Bodana S, Chandra S, Chen CS, Starcke CC, Guo Y, Schaefer CM, Lustigova E, Mahone E, Vadalia AM, Livingston T, Obst K, Hernandez J, Bokhari SR, Kleinpeter M, Alper AB, Lukitsch I, He H, Nieman DC, He J. Combination Treatment with Sodium Nitrite and Isoquercetin on Endothelial Dysfunction among Patients with CKD: A Randomized Phase 2 Pilot Trial. Clin J Am Soc Nephrol 2020; 15:1566-1575. [PMID: 33023894 PMCID: PMC7646238 DOI: 10.2215/cjn.02020220] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/28/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Endothelial dysfunction is common among patients with CKD. We tested the efficacy and safety of combination treatment with sodium nitrite and isoquercetin on biomarkers of endothelial dysfunction in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This randomized, double-blind, placebo-controlled phase 2 pilot trial enrolled 70 patients with predialysis CKD. Thirty-five were randomly assigned to combination treatment with sodium nitrite (40 mg twice daily) and isoquercetin (225 mg once daily) for 12 weeks, and 35 were randomly assigned to placebo. The primary outcome was mean change in flow-mediated vasodilation over the 12-week intervention. Secondary and safety outcomes included biomarkers of endothelial dysfunction, inflammation, and oxidative stress as well as kidney function, methemoglobin, and adverse events. Intention-to-treat analysis was conducted. RESULTS Baseline characteristics, including age, sex, race, cigarette smoking, history of hypertension and diabetes, use of renin-angiotensin system blockers, BP, fasting glucose, lipid profile, kidney function, urine albumin-creatinine ratio, and endothelial biomarkers, were comparable between groups. Over the 12-week intervention, flow-mediated vasodilation increased 1.1% (95% confidence interval, -0.1 to 2.3) in the treatment group and 0.3% (95% confidence interval, -0.9 to 1.5) in the placebo group, and net change was 0.8% (95% confidence interval, -0.9 to 2.5). In addition, changes in biomarkers of endothelial dysfunction (vascular adhesion molecule-1, intercellular adhesion molecule-1, E-selectin, vWf, endostatin, and asymmetric dimethylarginine), inflammation (TNF-α, IL-6, C-reactive protein, IL-1 receptor antagonist, and monocyte chemoattractant protein-1), and oxidative stress (oxidized LDL and nitrotyrosines) were not significantly different between the two groups. Furthermore, changes in eGFR, urine albumin-creatinine ratio, methemoglobin, and adverse events were not significantly different between groups. CONCLUSIONS This randomized phase 2 pilot trial suggests that combination treatment with sodium nitrite and isoquercetin did not significantly improve flow-mediated vasodilation or other endothelial function biomarkers but also did not increase adverse events compared with placebo among patients with CKD. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Nitrite, Isoquercetin, and Endothelial Dysfunction (NICE), NCT02552888.
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Affiliation(s)
- Jing Chen
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
- Department of Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana
| | - L. Lee Hamm
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Joshua D. Bundy
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | | | - Shirisha Bodana
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
| | - Sehgal Chandra
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Chung-Shiuan Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Charlton C. Starcke
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Yajun Guo
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Caroline M. Schaefer
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Eva Lustigova
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Erin Mahone
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Aarti M. Vadalia
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Terra Livingston
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Katherine Obst
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - Jesus Hernandez
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Syed Rizwan Bokhari
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Myra Kleinpeter
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Arnold B. Alper
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
| | - Ivo Lukitsch
- Department of Nephrology, Ochsner Health System, New Orleans, Louisiana
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
| | - David C. Nieman
- Human Performance Lab, Appalachian State University, Kannapolis, North Carolina
| | - Jiang He
- Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- Tulane University Translational Science Institute, New Orleans, Louisiana
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10
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Hegab RA, Pardue S, Shen X, Kevil C, Peppas NA, Caldorera‐Moore ME. Effect of network mesh size and swelling to the drug delivery from pH responsive hydrogels. J Appl Polym Sci 2020. [DOI: 10.1002/app.48767] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Rachel A. Hegab
- Department of Biomedical EngineeringLouisiana Tech University Ruston Louisiana 71272
| | - Sibile Pardue
- Center for Cardiovascular Diseases and SciencesLSU Health Shreveport Shreveport Louisiana 71130‐3932
| | - Xinggui Shen
- Center for Cardiovascular Diseases and SciencesLSU Health Shreveport Shreveport Louisiana 71130‐3932
| | - Christopher Kevil
- Center for Cardiovascular Diseases and SciencesLSU Health Shreveport Shreveport Louisiana 71130‐3932
| | - Nicholas A. Peppas
- McKetta Department of Chemical EngineeringThe University of Texas at Austin Austin Texas 78712
- Department of Biomedical EngineeringThe University of Texas at Austin Austin Texas 78712
- Institute for Biomaterials, Drug Delivery, and Regenerative MedicineThe University of Texas at Austin Austin Texas 78712
- Department of Surgery and Perioperative Care, Dell Medical SchoolThe University of Texas at Austin Austin Texas 78712
- Department of Pediatrics, Dell Medical SchoolThe University of Texas at Austin Austin Texas 78712
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11
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Kapil V, Khambata RS, Jones DA, Rathod K, Primus C, Massimo G, Fukuto JM, Ahluwalia A. The Noncanonical Pathway for In Vivo Nitric Oxide Generation: The Nitrate-Nitrite-Nitric Oxide Pathway. Pharmacol Rev 2020; 72:692-766. [DOI: 10.1124/pr.120.019240] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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12
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Liu Y, Croft KD, Hodgson JM, Mori T, Ward NC. Mechanisms of the protective effects of nitrate and nitrite in cardiovascular and metabolic diseases. Nitric Oxide 2020; 96:35-43. [PMID: 31954804 DOI: 10.1016/j.niox.2020.01.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 12/18/2019] [Accepted: 01/13/2020] [Indexed: 12/28/2022]
Abstract
Within the body, NO is produced by nitric oxide synthases via converting l-arginine to citrulline. Additionally, NO is also produced via the NOS-independent nitrate-nitrite-NO pathway. Unlike the classical pathway, the nitrate-nitrite-NO pathway is oxygen independent and viewed as a back-up function to ensure NO generation during ischaemia/hypoxia. Dietary nitrate and nitrite have emerged as substrates for endogenous NO generation and other bioactive nitrogen oxides with promising protective effects on cardiovascular and metabolic function. In brief, inorganic nitrate and nitrite can decrease blood pressure, protect against ischaemia-reperfusion injury, enhance endothelial function, inhibit platelet aggregation, modulate mitochondrial function and improve features of the metabolic syndrome. However, many questions regarding the specific mechanisms of these protective effects on cardiovascular and metabolic diseases remain unclear. In this review, we focus on nitrate/nitrite bioactivation, as well as the potential mechanisms for nitrate/nitrite-mediated effects on cardiovascular and metabolic diseases. Understanding how dietary nitrate and nitrite induce beneficial effect on cardiovascular and metabolic diseases could open up novel therapeutic opportunities in clinical practice.
