Abstract. Nitric oxide (NO) has recently been shown to be cytotoxic to both microfilariae and adult Brugia malayi in vitro and in a murine model, as well against Onchocerca lienalis microfilariae in vitro. We studied the kinetics of nitrite/nitrate, both stable end products of NO, by high-pressure liquid chromatography during microfilaricidal chemotherapy in four filariasis (three Loa loa, and one Onchocerca volvulus) patients. High serum levels of nitrite/nitrate were released during microfilarial clearance and sustained elevated levels were observed six months after chemotherapy, suggesting a role of NO in the elimination of microfilariae in human filariasis.The microfilaremic state of human filarial infection is associated with a parasite-specific immunologic hyporesponsiveness characterized by an expansion of T helper (Th)-2 cells and a lack of Th-1 cell responses. 1 Microfilaricidal chemotherapy with either diethylcarbamazine (DEC) or ivermectin induces an acute inflammatory reaction accompanied by an interleukin (IL)-5 dependent increase of eosinophils, eosinophil degranulation, and elevated proinflammatory cytokine levels like IL-6, tumor necrosis factor-alpha (TNF-␣) and interferon-gamma (IFN-␥). 2-6 Long-term effects of drug induced microfilarial clearance comprise a reversal of the parasite-specific hyporesponsiveness with restoration of Th-1 cell-mediated responses and resistance to reinfection. [7][8][9] It is therefore assumed that host factors play an essential role in the removal of microfilariae, which is emphasized by the fact that DEC is not microfilaricidal in vitro without host factors, but induces a rapid decrease in microfilarial levels in vivo. 10 Release of toxic granules and reactive oxygen intermediates by activated myeloid cells have all been implicated in microfilarial clearance. 11 However, the precise immune effector mechanisms operating against the developmental stages of filarial disease remain largely unexplored.Nitric oxide (NO) or its by-products have recently been shown to damage microfilariae of Brugia malayi and Onchocerca lienalis in vitro. 12 In addition, inhibitory effects of NO on the development of third-stage (L3) larvae of B. malayi in a murine model and its toxicity on adult B. malayi in vitro have been demonstrated. 13,14 Furthermore, the ivermectin-induced killing of microfilariae of Litosimoides carinii has been shown to be mediated by NO. 15 To determine whether NO plays a role in the removal and the long-term suppression of microfilariae after chemotherapy in human filariasis, serum levels of its stable end products nitrite and nitrate were closely monitored during microfilarial clearance and re-examined six and 12 months after chemotherapy.