Nitric oxide synthase expression in human bladder cancer and its relation to angiogenesis.

Nitric oxide (NO) is synthesized by the enzyme family of nitric oxide synthases (NOS) and plays an important role in tumor growth and angiogenesis. The expression of two of the NOS isoforms, the endothelial and inducible isoforms (eNOS and iNOS, respectively), were evaluated in bladder tissue from patients with transitional cell carcinoma (TCC). The specimens were procured from 58 patients with TCC and 14 cases of normal bladder mucosa were used as a control group. NOS immunohistochemistry was performed and microvessal density (MVD) was determined. iNOS specific proteins were found in 47 of 58 bladder cancer specimens but not in control bladder tissue. The endothelial cells in both normal urothelium and tumor tissue showed a highly positive eNOS immunostaining. The MVD was 39.3+/-19.5 and 29.3+/-10.5 in TCC positive and negative for iNOS, respectively ( P<0.01). A correlation between iNOS immunoreactivity and tumor grade in bladder carcinoma could not be verified. These results indicate that NO generation from iNOS in the malignant epithelium and from eNOS in tumor stroma play a important role in tumor angiogenesis.