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Affiliation(s)
- Yang Liu
- School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Kevin D Croft
- School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Jonathan M Hodgson
- School of Biomedical Sciences, University of Western Australia, Perth, Australia; School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
| | - Trevor Mori
- Medical School, University of Western Australia, Perth, Australia
| | - Natalie C Ward
- Medical School, University of Western Australia, Perth, Australia; School of Public Health and Curtin Health Innovation Research Institute, Curtin University, Perth, Australia.
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13
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Rajendran S, Shen X, Glawe J, Kolluru GK, Kevil CG. Nitric Oxide and Hydrogen Sulfide Regulation of Ischemic Vascular Growth and Remodeling. Compr Physiol 2019; 9:1213-1247. [PMID: 31187898 DOI: 10.1002/cphy.c180026] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ischemic vascular remodeling occurs in response to stenosis or arterial occlusion leading to a change in blood flow and tissue perfusion. Altered blood flow elicits a cascade of molecular and cellular physiological responses leading to vascular remodeling of the macro- and micro-circulation. Although cellular mechanisms of vascular remodeling such as arteriogenesis and angiogenesis have been studied, therapeutic approaches in these areas have had limited success due to the complexity and heterogeneous constellation of molecular signaling events regulating these processes. Understanding central molecular players of vascular remodeling should lead to a deeper understanding of this response and aid in the development of novel therapeutic strategies. Hydrogen sulfide (H2 S) and nitric oxide (NO) are gaseous signaling molecules that are critically involved in regulating fundamental biochemical and molecular responses necessary for vascular growth and remodeling. This review examines how NO and H2 S regulate pathophysiological mechanisms of angiogenesis and arteriogenesis, along with important chemical and experimental considerations revealed thus far. The importance of NO and H2 S bioavailability, their synthesis enzymes and cofactors, and genetic variations associated with cardiovascular risk factors suggest that they serve as pivotal regulators of vascular remodeling responses. © 2019 American Physiological Society. Compr Physiol 9:1213-1247, 2019.
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Affiliation(s)
| | - Xinggui Shen
- Departments of Pathology, LSU Health Sciences Center, Shreveport
| | - John Glawe
- Departments of Pathology, LSU Health Sciences Center, Shreveport
| | - Gopi K Kolluru
- Departments of Pathology, LSU Health Sciences Center, Shreveport
| | - Christopher G Kevil
- Departments of Pathology, LSU Health Sciences Center, Shreveport.,Departments of Cellular Biology and Anatomy, LSU Health Sciences Center, Shreveport.,Departments of Molecular and Cellular Physiology, LSU Health Sciences Center, Shreveport
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14
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Bock JM, Treichler DP, Norton SL, Ueda K, Hughes WE, Casey DP. Inorganic nitrate supplementation enhances functional capacity and lower-limb microvascular reactivity in patients with peripheral artery disease. Nitric Oxide 2018; 80:45-51. [PMID: 30118808 DOI: 10.1016/j.niox.2018.08.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/07/2018] [Accepted: 08/14/2018] [Indexed: 11/18/2022]
Abstract
Peripheral artery disease (PAD) is characterized by functional and vascular impairments as well as elevated levels of inflammation which are associated with reduced nitric oxide (NO) bioavailability. Inorganic nitrate supplementation boosts NO bioavailability potentially improving functional and vasodilatory capacities and may reduce inflammation. Twenty-one patients with PAD were randomly assigned to sodium nitrate (NaNO3) or placebo supplementation groups for eight-weeks. Outcome measures included a 6-min walk test (6 MWT), blood flow and vasodilator function in the forearm and calf, as well as plasma inflammatory and adhesion biomarker concentrations. NaNO3 elevated plasma nitrate (32.3 ± 20.0 to 379.8 ± 204.6 μM) and nitrite (192.2 ± 51.8 to 353.1 ± 134.2 nM), improved 6 MWT performance (387 ± 90 to 425 ± 82 m), peak calf blood flow (BFPeak; 11.6 ± 4.9 to 14.1 ± 5.1 mL/dL tissue/min), and peak calf vascular conductance (VCPeak; 11.1 ± 4.3 to 14.2 ± 4.9 mL/dL tissue/min/mmHg) (p < 0.05 for all). Improvements in calf BFPeak (r = 0.70, p < 0.05) and VCPeak (r = 0.61, p < 0.05) correlated with changes in 6 MWT distance. Placebo supplementation did not change plasma nitrate or nitrite, 6 MWT, calf BFPeak, or calf VCPeak. Forearm vascular function nor inflammatory and adhesion biomarker concentrations changed in either group. Eight-weeks of NaNO3 supplementation improves vasodilatory capacity in the lower-limbs of patients with PAD, which correlated with improvement in functional capacity.
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Affiliation(s)
- Joshua M Bock
- Department of Physical Therapy and Rehabilitation Science, USA.
| | | | - Samuel L Norton
- Department of Physical Therapy and Rehabilitation Science, USA.
| | - Kenichi Ueda
- Department of Anesthesia, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | | | - Darren P Casey
- Department of Physical Therapy and Rehabilitation Science, USA; Abboud Cardiovascular Research Center, USA; Fraternal Order of Eagles Diabetes Research Center, USA.
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15
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Nitric oxide donors for peripheral artery disease. Curr Opin Pharmacol 2018; 39:77-85. [DOI: 10.1016/j.coph.2018.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 02/18/2018] [Accepted: 02/22/2018] [Indexed: 01/02/2023]
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16
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Dezfulian C, Olsufka M, Fly D, Scruggs S, Do R, Maynard C, Nichol G, Kim F. Hemodynamic effects of IV sodium nitrite in hospitalized comatose survivors of out of hospital cardiac arrest. Resuscitation 2017; 122:106-112. [PMID: 29175357 DOI: 10.1016/j.resuscitation.2017.11.055] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 11/08/2017] [Accepted: 11/22/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Patients resuscitated from cardiac arrest have brain and cardiac injury. Recent animal studies suggest that the administration of sodium nitrite after resuscitation from 12min of asystole limits acute cardiac dysfunction and improves survival and neurologic outcomes. It has been hypothesized that low doses of IV sodium nitrite given during resuscitation of out of hospital cardiac arrest (OHCA) will improve survival. Low doses of sodium nitrite (e.g., 9.6mg of sodium nitrite) are safe in healthy individuals, however the effect of nitrite on blood pressure in resuscitated cardiac arrest patients is unknown. METHODS We performed a single-center, pilot trial of low dose sodium nitrite (1 or 9.6mg dose) vs. placebo in hospitalized out-of-hospital cardiac arrest patient to determine whether nitrite administration reduced blood pressure and whether whole blood nitrite levels increased in response to nitrite administration. RESULTS This is the first reported study of sodium nitrite in cardiac arrest patients. Infusion of low doses of sodium nitrite in comatose survivors of OHCA (n=7) compared to placebo (n=4) had no significant effects on heart rate within 30min after infusion (70±20 vs. 78±3 beats per minute, p=0.18), systolic blood pressure (103±20 vs 108±15mmHg, p=0.3), or methemoglobin levels (0.92±0.33 vs. 0.70±0.26, p=0.45). Serum nitrite levels of 2-4μM were achieved within 15min of a 9.6mg nitrite infusion. CONCLUSIONS Low dose sodium nitrite does not cause significant hemodynamic effect in patients with OHCA, which suggests that nitrite can be delivered safely in this critically ill patient population. Higher doses of sodium nitrite are necessary in order to achieve target serum level of 10μM.
