Journal
CIRCULATION
Volume 117, Issue 23, Pages 2986-2994Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.107.748814
Keywords
apoptosis; ischemia; magnetic resonance imaging; myocardial infarction; nitric oxide
Funding
- Intramural NIH HHS [Z01 HL004607-09, Z99 HL999999, ZIA HL005111-05, ZIA HL005112-05, ZIA HL006136-01, ZIA HL005111-06] Funding Source: Medline
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Background - Accumulating evidence suggests that the ubiquitous anion nitrite (NO2-) is a physiological signaling molecule, with roles in intravascular endocrine nitric oxide transport, hypoxic vasodilation, signaling, and cytoprotection. Thus, nitrite could enhance the efficacy of reperfusion therapy for acute myocardial infarction. The specific aims of this study were (1) to assess the efficacy of nitrite in reducing necrosis and apoptosis in canine myocardial infarction and (2) to determine the relative role of nitrite versus chemical intermediates, such as S-nitrosothiols. Methods and Results - We evaluated infarct size, microvascular perfusion, and left ventricular function by histopathology, microspheres, and magnetic resonance imaging in 27 canines subjected to 120 minutes of coronary artery occlusion. This was a blinded, prospective study comparing a saline control group (n = 9) with intravenous nitrite during the last 60 minutes of ischemia (n = 9) and during the last 5 minutes of ischemia (n = 9). In saline-treated control animals, 70 +/- 10% of the area at risk was infarcted compared with 23 +/- 5% in animals treated with a 60-minute nitrite infusion. Remarkably, a nitrite infusion in the last 5 minutes of ischemia also limited the extent of infarction (36 +/- 8% of area at risk). Nitrite improved microvascular perfusion, reduced apoptosis, and improved contractile function. S-Nitrosothiol and iron-nitrosyl-protein adducts did not accumulate in the 5-minute nitrite infusion, suggesting that nitrite is the bioactive intravascular nitric oxide species accounting for cardioprotection. Conclusions - Nitrite has significant potential as adjunctive therapy to enhance the efficacy of reperfusion therapy for acute myocardial infarction.
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