[Measurement of exhaled nitric oxide: methodology]

INTRODUCTION

The singular relationship between the exhaled nitric oxide (NO) fraction and the expiratory flow rate has both technical (subject of international guidelines) and theoretical (modelling of pulmonary NO exchange) implications.

STATE OF THE ART

Guidelines recommend the measurement of exhaled NO at a single, defined, expiratory flow rate (V') against a positive expiratory pressure to ensure velum closure, providing a fraction of exhaled NO, FE(NO,V'). With some oversimplifications concerning the relationship between FENO and V', NO exchange parameters independent of the expiratory flow rate can be calculated based on a two-compartment model: maximum conducting airway NO flux (J'awNO), alveolar NO concentration (CalvNO), and in some conditions, airway NO diffusing capacity (DawNO) and epithelial NO concentration of conducting airways (CawNO).

PERSPECTIVES

Technical progress has provided the pulmonologist with simple equipment to allow the determination of the NO output from the respiratory tract. The two-compartment model provides the physiologist with a non-invasive technique for evaluating the contribution of alveolar space and conducting airways.

CONCLUSION

The measurement of exhaled NO allows the non-invasive evaluation of a key mediator involved in the regulation of biological processes.

[The place of expired nitric oxide measurements in asthma]

INTRODUCTION

The production of nitric oxide (NO) can be assessed by measuring the fraction of NO during a prolonged expiration (FENO) or by estimating other parameters of NO exchange including the alveolar NO concentration (CalvNO).

STATE OF THE ART

Changes in the production of NO are seen in association with clinical events (allergen exposure, minor symptoms, acute crises, changes of treatment) and functional (bronchial hyper-reactivity) or pathological (eosinophilia, remodeling markers) features characterising asthmatic phenotypes.

PERSPECTIVE

Measurement of NO is a non-invasive tool for the evaluation of atopy, particularly in the course of allergic asthma. The interpretation of a single measurement is limited by the variability of the values associated with a stable state in the allergic population: the use in practice (risk of exacerbation, follow up, adjustment of steroid treatment) depends on analysis of sequential variations in FENO. Calculation of CalvNO may provide information about small airway inflammation and assist the optimal control of the disease.

CONCLUSION

Ambulatory measurement of expired NO and the estimation of parameters describing NO exchange, independently of expiratory flow, could become the key evaluations in the monitoring of allergic asthma.

Perivascular adipose tissue modulates vascular function in the human internal thoracic artery

OBJECTIVE

Recent studies have shown that perivascular adipose tissue from the rat aorta secretes a substance that can dilate the aorta. The purpose of the present study was to examine whether this vasodilator is also present in human internal thoracic arteries.

METHODS

Vascular function of human internal thoracic arteries with and without perivascular adipose tissue was assessed with wire myography, and morphology was examined with light microscopy.

RESULTS

The presence of perivascular adipose tissue attenuated the maximal contraction to U 46619 and the contraction to phenylephrine (1 micromol/L) by 37% and 24%, respectively. Transfer of the solution incubated with a perivascular adipose tissue-intact vessel (donor) to a vessel without perivascular adipose tissue (recipient) induced a significant relaxation (36%) in the recipient artery precontracted with phenylephrine. Transfer of incubation solution with perivascular adipose tissue alone also induced a relaxation response in the recipient vessel (37%). The relaxation of the recipient artery induced by the transfer of incubation solution from the donor (artery with intact perivascular adipose tissue or perivascular adipose tissue alone) was absent in vessels precontracted by KCl (60 mmol/L) and was prevented by calcium-dependent potassium channel blockers (tetraethylammonium chloride, 1 mmol/L; iberiotoxin, 100 nmol/L), but not by the voltage-dependent potassium channel blocker 4-aminopyridine (1 mmol/L) and the adenosine triphosphate-dependent potassium channel blocker glibenclamide (10 micromol/L).

CONCLUSIONS

Perivascular adipose tissue in human internal thoracic arteries releases a transferable relaxation factor that acts through the activation of calcium-dependent potassium channels. Because perivascular adipose tissue is often removed in coronary artery bypass grafting, retaining perivascular adipose tissue might be helpful in reducing the occurrence of vasospasm of the graft vessels.

