A series of experiments were designed to examine the potential cytotoxicity of nitric oxide (NO), or reactive species derived from NO, in HA1 fibroblasts and H202-resistant variants of this cell line, designated OC14 cells. A 1-h exposure at 37OC to a 1.7 mM bolus dose of NO, prepared in N2-gassed medium, significantly reduced clonogenic survival in the HA1 fibroblasts line to 60% of control cells treated with N2-gassed medium alone. The OC14 cells were found to be completely resistant (100% survival) to NO-mediated injury in comparable experiments. A second set of experiments was designed to determine the role of the intracellular antioxidant, glutathione, in protection against NO-mediated injury. Depletion of total glutathione resulted in a significant reduction in HA1 and OC14 clonogenic survival to 8% and 50% when compared with respective control cells. The effect of total glutathione depletion on NO-initiated toxicity in HA1 cells was dose-and cell-density dependent and was observed to occur within 5 min of exposure to NO. Further evidence of cytotoxicity was demonstrated by loss of trypan blue dye exclusion properties in glutathione-depleted HA1 cells after NO is a free radical molecule endogenously produced by a variety of cell types. NO has been demonstrated to participate in physiologic reactions involving regulation of vasomotor tone, neurotransmission, immune system function, and platelet aggregation (1-4). Recent clinical trials have demonstrated some efficacy for inhaled NO in treatment of neonatal pulmonary hypertension and adult respiratory distress syndrome (5-7). Paradoxically, elevated concentrations of atmospheric NO are known to be harmful in many animal models, and lethal exposures at high concentrations have been reported in both animals and humans (8-10). This same paradoxical beneficial and/or toxic effect of NO has been observed in vitro. Several Received August 10, 1993; accepted July 8, 1994. Correspondence: Dr. M. Whit Walker, Department of Neonatology, Greenville Hospital Systems, 701 Grove Road, Greenville, SC 29605.Supported by National Institutes of Health Grants HL42057, HL08841, HL51469, CA.51116, HD28810, GM08260, and DK38924.NO exposure. Other experiments demonstrated that nitrate and nitrite exposure produced no cytotoxicity in glutathione-depleted HA1 cells and that coincubation of NO-saturated medium with oxyhemoglobin inhibited NO-induced cytotoxicity in glutathione-depleted HA1 cells. These results demonstrate that 1 ) nitric oxide, or an NO-derived reactive nitrogen species other than nitrites or nitrates, is responsible for reduction in clonogenic survival and trypan blue dye exclusion capabilities in vitro; 2) biochemical pathways associated with cellular resistance to oxidative stress also confer resistance to NO-mediated injury in this cell model; and 3) total glutathione content determines a significant portion of cell sensitivity to NO-mediated cytotoxicity.