Nitric Oxide and its Metabolites in the Critical Phase of Illness: Rapid Biomarkers in the Making

Abstract

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable in several body compartments and fluids, and as such they are associated with many of the pathophysiological processes mentioned above. With methods such as high performance liquid chromatography and chemiluminescence these entities are relatively easy and inexpensive to analyze. Emphasis is placed on diagnostic rapidity, as this relates directly to quality of care in acute care situations. Further, a rationale is provided for more bench, translational and clinical research in the field of NO biomarkers for such settings. Developing standard protocols for the aforementioned disease states, centered on concentrations of NO and its metabolites, can prove to revolutionize diagnostics and prognostication along a spectrum of clinical care. We present a strong case for developing these biomarkers more as point-of-care assays with potential of color gradient test strips for rapid screening of disease entities in acute care and beyond. This will be relevant to global health.

Effects of Tigecycline and Doxycycline on Inflammation and Hemodynamics in Porcine Endotoxemia

“…Nitric oxide production has several feedback loops, and NO may be produced in tissues other than inflammatory cells. Furthermore, renal excretion of NO metabolites is dependent on glomerular excretion and tubular reabsorption that may be affected by the sepsis-induced inflammatory response and circulatory changes (16). In this study, we were not able to detect any significant difference in the urinary nitrite/ nitrate excretion.…”

Spontaneous coronary artery dissection in a patient with bacterial meningitis

“…Regarding the causes for SCAD in our patient, impairment of vascular integrity by increased vascular stress may have been induced by the increased level of nitric oxide from a systemic inflammatory response syndrome and sympathetic reflex discharge associated with bacterial meningitis 16. However, since sepsis was relatively mild in our patient and he was already in the recovery phase of the sepsis, this possible causative hypothesis is still awaiting further research.…”

Measuring and Evaluating Function, Impairment, and Change with Intervention

“…The authors present a strong case for developing these biomarkers more as point-of-care assays with potential of color gradient test strips for rapid screening of disease entities in acute care and beyond. 75 For more information, visit the Neogenesis Labs website. 76 This site provides valuable information on dietary supplement products tailored to promote NO formation to support healthy cardiovascular and erectile strength.…”