Coronary Blood Flow Responses are Impaired Independent of NO and Endothelial Function in Conscious Dogs with Dilated Cardiomyopathy

BACKGROUND

Dilated cardiomyopathy (DCM) is characterized by nitric oxide (NO) deficiency and endothelial dysfunction. Whether endothelium-independent vasodilation is preserved, particularly in the coronary circulation, remains controversial.

METHODS AND RESULTS

We studied systemic and coronary flow responses to the endothelium-dependent agonist, acetylcholine, the cGMP-dependent NO-donor, nitroglycerin, the predominantly endothelium-independent agonist, adenosine, the beta-adrenergic cAMP-dependent agonist, isoproterenol, and the calcium channel antagonist, nicardipine, in conscious dogs with pacing-induced DCM. Systemic blood flow response was impaired to acetylcholine but preserved to other vasodilators in DCM. In contrast, coronary blood flow response was significantly ( P < .05) depressed to all agonists. (Peak coronary blood flow response, control versus DCM: acetylcholine: 221 +/- 14% versus 156 +/- 11%; nitroglycerin: 220 +/- 17% versus 138 +/- 9%; adenosine: 635 +/- 65% versus 376 +/- 56%; nicardipine: 338 +/- 59% versus 115 +/- 23%; isoproterenol: 219 +/- 18% versus 86 +/- 20%). The attenuation was independent of systemic hemodynamic differences.

CONCLUSION

In contrast to systemic responses, coronary blood flow responses in DCM are impaired dependent or independent of NO or second messenger mechanisms, implying either distal signaling defects or structural abnormalities in the coronary vasculature.

[Morphological and hemodynamic indicators of early arteriosclerosis]

Das früheste, noch funktionelle Stadium der Arteriosklerose, die endotheliale Dysfunktion, kann mittels ultraschallbasierter Messung der Vasoreaktivität an der A. brachialis zuverlässig erfasst werden. Sowohl die Intima-Media-Dicke (IMT) als sonomorphologischer Parameter, als auch der dopplerbasierte Widerstandsindex RI, sind zuverlässige Indikatoren der Arteriosklerose. Eine scharfe Abgrenzung zwischen reversiblen Frühstadien und nicht reversiblen Spätstadien ist für beide Parameter zum jetzigen Zeitpunkt aber nicht etabliert. IMT-Werte über 0,8mm und RI-Werte über 0,72 scheinen aber eine ausgedehnte und wahrscheinlich nicht mehr zum normalen Gefäss reversible Arteriosklerose zu repräsentieren. Die prognostische Bedeutung eines pathologischen Intima-Media-Komplexes bezüglich kardiovaskulärer Morbidität und Mortalität ist etabliert, jene für den Widerstandsindex offen und durch weitere Studien zu belegen.

Estimation of EDRF and nitric oxide release using [3H]GTP-labeled human platelets

We have developed a new bioassay for endothelium-derived relaxing factor (EDRF) or nitric oxide (NO) using human [3H]guanosine triphosphate (GTP)-labeled platelets. The labeled platelets were preincubated with isobutyl-methylxanthine and co-cultured with endothelial cells and the [3H]cyclic guanosine monophosphate (cGMP) formed was isolated by ion-exchange chromatography. Endothelial cells, either in monolayer cells or in suspension, increased platelet cGMP accumulation dose-dependently, a significant increase being detected with 5000 endothelial cells or more/assay when suspended cells were used. Co-culturing with the same number of skin fibroblasts failed to elevate platelet cGMP. Preincubation of endothelial cells with bradykinin and superoxide dismutase (SOD) synergistically potentiated the increase in platelet cGMP, but was attenuated by Nomega-nitro-L-arginine, with partial restoration by L-arginine but not by D-arginine. These compounds, however, did not affect cGMP accumulation by sodium nitroprusside. Moreover, preincubation of the labeled platelets with the NO synthase inhibitor prior to EDRF assay had no effect. We conclude that [3H]GTP-labeled platelets could provide a simple, sensitive and specific bioassay for estimating EDRF or NO release.