Dietary inorganic nitrate mobilizes circulating angiogenic cells.

Nitric oxide (NO) was implicated in the regulation of mobilization and function of circulating angiogenic cells (CACs). The supposedly inert anion nitrate, abundant in vegetables, can be stepwise reduced in vivo to form nitrite, and consecutively NO, representing an alternative to endogenous NO formation by NO synthases. This study investigated whether inorganic dietary nitrate influences mobilization of CACs. In a randomized double-blind fashion, healthy volunteers ingested 150 ml water with 0.15 mmol/kg (12.7 mg/kg) of sodium nitrate, an amount corresponding to 100-300 g of a nitrate-rich vegetable, or water alone as control. Mobilization of CACs was determined by the number of CD34(+)/KDR(+) and CD133(+)/KDR(+) cells using flow cytometry and the mobilization markers stem cell factor (SCF) and stromal cell-derived factor-1a (SDF-1α) were determined in plasma via ELISA. Nitrite and nitrate were measured using high-performance liquid chromatography and reductive gas-phase chemiluminescence, respectively. NOS-dependent vasodilation was measured as flow-mediated vasodilation. Further mechanistic studies were performed in mice after intravenous application of nitrite together with an NO scavenger to identify the role of nitrite and NO in CAC mobilization. Nitrate ingestion led to a rise in plasma nitrite together with an acute increase in CD34(+)/KDR(+) and CD133(+)/KDR(+)-CACs along with increased NOS-dependent vasodilation. This was paralleled by an increase in SCF and SDF-1α and the maximal increase in plasma nitrite correlated with CD133(+)/KDR(+)-CACs (r=0.73, P=0.016). In mice, nitrate given per gavage and direct intravenous injection of nitrite led to CAC mobilization, which was abolished by the NO scavenger cPTIO, suggesting that nitrite mediated its effect via formation of NO. Dietary inorganic nitrate acutely mobilizes CACs via serial reduction to nitrite and NO. The nitrate-nitrite-NO pathway could offer a novel nutritional approach for regulation of vascular regenerative processes.