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Affiliation(s)
- Cameron Dezfulian
- Department of Adult and Pediatric Critical Care Medicine, Safar Center for Resuscitation Research and Vascular Medicine Institute, University of Pittsburgh, United States
| | - Michele Olsufka
- Department of Medicine, Harborview Medical Center, University of Washington, United States
| | - Deborah Fly
- Department of Medicine, Harborview Medical Center, University of Washington, United States
| | - Sue Scruggs
- Department of Medicine, Harborview Medical Center, University of Washington, United States
| | - Rose Do
- Department of Medicine, Harborview Medical Center, University of Washington, United States
| | - Charles Maynard
- Department of Health Services, University of Washington, United States
| | - Graham Nichol
- Department of Medicine, Harborview Medical Center, University of Washington, United States
| | - Francis Kim
- Department of Medicine, Harborview Medical Center, University of Washington, United States.
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17
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Poole DC, Richardson RS, Haykowsky MJ, Hirai DM, Musch TI. Exercise limitations in heart failure with reduced and preserved ejection fraction. J Appl Physiol (1985) 2017; 124:208-224. [PMID: 29051336 DOI: 10.1152/japplphysiol.00747.2017] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The hallmark symptom of chronic heart failure (HF) is severe exercise intolerance. Impaired perfusive and diffusive O2 transport are two of the major determinants of reduced physical capacity and lowered maximal O2 uptake in patients with HF. It has now become evident that this syndrome manifests at least two different phenotypic variations: heart failure with preserved or reduced ejection fraction (HFpEF and HFrEF, respectively). Unlike HFrEF, however, there is currently limited understanding of HFpEF pathophysiology, leading to a lack of effective pharmacological treatments for this subpopulation. This brief review focuses on the disturbances within the O2 transport pathway resulting in limited exercise capacity in both HFpEF and HFrEF. Evidence from human and animal research reveals HF-induced impairments in both perfusive and diffusive O2 conductances identifying potential targets for clinical intervention. Specifically, utilization of different experimental approaches in humans (e.g., small vs. large muscle mass exercise) and animals (e.g., intravital microscopy and phosphorescence quenching) has provided important clues to elucidating these pathophysiological mechanisms. Adaptations within the skeletal muscle O2 delivery-utilization system following established and emerging therapies (e.g., exercise training and inorganic nitrate supplementation, respectively) are discussed. Resolution of the underlying mechanisms of skeletal muscle dysfunction and exercise intolerance is essential for the development and refinement of the most effective treatments for patients with HF.
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18
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Joshipura KJ, Muñoz-Torres FJ, Morou-Bermudez E, Patel RP. Over-the-counter mouthwash use and risk of pre-diabetes/diabetes. Nitric Oxide 2017; 71:14-20. [PMID: 28939409 DOI: 10.1016/j.niox.2017.09.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
Abstract
AIMS Over-the-counter mouthwash comprises part of routine oral care for many; however, potential adverse effects of the long-term daily use have not been evaluated. Most mouthwash contain antibacterial ingredients, which could impact oral microbes critical for nitric oxide formation, and in turn predispose to metabolic disorders including diabetes. Our aim was to evaluate longitudinally the association between baseline over-the-counter mouthwash use and development of pre-diabetes/diabetes over a 3-year follow-up. MATERIALS AND METHODS The San Juan Overweight Adults Longitudinal Study (SOALS) recruited 1206 overweight/obese individuals, aged 40-65, and free of diabetes and major cardiovascular diseases; 945 with complete follow-up data were included in the analyses. We used Poisson regression models adjusting for baseline age, sex, smoking, physical activity, waist circumference, alcohol consumption, pre-hypertension/hypertension status; time between visits was included in the models as an offset. RESULTS Many participants (43%) used mouthwash at least once daily and 22% at least twice daily. Participants using mouthwash ≥ twice daily at baseline, had a significantly elevated risk of pre-diabetes/diabetes compared to less frequent users (multivariate IRR = 1.55, 95% CI: 1.21-1.99), or non-users of mouthwash (multivariate IRR = 1.49; 95% CI: 1.13-1.95). The effect estimates were similar after adding income, education, oral hygiene, oral conditions, sleep breathing disorders, diet (processed meat, fruit, and vegetable intake), medications, HOMA-IR, fasting glucose, 2hr post load glucose or CRP to the multivariate models. Both associations were also significant among never-smokers and obese individuals. Mouthwash use lower than twice daily showed no association, suggesting a threshold effect at twice or more daily. CONCLUSIONS Frequent regular use of over-the-counter mouthwash was associated with increased risk of developing pre-diabetes/diabetes in this population.
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Affiliation(s)
- Kaumudi J Joshipura
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, PR, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
| | - Francisco J Muñoz-Torres
- Center for Clinical Research and Health Promotion, University of Puerto Rico Medical Sciences Campus, School of Dental Medicine, San Juan, PR, USA
| | | | - Rakesh P Patel
- Department of Pathology and Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, USA
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19
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Montenegro MF, Sundqvist ML, Larsen FJ, Zhuge Z, Carlström M, Weitzberg E, Lundberg JO. Blood Pressure–Lowering Effect of Orally Ingested Nitrite Is Abolished by a Proton Pump Inhibitor. Hypertension 2017; 69:23-31. [DOI: 10.1161/hypertensionaha.116.08081] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 07/19/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
Abstract
Inorganic nitrate and nitrite from dietary and endogenous sources are metabolized to NO and other bioactive nitrogen oxides that affect blood pressure. The mechanisms for nitrite bioactivation are unclear, but recent studies in rodents suggest that gastric acidity may influence the systemic effects of this anion. In a randomized, double-blind, placebo-controlled crossover study, we tested the effects of a proton pump inhibitor on the acute cardiovascular effects of nitrite. Fifteen healthy nonsmoking, normotensive subjects, aged 19 to 39 years, were pretreated with placebo or esomeprazole (3×40 mg) before ingesting sodium nitrite (0.3 mg kg
−1
), followed by blood pressure monitoring. Nitrite reduced systolic blood pressure by a maximum of 6±1.3 mm Hg when taken after placebo, whereas pretreatment with esomeprazole blunted this effect. Peak plasma nitrite, nitrate, and nitroso species levels after nitrite ingestion were similar in both interventions. In 8 healthy volunteers, we then infused increasing doses of sodium nitrite (1, 10, and 30 nmol kg
−1
min
−1
) intravenously. Interestingly, although plasma nitrite peaked at similar levels as with orally ingested nitrite (≈1.8 µmol/L), no changes in blood pressure were observed. In rodents, esomeprazole did not affect the blood pressure response to the NO donor, DEA NONOate, or vascular relaxation to nitroprusside and acetylcholine, demonstrating an intact downstream NO-signaling pathway. We conclude that the acute blood pressure–lowering effect of nitrite requires an acidic gastric environment. Future studies will reveal if the cardiovascular complications associated with the use of proton pump inhibitors are linked to interference with the nitrate–nitrite–NO pathway.
