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Winkler MS, Kluge S, Holzmann M, Moritz E, Robbe L, Bauer A, Zahrte C, Priefler M, Schwedhelm E, Böger RH, Goetz AE, Nierhaus A, Zoellner C. Markers of nitric oxide are associated with sepsis severity: an observational study. Crit Care 2017; 21:189. [PMID: 28709458 PMCID: PMC5513203 DOI: 10.1186/s13054-017-1782-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/29/2017] [Indexed: 02/23/2023] Open
Abstract
Background Nitric oxide (NO) regulates processes involved in sepsis progression, including vascular function and pathogen defense. Direct NO measurement in patients is unfeasible because of its short half-life. Surrogate markers for NO bioavailability are substrates of NO generating synthase (NOS): L-arginine (lArg) and homoarginine (hArg) together with the inhibitory competitive substrate asymmetric dimethylarginine (ADMA). In immune cells ADMA is cleaved by dimethylarginine-dimethylaminohydrolase-2 (DDAH2). The aim of this study was to investigate whether concentrations of surrogate markers for NO bioavailability are associated with sepsis severity. Method This single-center, prospective study involved 25 controls and 100 patients with surgical trauma (n = 20), sepsis (n = 63), or septic shock (n = 17) according to the Sepsis-3 definition. Plasma lArg, hArg, and ADMA concentrations were measured by mass spectrometry and peripheral blood mononuclear cells (PBMCs) were analyzed for DDAH2 expression. Results lArg concentrations did not differ between groups. Median (IQR) hArg concentrations were significantly lower in patient groups than controls, being 1.89 (1.30–2.29) μmol/L (P < 0.01), with the greatest difference in the septic shock group, being 0.74 (0.36–1.44) μmol/L. In contrast median ADMA concentrations were significantly higher in patient groups compared to controls, being 0.57 (0.46–0.65) μmol/L (P < 0.01), with the highest levels in the septic shock group, being 0.89 (0.56–1.39) μmol/L. The ratio of hArg:ADMA was inversely correlated with disease severity as determined by the Sequential Organ Failure Assessment (SOFA) score. Receiver-operating characteristic analysis for the presence or absence of septic shock revealed equally high sensitivity and specificity for the hArg:ADMA ratio compared to the SOFA score. DDAH2 expression was lower in patients than controls and lowest in the subgroup of patients with increasing SOFA. Conclusions In patients with sepsis, plasma hArg concentrations are decreased and ADMA concentrations are increased. Both metabolites affect NO metabolism and our findings suggest reduced NO bioavailability in sepsis. In addition, reduced expression of DDAH2 in immune cells was observed and may not only contribute to blunted NO signaling but also to subsequent impaired pathogen defense.
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Affiliation(s)
- Martin Sebastian Winkler
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Maximilian Holzmann
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eileen Moritz
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Linda Robbe
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Antonia Bauer
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Corinne Zahrte
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Marion Priefler
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Edzard Schwedhelm
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Rainer H Böger
- Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alwin E Goetz
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Axel Nierhaus
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christian Zoellner
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.,Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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6
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Lambden S, Kelly P, Ahmetaj-Shala B, Wang Z, Lee B, Nandi M, Torondel B, Delahaye M, Dowsett L, Piper S, Tomlinson J, Caplin B, Colman L, Boruc O, Slaviero A, Zhao L, Oliver E, Khadayate S, Singer M, Arrigoni F, Leiper J. Dimethylarginine dimethylaminohydrolase 2 regulates nitric oxide synthesis and hemodynamics and determines outcome in polymicrobial sepsis. Arterioscler Thromb Vasc Biol 2015; 35:1382-92. [PMID: 25857313 DOI: 10.1161/atvbaha.115.305278] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nitric oxide is a key to numerous physiological and pathophysiological processes. Nitric oxide production is regulated endogenously by 2 methylarginines, asymmetric dimethylarginine (ADMA) and monomethyl-L-arginine. The enzyme that specifically metabolizes asymmetric dimethylarginine and monomethyl-L-arginine is dimethylarginine dimethylaminohydrolase (DDAH). The first isoform dimethylarginine dimethylaminohydrolase 1 has previously been shown to be an important regulator of methylarginines in both health and disease. This study explores for the first time the role of endogenous dimethylarginine dimethylaminohydrolase 2 in regulating cardiovascular physiology and also determines the functional impact of dimethylarginine dimethylaminohydrolase 2 deletion on outcome and immune function in sepsis. APPROACH AND RESULTS Mice, globally deficient in Ddah2, were compared with their wild-type littermates to determine the physiological role of Ddah2 using in vivo and ex vivo assessments of vascular function. We show that global knockout of Ddah2 results in elevated blood pressure during periods of activity (mean [SEM], 118.5 [1.3] versus 112.7 [1.1] mm Hg; P=0.025) and changes in vascular responsiveness mediated by changes in methylarginine concentration, mean myocardial tissue asymmetric dimethylarginine (SEM) was 0.89 (0.06) versus 0.67 (0.05) μmol/L (P=0.02) and systemic nitric oxide concentrations. In a model of severe polymicrobial sepsis, Ddah2 knockout affects outcome (120-hour survival was 12% in Ddah2 knockouts versus 53% in wild-type animals; P<0.001). Monocyte-specific deletion of Ddah2 results in a similar pattern of increased severity to that seen in globally deficient animals. CONCLUSIONS Ddah2 has a regulatory role both in normal physiology and in determining outcome of severe polymicrobial sepsis. Elucidation of this role identifies a mechanism for the observed relationship between Ddah2 polymorphisms, cardiovascular disease, and outcome in sepsis.
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Affiliation(s)
- Simon Lambden
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Peter Kelly
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Blerina Ahmetaj-Shala
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Zhen Wang
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Benjamin Lee
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Manasi Nandi
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Belen Torondel
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Matthew Delahaye
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Laura Dowsett
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Sophie Piper
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - James Tomlinson
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Ben Caplin
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Lucy Colman
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Olga Boruc
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Anna Slaviero
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Lan Zhao
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Eduardo Oliver
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Sanjay Khadayate
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Mervyn Singer
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - Francesca Arrigoni
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.)
| | - James Leiper
- From the Nitric Oxide Signalling Group (S.L., P.K., Z.W., B.L., B.T., M.D., L.D., S.P., J.T., B.C., L.C., O.B., A.S., J.L.) and Bioinformatics Core (S.K.), Clinical Sciences Centre, Medical Research Council, Hammersmith Hospital, London, United Kingdom; National Heart and Lung Institute (B.A.-S.) and Centre for Pharmacology and Therapeutics (L.Z., E.O.), Imperial College London, London, United Kingdom; Institute of Pharmaceutical Science, King's College London, London, United Kingdom (M.N.); Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom (M.S.); and School of Pharmacy and Chemistry, Kingston University, Surrey, United Kingdom (F.A.).
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