Skip to main content
British Journal of Pharmacology logoLink to British Journal of Pharmacology
. 1995 Jan;114(2):363–368. doi: 10.1111/j.1476-5381.1995.tb13235.x

Effects of nitric oxide synthase inhibition combined with nitric oxide inhalation in a porcine model of endotoxin shock.

P Klemm 1, C Thiemermann 1, G Winklmaier 1, P A Martorana 1, R Henning 1
PMCID: PMC1510256  PMID: 7533615

Abstract

1. The present investigation compares the effects of intravenous infusion of the NO synthase inhibitor NG-monomethyl-L-arginine (L-NMMA) with that of an inhalation with NO gas in a porcine model of endotoxin (lipopolysaccharide, LPS) shock. In addition, the effects of the combination of these two treatments were also investigated. 2. Male pigs were anaesthetized and instrumented for the measurement of haemodynamic parameters. Blood samples were withdrawn at different time intervals for determination of blood gases, pH, and plasma levels of nitrite/nitrate and tumour necrosis factor. 3. Endotoxin infusion (15 micrograms kg-1 h-1 for 3 h) caused a progressive fall in mean arterial blood pressure (MABP) and cardiac output (CO) and a biphasic increase in mean pulmonary arterial pressure (MPAP) and pulmonary vascular resistance (PVR). A continuous infusion of L-NMMA (0.1 mg kg-1 min-1) significantly attenuated the fall in MABP, but did not affect MPAP, CO and PVR. NO-inhalation (50 p.p.m.) did not affect MABP, but significantly blunted the biphasic increase in MPAP and PVR and significantly delayed the fall in CO. The combination of L-NMMA infusion (0.1 mg kg-1 min-1) with NO-inhalation (50 p.p.m.) completely prevented the fall in MABP, significantly improved CO, and attenuated the biphasic increase in MPAP and PVR. 4. Endotoxin also caused a decline in PaO2 and a rise of PaCO2. Infusion of L-NMMA neither affected the fall in PaO2 nor the increase in PaCO2.(ABSTRACT TRUNCATED AT 250 WORDS)