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Affiliation(s)
- Marcelo F. Montenegro
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Michaela L. Sundqvist
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Filip J. Larsen
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Zhengbing Zhuge
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Mattias Carlström
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Eddie Weitzberg
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
| | - Jon O. Lundberg
- From the Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden (M.F.M., M.S., Z.Z., M.C., E.W., J.O.L.); and Åstrand Laboratory, The Swedish School of Sport and Health Sciences, Stockholm, Sweden (F.J.L.)
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20
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Hirai DM, Zelt JT, Jones JH, Castanhas LG, Bentley RF, Earle W, Staples P, Tschakovsky ME, McCans J, O’Donnell DE, Neder JA. Dietary nitrate supplementation and exercise tolerance in patients with heart failure with reduced ejection fraction. Am J Physiol Regul Integr Comp Physiol 2017; 312:R13-R22. [DOI: 10.1152/ajpregu.00263.2016] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/03/2016] [Accepted: 10/26/2016] [Indexed: 11/22/2022]
Abstract
Endothelial dysfunction and reduced nitric oxide (NO) signaling are key abnormalities leading to skeletal muscle oxygen delivery-utilization mismatch and poor physical capacity in patients with heart failure with reduced ejection fraction (HFrEF). Oral inorganic nitrate supplementation provides an exogenous source of NO that may enhance locomotor muscle function and oxygenation with consequent improvement in exercise tolerance in HFrEF. Thirteen patients (left ventricular ejection fraction ≤40%) were enrolled in a double-blind, randomized crossover study to receive concentrated nitrate-rich (nitrate) or nitrate-depleted (placebo) beetroot juice for 9 days. Low- and high-intensity constant-load cardiopulmonary exercise tests were performed with noninvasive measurements of central hemodynamics (stroke volume, heart rate, and cardiac output via impedance cardiography), arterial blood pressure, pulmonary oxygen uptake, quadriceps muscle oxygenation (near-infrared spectroscopy), and blood lactate concentration. Ten patients completed the study with no adverse clinical effects. Nitrate-rich supplementation resulted in significantly higher plasma nitrite concentration compared with placebo (240 ± 48 vs. 56 ± 8 nM, respectively; P < 0.05). There was no significant difference in the primary outcome of time to exercise intolerance between nitrate and placebo (495 ± 53 vs. 489 ± 58 s, respectively; P > 0.05). Similarly, there were no significant differences in central hemodynamics, arterial blood pressure, pulmonary oxygen uptake kinetics, skeletal muscle oxygenation, or blood lactate concentration from rest to low- or high-intensity exercise between conditions. Oral inorganic nitrate supplementation with concentrated beetroot juice did not present with beneficial effects on central or peripheral components of the oxygen transport pathway thereby failing to improve exercise tolerance in patients with moderate HFrEF.
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Affiliation(s)
- Daniel M. Hirai
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
- Department of Medicine, Respiratory Division, Pulmonary Function and Clinical Exercise Physiology Unit, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Joel T. Zelt
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Joshua H. Jones
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Luiza G. Castanhas
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
| | - Robert F. Bentley
- School of Kinesiology and Health Studies, Human Vascular Control Laboratory, Queen’s University, Kingston, Ontario, Canada
| | - Wendy Earle
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Patti Staples
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Michael E. Tschakovsky
- School of Kinesiology and Health Studies, Human Vascular Control Laboratory, Queen’s University, Kingston, Ontario, Canada
| | - John McCans
- Department of Medicine, Division of Cardiology, Queen’s University, Kingston, Ontario, Canada; and
| | - Denis E. O’Donnell
- Department of Medicine, Division of Respirology, Respiratory Investigation Unit, Queen’s University, Kingston, Ontario, Canada
| | - J. Alberto Neder
- Department of Medicine, Division of Respirology, Laboratory of Clinical Exercise Physiology, Queen’s University, Kingston, Ontario, Canada
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21
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Yuan S, Kevil CG. Nitric Oxide and Hydrogen Sulfide Regulation of Ischemic Vascular Remodeling. Microcirculation 2016; 23:134-45. [PMID: 26381654 DOI: 10.1111/micc.12248] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/13/2015] [Indexed: 12/22/2022]
Abstract
Blockage or restriction of blood flow through conduit arteries results in tissue ischemia downstream of the disturbed area. Local tissues can adapt to this challenge by stimulating vascular remodeling through angiogenesis and arteriogenesis thereby restoring blood perfusion and removal of wastes. Multiple molecular mechanisms of vascular remodeling during ischemia have been identified and extensively studied. However, therapeutic benefits from these findings and insights are limited due to the complexity of various signaling networks and a lack of understanding central metabolic regulators governing these responses. The gasotransmitters NO and H2 S have emerged as master regulators that influence multiple molecular targets necessary for ischemic vascular remodeling. In this review, we discuss how NO and H2 S are individually regulated under ischemia, what their roles are in angiogenesis and arteriogenesis, and how their interaction controls ischemic vascular remodeling.
