Fischer L G, Horstman D J, Hahnenkamp K, Kechner N E, Rich G F
Department of Anesthesiology, University of Virginia, Health Sciences Center, Charlottesville 22906-0010, USA.
Anesthesiology. 1999 Dec;91(6):1724-32. doi: 10.1097/00000542-199912000-00026.
Nonselective nitric oxide synthase (NOS) inhibition has detrimental effects in sepsis because of inhibition of the physiologically important endothelial NOS (eNOS). The authors hypothesized that selective inducible NOS (iNOS) inhibition would maintain eNOS vasodilation but prevent acetylcholine- and bradykinin-mediated vasoconstriction caused by lipopolysaccharide-induced endothelial dysfunction.
Rats were administered intraperitoneal lipopolysaccharide (15 mg/kg) with and without the selective iNOS inhibitors L-N6-(1-iminoethyl)-lysine (L-NIL, 3 mg/kg), dexamethasone (1 mg/kg), or the nonselective NOS inhibitor Nomega-nitro-L-arginine methylester (L-NAME, 5 mg/kg). Six hours later, the lungs were isolated and pulmonary vasoreactivity was assessed with hypoxic vasoconstrictions (3% O2), acetylcholine (1 microg), Biochemical Engineering, and bradykinin (3 microg). In additional lipopolysaccharide experiments, L-NIL (10 microM) or 4-Diphenylacetoxy-N-methylpiperidine methiodide (4-DAMP, 100 microM), a selective muscarinic M3 antagonist, was added into the perfusate.
Exhaled nitric oxide was higher in the lipopolysaccharide group (37.7+/-17.8 ppb) compared with the control group (0.4+/-0.7 ppb). L-NIL and dexamethasone decreased exhaled nitric oxide in lipopolysaccharide rats by 83 and 79%, respectively, whereas L-NAME had no effect. In control lungs, L-NAME significantly decreased acetylcholine- and bradykinin-induced vasodilation by 75% and increased hypoxic vasoconstrictions, whereas L-NIL and dexamethasone had no effect. In lipopolysaccharide lungs, acetylcholine and bradykinin both transiently increased the pulmonary artery pressure by 8.4+/-2.0 mmHg and 35.3+/-11.7 mmHg, respectively, immediately after vasodilation. L-NIL and dexamethasone both attenuated this vasoconstriction by 70%, whereas L-NAME did not. The acetylcholine vasoconstriction was dose-dependent (0.01-1.0 microg), unaffected by L-NIL added to the perfusate, and abolished by 4-DAMP.
In isolated perfused lungs, acetylcholine and bradykinin caused vasoconstriction in lipopolysaccharide-treated rats. This vasoconstriction was attenuated by administration of the iNOS inhibitor L-NIL but not with L-NAME. Furthermore, L-NIL administered with lipopolysaccharide preserved endothelium nitric oxide-dependent vasodilation, whereas L-NAME did not.
非选择性一氧化氮合酶(NOS)抑制在脓毒症中具有有害作用,因为它会抑制生理上重要的内皮型NOS(eNOS)。作者推测,选择性诱导型NOS(iNOS)抑制可维持eNOS介导的血管舒张,但可预防脂多糖诱导的内皮功能障碍所导致的乙酰胆碱和缓激肽介导的血管收缩。
给大鼠腹腔注射脂多糖(15mg/kg),同时或不同时给予选择性iNOS抑制剂L-N6-(1-亚氨基乙基)-赖氨酸(L-NIL,3mg/kg)、地塞米松(1mg/kg)或非选择性NOS抑制剂Nω-硝基-L-精氨酸甲酯(L-NAME,5mg/kg)。6小时后,分离肺脏,通过低氧性血管收缩(3%氧气)、乙酰胆碱(1μg)、生物化学工程和缓激肽(3μg)评估肺血管反应性。在另外的脂多糖实验中,将L-NIL(10μM)或4-二苯基乙酰氧基-N-甲基哌啶甲碘化物(4-DAMP,100μM,一种选择性毒蕈碱M3拮抗剂)加入灌注液中。
与对照组(0.4±0.7ppb)相比,脂多糖组呼出的一氧化氮更高(37.7±17.8ppb)。L-NIL和地塞米松分别使脂多糖处理大鼠呼出的一氧化氮降低83%和79%,而L-NAME无此作用。在对照肺脏中,L-NAME使乙酰胆碱和缓激肽诱导的血管舒张显著降低75%,并增加低氧性血管收缩,而L-NIL和地塞米松无此作用。在脂多糖处理的肺脏中,乙酰胆碱和缓激肽在血管舒张后立即分别使肺动脉压短暂升高8.4±2.0mmHg和35.3±11.7mmHg。L-NIL和地塞米松均使这种血管收缩减弱70%,而L-NAME则无此作用。乙酰胆碱引起的血管收缩呈剂量依赖性(0.01-1.0μg),不受灌注液中添加的L-NIL影响,并被4-DAMP消除。
在离体灌注肺脏中,乙酰胆碱和缓激肽在脂多糖处理的大鼠中引起血管收缩。给予iNOS抑制剂L-NIL可减弱这种血管收缩,而L-NAME则不能。此外,与脂多糖同时给予L-NIL可保留内皮型一氧化氮依赖性血管舒张,而L-NAME则不能。