Full text

PDF
363

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bertoni G., Kuhnert P., Peterhans E., Pauli U. Improved bioassay for the detection of porcine tumor necrosis factor using a homologous cell line: PK(15). J Immunol Methods. 1993 Apr 2;160(2):267–271. doi: 10.1016/0022-1759(93)90187-c. [DOI] [PubMed] [Google Scholar]
  2. Bone R. C. Sepsis, the sepsis syndrome, multi-organ failure: a plea for comparable definitions. Ann Intern Med. 1991 Feb 15;114(4):332–333. doi: 10.7326/0003-4819-114-4-332. [DOI] [PubMed] [Google Scholar]
  3. Cox R. H., Bagshaw R. J., Detweiler D. K. Arterial baroreceptor reflexes in young and old racing greyhounds. Am J Physiol. 1981 Mar;240(3):H383–H390. doi: 10.1152/ajpheart.1981.240.3.H383. [DOI] [PubMed] [Google Scholar]
  4. Frostell C., Fratacci M. D., Wain J. C., Jones R., Zapol W. M. Inhaled nitric oxide. A selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation. 1991 Jun;83(6):2038–2047. doi: 10.1161/01.cir.83.6.2038. [DOI] [PubMed] [Google Scholar]
  5. Green L. C., Wagner D. A., Glogowski J., Skipper P. L., Wishnok J. S., Tannenbaum S. R. Analysis of nitrate, nitrite, and [15N]nitrate in biological fluids. Anal Biochem. 1982 Oct;126(1):131–138. doi: 10.1016/0003-2697(82)90118-x. [DOI] [PubMed] [Google Scholar]
  6. Harbrecht B. G., Billiar T. R., Stadler J., Demetris A. J., Ochoa J., Curran R. D., Simmons R. L. Inhibition of nitric oxide synthesis during endotoxemia promotes intrahepatic thrombosis and an oxygen radical-mediated hepatic injury. J Leukoc Biol. 1992 Oct;52(4):390–394. doi: 10.1002/jlb.52.4.390. [DOI] [PubMed] [Google Scholar]
  7. Hardie E. M., Olson N. C. Prostaglandin and thromboxane levels during endotoxin-induced respiratory failure in pigs. Prostaglandins Leukot Med. 1987 Aug;28(3):255–265. doi: 10.1016/0262-1746(87)90115-6. [DOI] [PubMed] [Google Scholar]
  8. Hutcheson I. R., Whittle B. J., Boughton-Smith N. K. Role of nitric oxide in maintaining vascular integrity in endotoxin-induced acute intestinal damage in the rat. Br J Pharmacol. 1990 Dec;101(4):815–820. doi: 10.1111/j.1476-5381.1990.tb14163.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Ignarro L. J., Fukuto J. M., Griscavage J. M., Rogers N. E., Byrns R. E. Oxidation of nitric oxide in aqueous solution to nitrite but not nitrate: comparison with enzymatically formed nitric oxide from L-arginine. Proc Natl Acad Sci U S A. 1993 Sep 1;90(17):8103–8107. doi: 10.1073/pnas.90.17.8103. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kilbourn R. G., Jubran A., Gross S. S., Griffith O. W., Levi R., Adams J., Lodato R. F. Reversal of endotoxin-mediated shock by NG-methyl-L-arginine, an inhibitor of nitric oxide synthesis. Biochem Biophys Res Commun. 1990 Nov 15;172(3):1132–1138. doi: 10.1016/0006-291x(90)91565-a. [DOI] [PubMed] [Google Scholar]
  11. Klabunde R. E., Ritger R. C. NG-monomethyl-l-arginine (NMA) restores arterial blood pressure but reduces cardiac output in a canine model of endotoxic shock. Biochem Biophys Res Commun. 1991 Aug 15;178(3):1135–1140. doi: 10.1016/0006-291x(91)91010-a. [DOI] [PubMed] [Google Scholar]
  12. Kubes P., Suzuki M., Granger D. N. Nitric oxide: an endogenous modulator of leukocyte adhesion. Proc Natl Acad Sci U S A. 1991 Jun 1;88(11):4651–4655. doi: 10.1073/pnas.88.11.4651. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Leeper-Woodford S. K., Carey P. D., Byrne K., Fisher B. J., Blocher C., Sugerman H. J., Fowler A. A., 3rd Ibuprofen attenuates plasma tumor necrosis factor activity during sepsis-induced acute lung injury. J Appl Physiol (1985) 1991 Sep;71(3):915–923. doi: 10.1152/jappl.1991.71.3.915. [DOI] [PubMed] [Google Scholar]
  14. Moore P. K., al-Swayeh O. A., Chong N. W., Evans R. A., Gibson A. L-NG-nitro arginine (L-NOARG), a novel, L-arginine-reversible inhibitor of endothelium-dependent vasodilatation in vitro. Br J Pharmacol. 1990 Feb;99(2):408–412. doi: 10.1111/j.1476-5381.1990.tb14717.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Parrillo J. E., Parker M. M., Natanson C., Suffredini A. F., Danner R. L., Cunnion R. E., Ognibene F. P. Septic shock in humans. Advances in the understanding of pathogenesis, cardiovascular dysfunction, and therapy. Ann Intern Med. 1990 Aug 1;113(3):227–242. doi: 10.7326/0003-4819-113-3-227. [DOI] [PubMed] [Google Scholar]