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Affiliation(s)
- Shuai Yuan
- Departments of Pathology, Molecular and Cellular Physiology, and Cell Biology and Anatomy, LSU Health Shreveport, Shreveport, Louisiana, USA
| | - Christopher G Kevil
- Departments of Pathology, Molecular and Cellular Physiology, and Cell Biology and Anatomy, LSU Health Shreveport, Shreveport, Louisiana, USA
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Chirinos JA, Zamani P. The Nitrate-Nitrite-NO Pathway and Its Implications for Heart Failure and Preserved Ejection Fraction. Curr Heart Fail Rep 2016; 13:47-59. [PMID: 26792295 DOI: 10.1007/s11897-016-0277-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The pathogenesis of exercise intolerance in patients with heart failure and preserved ejection fraction (HFpEF) is likely multifactorial. In addition to cardiac abnormalities (diastolic dysfunction, abnormal contractile reserve, chronotropic incompetence), several peripheral abnormalities are likely to be involved. These include abnormal pulsatile hemodynamics, abnormal arterial vasodilatory responses to exercise, and abnormal peripheral O2 delivery, extraction, and utilization. The nitrate-nitrite-NO pathway is emerging as a potential target to modify key physiologic abnormalities, including late systolic left ventricular (LV) load from arterial wave reflections (which has deleterious short- and long-term consequences for the LV), arterial vasodilatory reserve, muscle O2 delivery, and skeletal muscle mitochondrial function. In a recently completed randomized trial, the administration of a single dose of exogenous inorganic nitrate has been shown to exert various salutary arterial hemodynamic effects, ultimately leading to enhanced aerobic capacity in patients with HFpEF. These effects have the potential for both immediate improvements in exercise tolerance and for long-term "disease-modifying" effects. In this review, we provide an overview of key mechanistic contributors to exercise intolerance in HFpEF, and of the potential therapeutic role of drugs that target the nitrate-nitrite-NO pathway.
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Affiliation(s)
- Julio A Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Hospital of the University of Pennsylvania, Philadelphia, PA, USA. .,Ghent University, Ghent, Belgium.
| | - Payman Zamani
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Mills CE, Khatri J, Maskell P, Odongerel C, Webb AJ. It is rocket science - why dietary nitrate is hard to 'beet'! Part II: further mechanisms and therapeutic potential of the nitrate-nitrite-NO pathway. Br J Clin Pharmacol 2016; 83:140-151. [PMID: 26914827 DOI: 10.1111/bcp.12918] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 02/17/2016] [Indexed: 12/14/2022] Open
Abstract
Dietary nitrate (found in green leafy vegetables such as rocket and in beetroot) is now recognized to be an important source of nitric oxide, via the nitrate-nitrite-NO pathway. Dietary nitrate confers several cardiovascular beneficial effects on blood pressure, platelets, endothelial function, mitochondrial efficiency and exercise. Having described key twists and turns in the elucidation of the pathway and the underlying mechanisms in Part I, we explore the more recent developments which have served to confirm mechanisms, extend our understanding, and discover new properties and potential therapeutic uses of the pathway in Part II. Even the established dependency on low oxygen states for bioactivation of nitrite has recently been challenged. Dietary nitrate appears to be an important component of 'healthy diets', such as the DASH diet to lower blood pressure and the Mediterranean diet, with its potential to lower cardiovascular risk, possibly through beneficial interactions with a range of other constituents. The World Cancer Research Foundation report strong evidence for vegetables including spinach and lettuce (high nitrate-containing) decreasing cancer risk (mouth, pharynx, larynx, oesophagus and stomach), summarized in a 'Nitrate-Cancer Risk Veg-Table'. The European Space Agency recommends that beetroot, lettuce, spinach and rocket (high-nitrate vegetables) are grown to provide food for long-term space missions. Nitrate, an ancient component of rocket fuel, could support sustainable crops for healthy humans.
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Affiliation(s)
- Charlotte Elizabeth Mills
- Department of Dietetics and Nutrition, Division of Diabetes and Nutritional Sciences, King's College London, Franklins Wilkins Building, London, SE1 0NH
| | - Jibran Khatri
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Perry Maskell
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Chimed Odongerel
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
| | - Andrew James Webb
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St.Thomas, Hospital, London, SE1 7EH, UK
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DeVan AE, Johnson LC, Brooks FA, Evans TD, Justice JN, Cruickshank-Quinn C, Reisdorph N, Bryan NS, McQueen MB, Santos-Parker JR, Chonchol MB, Bassett CJ, Sindler AL, Giordano T, Seals DR. Effects of sodium nitrite supplementation on vascular function and related small metabolite signatures in middle-aged and older adults. J Appl Physiol (1985) 2015; 120:416-25. [PMID: 26607249 DOI: 10.1152/japplphysiol.00879.2015] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/20/2015] [Indexed: 12/20/2022] Open
Abstract
Insufficient nitric oxide (NO) bioavailability plays an important role in endothelial dysfunction and arterial stiffening with aging. Supplementation with sodium nitrite, a precursor of NO, ameliorates age-related vascular endothelial dysfunction and arterial stiffness in mice, but effects on humans, including the metabolic pathways altered, are unknown. The purpose of this study was to determine the safety, feasibility, and efficacy of oral sodium nitrite supplementation for improving vascular function in middle-aged and older adults and to identify related circulating metabolites. Ten weeks of sodium nitrite (80 or 160 mg/day, capsules, TheraVasc; randomized, placebo control, double blind) increased plasma nitrite acutely (5- to 15-fold, P < 0.001 vs. placebo) and chronically (P < 0.10) and was well tolerated without symptomatic hypotension or clinically relevant elevations in blood methemoglobin. Endothelial function, measured by brachial artery flow-mediated dilation, increased 45-60% vs. baseline (P < 0.10) without changes in body mass or blood lipids. Measures of carotid artery elasticity (ultrasound and applanation tonometry) improved (decreased β-stiffness index, increased cross-sectional compliance, P < 0.05) without changes in brachial or carotid artery blood pressure. Aortic pulse wave velocity was unchanged. Nitrite-induced changes in vascular measures were significantly related to 11 plasma metabolites identified by untargeted analysis. Baseline abundance of multiple metabolites, including glycerophospholipids and fatty acyls, predicted vascular changes with nitrite. This study provides evidence that sodium nitrite supplementation is well tolerated, increases plasma nitrite concentrations, improves endothelial function, and lessens carotid artery stiffening in middle-aged and older adults, perhaps by altering multiple metabolic pathways, thereby warranting a larger clinical trial.
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Affiliation(s)
- Allison E DeVan
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado;
| | - Lawrence C Johnson
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Forrest A Brooks
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Trent D Evans
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Jamie N Justice
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Nichole Reisdorph
- Integrated Department of Immunology, National Jewish Health, Denver, Colorado
| | | | - Matthew B McQueen
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Michel B Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, Colorado
| | - Candace J Bassett
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Amy L Sindler
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | | | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
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Golzarand M, Bahadoran Z, Mirmiran P, Zadeh-Vakili A, Azizi F. Consumption of nitrate-containing vegetables is inversely associated with hypertension in adults: a prospective investigation from the Tehran Lipid and Glucose Study. J Nephrol 2015; 29:377-384. [PMID: 26335410 DOI: 10.1007/s40620-015-0229-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 08/19/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND There is growing evidence of the potential properties of nitrate-rich foods against development of hypertension (HTN) and vascular disease. In this study, we investigated the association of nitrate-containing vegetables (NCVs) with risk of HTN after 3 years of follow-up. METHODS This prospective study was conducted on 1546 non-hypertensive subjects, aged 20-70 years. Blood pressure was measured at baseline and after 3 years and HTN was defined by the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure criteria. Dietary intake was collected using a validated semi-quantitative food frequency questionnaire (FFQ). NCVs and high-, medium- and low-NCV subcategories were defined, and the odds of HTN after 3 years according to tertiles of NCV and NCV-category intake were estimated by logistic regression and adjusted for potential variables. RESULTS Mean age of participants was 38.0 ± 12.0 years at baseline and 57.0 % were women. Mean dietary intake of energy-adjusted NCV was 298.0 ± 177.3 g/day. After adjustment for total energy intake, fiber, sodium, potassium and processed meat, a significant inverse association was observed between NCV and the risk of HTN in the highest tertile category (odds ratio 0.63, 95 % confidence interval: 0.41-0.98, p for trend = 0.05). There was no significant association of 3 year risk of HTN across tertiles of low nitrate-, medium nitrate- and high-nitrate vegetables. CONCLUSION Higher dietary nitrate intake from vegetables sources may have a protective effect against development of HTN.
