The synthesis of nitric oxide (NO) in the circulation has been attributed exclusively to the vascular endothelium. Red blood cells (RBCs) have been demonstrated to carry a nonfunctional NO synthase (NOS) and, due to their huge hemoglobin content, have been assumed to metabolize large quantities of NO. More recently, however, RBCs have been identified to reversibly bind, transport, and release NO within the cardiovascular system. We now provide evidence that RBCs from humans express an active and functional endothelial-type NOS (eNOS), which is localized in the plasma membrane and the cytoplasm of RBCs. This NOS is regulated by its substrate L-arginine, by calcium, and by phosphorylation via PI3 kinase. RBC-NOS activity regulates deformability of RBC membrane and inhibits activation of platelets. The NOS-dependent conversion of L-arginine
IntroductionNitric oxide (NO) is a signaling molecule of major importance present in various cell types. 1,2 It modulates not only the function of the vascular wall but also that of blood cells, such as platelets and leukocytes. NO is synthesized by a family of NO synthases (NOSs) through the conversion of L-arginine to L-citrulline, using molecular oxygen. Until recently, the expression pattern of NOS isoforms appeared to be cell specific. Constitutively expressed neuronal and endothelial NOS (referred as NOS1 and NOS3) were identified in and cloned from neuronal and endothelial cells at first. Inducible NOS (NOS2) was originally isolated from activated macrophages. 3,4 In the vascular system under resting conditions, NO synthesis has been attributed exclusively to the vascular endothelium expressing a NOS3 (eNOS) isoform. Initially thought to be a simple calmodulin-regulated enzyme, it is clear that eNOS has evolved to be tightly controlled by cofactors and posttranslational modifications, phosphorylation on multiple residues, and regulated protein-protein interactions. 5,6 To date, human blood and, in particular, hemoglobin-carrying red blood cells (RBCs) have been considered as a major sink of NO. 7,8 Although early reports postulated a NOS resident in RBCs, 9 subsequent studies were unable to confirm an active NOS within RBCs. 10 Current information on the NOS isoform, its localization, and functional activity within RBCs is still inconsistent and subject to considerable debate. Most importantly, a NOS-dependent formation and release of NO-related species from RBCs has not been shown so far. In fact, the diffusion-limited chemical inactivation of NO by intra-erythrocytic hemoglobin would suggest that even if RBCs contain NOS, NO production from such would represent a futile vestigial function derived from an earlier stem-cell precursor (prior to RBC hemoglobinization).Indeed, the characterization and proof of a functional NOS in RBCs has been hampered by the high content of hemoglobin. First, the complex and oxygen-sensitive biochemistry of NO with intracellular and extracellular proteins 8 demands a composite analysis of the various constituents of the circulating NO p...