Precis: Nitric oxide (NO) is a soluble gas continuously synthesized by the endothelium that contributes importantly to vasodilator tone of the coronary and systemic circulations by activating guanylyl cyclase in vascular smooth muscle. Patients with coronary artery disease, however, have deficient synthesis or increased degradation of NO due to endothelial damage or dysfunction. Reduced NO could contribute to symptoms and progression of coronary artery disease through vasoconstriction, platelet activation, inflammatory cell attachment to the arterial wall, and increased growth of cellular elements of the vessel wall. We have recently determined that nitrite, formed by the auto-oxidation of NO, can be converted to bioactive NO, in part through reactions with deoxyheme proteins that exist not only in red blood cells, but also within the vessel wall. An alternative source of bioactive NO may be via the diet, as nitrates found in vegetables and cured meats may be converted to nitrite by action of nitrate reductases present in oral bacteria. Nitrite may then be converted to NO within the acidic environment in the stomach and absorbed into the bloodstream, or absorbed directly and converted to NO in the bloodstream via reaction with deoxyheme proteins. This study is designed to determine the contribution of dietary nitrate/nitrite to NO adducts in blood and to vascular dilator tone assessed directly in the forearm and indirectly through treadmill exercise testing. Findings in this study may have important clinical implications not only in coronary artery disease, but also in other conditions associated with regional endothelial dysfunction and reduced endothelial NO bioactivity (e.g., hypertension, diabetes mellitus, hypercholesterolemia, cigarette smoking, estrogen deficiency), and possibly account for the cardiovascular benefit of diets rich in vegetables shown in epidemiological survey studies. ? ? Protocol Progress: 31 patients met eligibility criteria for this protocol and were consented. There have been two drop-outs from the study; one because of unwillingness to continue with diet and the second because of chest pain on the morning of testing, reported to the IRB as an SAE (both reported at last year?s continuing review). In all others, compliance with diet was highly satisfactory and measurements were performed as stipulated in the protocol.
| Cosby, Kenyatta; Partovi, Kristine S; Crawford, Jack H et al. (2003) Nitrite reduction to nitric oxide by deoxyhemoglobin vasodilates the human circulation. Nat Med 9:1498-505 |
| Schechter, Alan N; Gladwin, Mark T; Cannon 3rd, Richard O (2002) NO solutions? J Clin Invest 109:1149-51 |