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Affiliation(s)
- Mahdieh Golzarand
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.,Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Zahra Bahadoran
- Nutrition and Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.,Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran. .,, No. 24, Parvaneh St, Yemen St, Chamran Exp, PO Box 19395-4763, Tehran, Islamic Republic of Iran.
| | - Azita Zadeh-Vakili
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran.,Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Islamic Republic of Iran
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Lundberg JO, Gladwin MT, Weitzberg E. Strategies to increase nitric oxide signalling in cardiovascular disease. Nat Rev Drug Discov 2015; 14:623-41. [PMID: 26265312 DOI: 10.1038/nrd4623] [Citation(s) in RCA: 376] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nitric oxide (NO) is a key signalling molecule in the cardiovascular, immune and central nervous systems, and crucial steps in the regulation of NO bioavailability in health and disease are well characterized. Although early approaches to therapeutically modulate NO bioavailability failed in clinical trials, an enhanced understanding of fundamental subcellular signalling has enabled a range of novel therapeutic approaches to be identified. These include the identification of: new pathways for enhancing NO synthase activity; ways to amplify the nitrate-nitrite-NO pathway; novel classes of NO-donating drugs; drugs that limit NO metabolism through effects on reactive oxygen species; and ways to modulate downstream phosphodiesterases and soluble guanylyl cyclases. In this Review, we discuss these latest developments, with a focus on cardiovascular disease.
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Affiliation(s)
- Jon O Lundberg
- Department of Physiology and Pharmacology, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Mark T Gladwin
- Vascular Medicine Institute, Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pennsylvania 15213, USA
| | - Eddie Weitzberg
- Department of Physiology and Pharmacology, Karolinska Institute, SE-171 77 Stockholm, Sweden
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Bahadoran Z, Ghasemi A, Mirmiran P, Azizi F, Hadaegh F. Beneficial effects of inorganic nitrate/nitrite in type 2 diabetes and its complications. Nutr Metab (Lond) 2015; 12:16. [PMID: 25991919 PMCID: PMC4436104 DOI: 10.1186/s12986-015-0013-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/07/2015] [Indexed: 12/17/2022] Open
Abstract
Background and aim The ability of inorganic nitrate and nitrite to convert to nitric oxide (NO), and some of its properties e.g. regulation of glucose metabolism, vascular homeostasis, and insulin signaling pathway, have recently raised the hypothesis that inorganic nitrate and nitrite could be potential therapeutic agents in type 2 diabetes. In this review, we reviewed experimental and clinical studies investigating the effect of nitrate/nitrite administration on various aspects of type 2 diabetes. Findings Studies showed that an altered metabolism of nitrate/nitrite and impaired NO pathway occurs in diabetes which could contribute to its complications. Some important beneficial properties, including regulation of glucose homeostasis and insulin signaling pathway, improvement of insulin resistance and vascular function, hypotensive, hypolipidemic as well as anti-inflammatory and anti-oxidative effects have been observed following administration of inorganic nitrate/nitrite. Conclusion It seems that dietary nitrate/nitrite could be a compensatory fuel for a disrupted nitrate/nitrite/NO pathway and related disorders in diabetes. Although some beneficial properties of nitrate/nitrite have been reported by experimental investigations, long-term clinical studies with various doses of inorganic nitrate/nitrite supplementation, are recommended to confirm these effects.
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Affiliation(s)
- Zahra Bahadoran
- Nutrition and Endocrine Research Center, and Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran ; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, No. 24, Sahid-Erabi St, Yemen St, Chamran Exp, 19395-4763 Tehran, Iran
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Polhemus DJ, Bradley JM, Islam KN, Brewster LP, Calvert JW, Tao YX, Chang CC, Pipinos II, Goodchild TT, Lefer DJ. Therapeutic potential of sustained-release sodium nitrite for critical limb ischemia in the setting of metabolic syndrome. Am J Physiol Heart Circ Physiol 2015; 309:H82-92. [PMID: 25910804 DOI: 10.1152/ajpheart.00115.2015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/13/2015] [Indexed: 01/12/2023]
Abstract
Nitrite is a storage reservoir of nitric oxide that is readily reduced to nitric oxide under pathological conditions. Previous studies have demonstrated that nitrite levels are significantly reduced in cardiovascular disease states, including peripheral vascular disease. We investigated the cytoprotective and proangiogenic actions of a novel, sustained-release formulation of nitrite (SR-nitrite) in a clinically relevant in vivo swine model of critical limb ischemia (CLI) involving central obesity and metabolic syndrome. CLI was induced in obese Ossabaw swine (n = 18) by unilateral external iliac artery deployment of a full cross-sectional vessel occlusion device positioned within an endovascular expanded polytetrafluoroethylene-lined nitinol stent-graft. At post-CLI day 14, pigs were randomized to placebo (n = 9) or SR-nitrite (80 mg, n = 9) twice daily by mouth for 21 days. SR-nitrite therapy increased nitrite, nitrate, and S-nitrosothiol in plasma and ischemic skeletal muscle. Oxidative stress was reduced in ischemic limb tissue of SR-nitrite- compared with placebo-treated pigs. Ischemic limb tissue levels of proangiogenic growth factors were increased following SR-nitrite therapy compared with placebo. Despite the increases in cytoprotective and angiogenic signals with SR-nitrite therapy, new arterial vessel formation and enhancement of blood flow to the ischemic limb were not different from placebo. Our data clearly demonstrate cytoprotective and proangiogenic signaling in ischemic tissues following SR-nitrite therapy in a very severe model of CLI. Further studies evaluating longer-duration nitrite therapy and/or additional nitrite dosing strategies are warranted to more fully evaluate the therapeutic potential of nitrite therapy in peripheral vascular disease.