  16. Petros A., Bennett D., Vallance P. Effect of nitric oxide synthase inhibitors on hypotension in patients with septic shock. Lancet. 1991 Dec 21;338(8782-8783):1557–1558. doi: 10.1016/0140-6736(91)92376-d. [DOI] [PubMed] [Google Scholar]
  17. Petros A., Lamb G., Leone A., Moncada S., Bennett D., Vallance P. Effects of a nitric oxide synthase inhibitor in humans with septic shock. Cardiovasc Res. 1994 Jan;28(1):34–39. doi: 10.1093/cvr/28.1.34. [DOI] [PubMed] [Google Scholar]
  18. Radomski M. W., Palmer R. M., Moncada S. The anti-aggregating properties of vascular endothelium: interactions between prostacyclin and nitric oxide. Br J Pharmacol. 1987 Nov;92(3):639–646. doi: 10.1111/j.1476-5381.1987.tb11367.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Rees D. D., Palmer R. M., Moncada S. Role of endothelium-derived nitric oxide in the regulation of blood pressure. Proc Natl Acad Sci U S A. 1989 May;86(9):3375–3378. doi: 10.1073/pnas.86.9.3375. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Robertson F. M., Offner P. J., Ciceri D. P., Becker W. K., Pruitt B. A., Jr Detrimental hemodynamic effects of nitric oxide synthase inhibition in septic shock. Arch Surg. 1994 Feb;129(2):149–156. doi: 10.1001/archsurg.1994.01420260045005. [DOI] [PubMed] [Google Scholar]
  21. Rossaint R., Pison U., Gerlach H., Falke K. J. Inhaled nitric oxide: its effects on pulmonary circulation and airway smooth muscle cells. Eur Heart J. 1993 Nov;14 (Suppl 1):133–140. [PubMed] [Google Scholar]
  22. Shultz P. J., Raij L. Endogenously synthesized nitric oxide prevents endotoxin-induced glomerular thrombosis. J Clin Invest. 1992 Nov;90(5):1718–1725. doi: 10.1172/JCI116045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Sprague R. S., Thiemermann C., Vane J. R. Endogenous endothelium-derived relaxing factor opposes hypoxic pulmonary vasoconstriction and supports blood flow to hypoxic alveoli in anesthetized rabbits. Proc Natl Acad Sci U S A. 1992 Sep 15;89(18):8711–8715. doi: 10.1073/pnas.89.18.8711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Suffredini A. F., Fromm R. E., Parker M. M., Brenner M., Kovacs J. A., Wesley R. A., Parrillo J. E. The cardiovascular response of normal humans to the administration of endotoxin. N Engl J Med. 1989 Aug 3;321(5):280–287. doi: 10.1056/NEJM198908033210503. [DOI] [PubMed] [Google Scholar]
  25. Szabó C., Mitchell J. A., Thiemermann C., Vane J. R. Nitric oxide-mediated hyporeactivity to noradrenaline precedes the induction of nitric oxide synthase in endotoxin shock. Br J Pharmacol. 1993 Mar;108(3):786–792. doi: 10.1111/j.1476-5381.1993.tb12879.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Thiemermann C. The role of the L-arginine: nitric oxide pathway in circulatory shock. Adv Pharmacol. 1994;28:45–79. doi: 10.1016/s1054-3589(08)60493-7. [DOI] [PubMed] [Google Scholar]
  27. Thiemermann C., Vane J. Inhibition of nitric oxide synthesis reduces the hypotension induced by bacterial lipopolysaccharides in the rat in vivo. Eur J Pharmacol. 1990 Jul 17;182(3):591–595. doi: 10.1016/0014-2999(90)90062-b. [DOI] [PubMed] [Google Scholar]
  28. Weitzberg E. Circulatory responses to endothelin-1 and nitric oxide with special reference to endotoxin shock and nitric oxide inhalation. Acta Physiol Scand Suppl. 1993;611:1–72. [PubMed] [Google Scholar]
  29. Weitzberg E., Rudehill A., Lundberg J. M. Nitric oxide inhalation attenuates pulmonary hypertension and improves gas exchange in endotoxin shock. Eur J Pharmacol. 1993 Mar 16;233(1):85–94. doi: 10.1016/0014-2999(93)90352-i. [DOI] [PubMed] [Google Scholar]
  30. Wright C. E., Rees D. D., Moncada S. Protective and pathological roles of nitric oxide in endotoxin shock. Cardiovasc Res. 1992 Jan;26(1):48–57. doi: 10.1093/cvr/26.1.48. [DOI] [PubMed] [Google Scholar]
  31. Zapol W. M., Snider M. T. Pulmonary hypertension in severe acute respiratory failure. N Engl J Med. 1977 Mar 3;296(9):476–480. doi: 10.1056/NEJM197703032960903. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Pharmacology are provided here courtesy of The British Pharmacological Society

RESOURCES