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Affiliation(s)
- David J Polhemus
- Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana
| | - Jessica M Bradley
- Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana
| | - Kazi N Islam
- Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana
| | - Luke P Brewster
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia; Surgery and Research Services, Atlanta Veterans Affairs Medical Center, Decatur, Georgia; Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, Georgia
| | - John W Calvert
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Ya-Xiong Tao
- Department of Anatomy, Physiology, and Pharmacology, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | | | - Iraklis I Pipinos
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Traci T Goodchild
- Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana
| | - David J Lefer
- Cardiovascular Center of Excellence and Department of Pharmacology, LSU Health Sciences Center, New Orleans, Louisiana;
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Bahadoran Z, Mirmiran P, Ghasemi A, Kabir A, Azizi F, Hadaegh F. Is dietary nitrate/nitrite exposure a risk factor for development of thyroid abnormality? A systematic review and meta-analysis. Nitric Oxide 2015; 47:65-76. [PMID: 25889269 DOI: 10.1016/j.niox.2015.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 04/06/2015] [Accepted: 04/08/2015] [Indexed: 12/15/2022]
Abstract
The potential effects of inorganic nitrate/nitrite on global health are a much debated issue. In addition to possible methemoglobinemia and carcinogenic properties, anti-thyroid effects of nitrate/nitrite have been suggested. Considering the growing significance of nitrate/nitrite and since there is no comprehensive review in data available, clarifying the effect of nitrate/nitrite on thyroid disorder outcomes is essential. Therefore, we conducted this systematic review of experimental and clinical studies, and a meta-analysis of relevant cohort and cross-sectional studies investigating the association of nitrate/nitrite exposure and thyroid function. Most animal studies show that high exposure (~10-600 times of acceptable daily intake) to nitrate/nitrite induces anti-thyroid effects, including decreased serum level of thyroid hormones and histomorphological changes in thyroid gland; however no similar observations have been documented in humans. Based on our meta-analysis, no significant association was observed between nitrate exposure and the risk of thyroid cancer, hyper- and hypothyroidism; findings from three cohort studies however showed a significant association between higher exposure to nitrite and the risk of thyroid cancer (risk = 1.48, 95% confidence interval = 1.09-2.02, P = 0.012). Additional research is needed to clarify the association between nitrate/nitrite exposures and both thyroid function and cancer.
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Affiliation(s)
- Zahra Bahadoran
- Nutrition and Endocrine Research Center, Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Parvin Mirmiran
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition Sciences and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Asghar Ghasemi
- Endocrine Physiology Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Kabir
- Minimally Invasive Surgery Research Center; Iran University of Medical Sciences, Tehran, Iran; Department of Epidemiology, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Omar SA, Fok H, Tilgner KD, Nair A, Hunt J, Jiang B, Taylor P, Chowienczyk P, Webb AJ. Paradoxical normoxia-dependent selective actions of inorganic nitrite in human muscular conduit arteries and related selective actions on central blood pressures. Circulation 2015; 131:381-9; discussion 389. [PMID: 25533964 DOI: 10.1161/circulationaha.114.009554] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Inorganic nitrite dilates small resistance arterioles via hypoxia-facilitated reduction to vasodilating nitric oxide. The effects of nitrite in human conduit arteries have not been investigated. In contrast to nitrite, organic nitrates are established selective dilators of conduit arteries. METHODS AND RESULTS We examined the effects of local and systemic administration of sodium nitrite on the radial artery (a muscular conduit artery), forearm resistance vessels (forearm blood flow), and systemic hemodynamics in healthy male volunteers (n=43). Intrabrachial sodium nitrite (8.7 μmol/min) increased radial artery diameter by a median of 28.0% (25th and 75th percentiles, 25.7% and 40.1%; P<0.001). Nitrite (0.087-87 μmol/min) displayed conduit artery selectivity similar to that of glyceryl trinitrate (0.013-4.4 nmol/min) over resistance arterioles. Nitrite dose-dependently increased local cGMP production at the dose of 2.6 μmol/min by 1.1 pmol·min(-1)·100 mL(-1) tissue (95% confidence interval, 0.5-1.8). Nitrite-induced radial artery dilation was enhanced by administration of acetazolamide (oral or intra-arterial) and oral raloxifene (P=0.0248, P<0.0001, and P=0.0006, respectively) but was inhibited under hypoxia (P<0.0001) and hyperoxia (P=0.0006) compared with normoxia. Systemic intravenous administration of sodium nitrite (8.7 μmol/min) dilated the radial artery by 10.7% (95% confidence interval, 6.8-14.7) and reduced central systolic blood pressure by 11.6 mm Hg (95% confidence interval, 2.4-20.7), augmentation index, and pulse wave velocity without changing peripheral blood pressure. CONCLUSIONS Nitrite selectively dilates conduit arteries at supraphysiological and near-physiological concentrations via a normoxia-dependent mechanism that is associated with cGMP production and is enhanced by acetazolamide and raloxifene. The selective central blood pressure-lowering effects of nitrite have therapeutic potential to reduce cardiovascular events.
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Affiliation(s)
- Sami A Omar
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Henry Fok
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Katharina D Tilgner
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Ashok Nair
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Joanne Hunt
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Benyu Jiang
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Paul Taylor
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Phil Chowienczyk
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Andrew J Webb
- From the King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, London, UK (S.A.O., H.F., A.N., J.H., B.J., P.C., A.J.W.); Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK (K.D.T., P.T.); Department of Anaesthetics (A.N.), and Biomedical Research Centre (S.A.O., H.F., A.N., J.H., B.J., P.C., A.W.), Guy's & St. Thomas' NHS Foundation Trust, London, UK.
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Ohtake K, Nakano G, Ehara N, Sonoda K, Ito J, Uchida H, Kobayashi J. Dietary nitrite supplementation improves insulin resistance in type 2 diabetic KKA(y) mice. Nitric Oxide 2014; 44:31-8. [PMID: 25461271 DOI: 10.1016/j.niox.2014.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/03/2014] [Accepted: 11/11/2014] [Indexed: 01/30/2023]
Abstract
BACKGROUND Because insulin signaling is essential for endothelial nitric oxide synthase (eNOS)-derived nitric oxide (NO) production, the loss of bioavailable NO might be a common molecular mechanism underlying the development of insulin resistance and endothelial dysfunction. Although dietary nitrite acts as a substrate for systemic NO generation, thereby serving as a physiological alternative source of NO for signaling, it is not precisely known how dietary nitrite affects type 2 diabetes mellitus. Here we report the therapeutic effects of dietary nitrite on the metabolic and histological features of KKA(y) diabetic mice. METHODS KKA(y) mice were divided into three groups (without nitrite, and with 50 mg/L and 150 mg/L nitrite in drinking water), and two groups of C57BL/6J mice served as controls (without nitrite and with 150 mg/L nitrite in drinking water). After 10 weeks, blood samples, visceral adipose tissues, and gastrocnemius muscles were collected after a 16-hour fast to assess the homeostasis model assessment of insulin resistance (HOMA-IR) levels, the histology of the adipose tissue, insulin-stimulated sequential signaling to glucose transporter 4 (GLUT4), and nitrite and nitrate contents in the muscle using an HPLC system. RESULTS KKA(y) mice developed obesity with enhanced fasting plasma levels of glucose and insulin and exhibited increased HOMA-IR scores compared with the C57BL/6J control mice. Dietary nitrite dose-dependently reduced the size of the hypertrophic adipocytes and TNF-α transcription in the adipose tissue of KKA(y) diabetic mice, which also restored the insulin-mediated signal transduction, including p85 and Akt phosphorylation, and subsequently restored the GLUT4 expression in the skeletal muscles. CONCLUSIONS These results suggest that dietary nitrite provides an alternative source of NO, and subsequently improves the insulin-mediated signaling and the metabolic and histological features in KKA(y) diabetic mice.
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Affiliation(s)
- Kazuo Ohtake
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Genya Nakano
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Nobuyuki Ehara
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Kunihiro Sonoda
- Department of Food and Nutritional Environment, College of Human Life and Environment, Kinjo Gakuin University, Nagoya, Japan
| | - Junta Ito
- Division of Oral Anatomy, Department of Human Development and Fostering, Meikai University School of Dentistry, Saitama, Japan
| | - Hiroyuki Uchida
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan
| | - Jun Kobayashi
- Division of Pathophysiology, Department of Clinical Dietetics and Human Nutrition, Faculty of Pharmaceutical Science, Josai University, Saitama, Japan.
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Revsbech IG, Shen X, Chakravarti R, Jensen FB, Thiel B, Evans AL, Kindberg J, Fröbert O, Stuehr DJ, Kevil CG, Fago A. Hydrogen sulfide and nitric oxide metabolites in the blood of free-ranging brown bears and their potential roles in hibernation. Free Radic Biol Med 2014; 73:349-57. [PMID: 24909614 PMCID: PMC4413933 DOI: 10.1016/j.freeradbiomed.2014.05.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/19/2014] [Accepted: 05/30/2014] [Indexed: 02/08/2023]
Abstract
During winter hibernation, brown bears (Ursus arctos) lie in dens for half a year without eating while their basal metabolism is largely suppressed. To understand the underlying mechanisms of metabolic depression in hibernation, we measured type and content of blood metabolites of two ubiquitous inhibitors of mitochondrial respiration, hydrogen sulfide (H2S) and nitric oxide (NO), in winter-hibernating and summer-active free-ranging Scandinavian brown bears. We found that levels of sulfide metabolites were overall similar in summer-active and hibernating bears but their composition in the plasma differed significantly, with a decrease in bound sulfane sulfur in hibernation. High levels of unbound free sulfide correlated with high levels of cysteine (Cys) and with low levels of bound sulfane sulfur, indicating that during hibernation H2S, in addition to being formed enzymatically from the substrate Cys, may also be regenerated from its oxidation products, including thiosulfate and polysulfides. In the absence of any dietary intake, this shift in the mode of H2S synthesis would help preserve free Cys for synthesis of glutathione (GSH), a major antioxidant found at high levels in the red blood cells of hibernating bears. In contrast, circulating nitrite and erythrocytic S-nitrosation of glyceraldehyde-3-phosphate dehydrogenase, taken as markers of NO metabolism, did not change appreciably. Our findings reveal that remodeling of H2S metabolism and enhanced intracellular GSH levels are hallmarks of the aerobic metabolic suppression of hibernating bears.
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Affiliation(s)
- Inge G Revsbech
- Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark
| | - Xinggui Shen
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
| | - Ritu Chakravarti
- Department of Pathobiology, Cleveland Clinic Lerner Research Institute, Cleveland, OH 44195, USA
| | - Frank B Jensen
- Department of Biology, University of Southern Denmark, 5230 Odense M, Denmark
| | - Bonnie Thiel
- Department of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Alina L Evans
- Department of Forestry and Wildlife Management, Faculty of Applied Ecology and Agricultural Sciences, Hedmark University College, Campus Evenstad, 2418 Elverum, Norway
| | - Jonas Kindberg
- Department of Wildlife, Fish, and Environmental Studies, Swedish University of Agricultural Sciences, 90183 Umeå, Sweden
| | - Ole Fröbert
- Department of Cardiology, Örebro University Hospital, 70362 Örebro, Sweden
| | - Dennis J Stuehr
- Department of Pathobiology, Cleveland Clinic Lerner Research Institute, Cleveland, OH 44195, USA
| | - Christopher G Kevil
- Department of Pathology, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
| | - Angela Fago
- Department of Bioscience, Aarhus University, 8000 Aarhus C, Denmark.
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Bir SC, Pattillo CB, Pardue S, Kolluru GK, Shen X, Giordano T, Kevil CG. Nitrite anion therapy protects against chronic ischemic tissue injury in db/db diabetic mice in a NO/VEGF-dependent manner. Diabetes 2014; 63:270-81. [PMID: 24009258 PMCID: PMC4179307 DOI: 10.2337/db13-0890] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Nitrite anion has been demonstrated to be a prodrug of nitric oxide (NO) with positive effects on tissue ischemia/reperfusion injury, cytoprotection, and vasodilation. However, effects of nitrite anion therapy for ischemic tissue vascular remodeling during diabetes remain unknown. We examined whether sodium nitrite therapy altered ischemic revascularization in BKS-Lepr(db/db) mice subjected to permanent unilateral femoral artery ligation. Sodium nitrite therapy completely restored ischemic hind limb blood flow compared with nitrate or PBS therapy. Importantly, delayed nitrite therapy 5 days after ischemia restored ischemic limb blood flow in aged diabetic mice. Restoration of blood flow was associated with increases in ischemic tissue angiogenesis activity and cell proliferation. Moreover, nitrite but not nitrate therapy significantly prevented ischemia-mediated tissue necrosis in aged mice. Nitrite therapy significantly increased ischemic tissue vascular endothelial growth factor (VEGF) protein expression that was essential for nitrite-mediated reperfusion of ischemic hind limbs. Nitrite significantly increased ischemic tissue NO bioavailability along with concomitant reduction of superoxide formation. Lastly, nitrite treatment also significantly stimulated hypoxic endothelial cell proliferation and migration in the presence of high glucose in an NO/VEGF-dependent manner. These results demonstrate that nitrite therapy effectively stimulates ischemic tissue vascular remodeling in the setting of metabolic dysfunction that may be clinically useful.
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Affiliation(s)
- Shyamal C. Bir
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | - Christopher B. Pattillo
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | - Sibile Pardue
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | - Gopi K. Kolluru
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | - Xinggui Shen
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
| | | | - Christopher G. Kevil
- Department of Pathology, Louisiana State University Health Sciences Center–Shreveport, Shreveport, LA
- TheraVasc Inc., Cleveland, OH
- Corresponding author: Christopher G. Kevil,
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