Cited by 113Nitric Oxide and Endothelin EffectsRedox biology and oxidative stressCardiovascular Health and Disease Prevention

The DOI matches its Crossref record; 287 of the 287 references it cites were found in a registry or an index; 14 of the 277 sources its claims cite were checked for support.

Inorganic nitrite therapy: historical perspective and future directions

Open access

Abstract

Over the past several years, investigators studying nitric oxide (NO) biology and metabolism have come to learn that the one electron oxidation product of NO, nitrite anion, serves as a unique player in modulating tissue NO bioavailability. Numerous studies have examined how this oxidized metabolite of NO can act as a salvage pathway for maintaining NO equivalents through multiple reduction mechanisms in permissive tissue environments. Moreover, it is now clear that nitrite anion production and distribution throughout the body can act in an endocrine manner to augment NO bioavailability that is important for physiological and pathological processes. These discoveries have led to renewed hope and efforts for an effective NO based therapeutic agent through the unique action of sodium nitrite as an NO pro-drug. More recent studies also indicate that sodium nitrate may also increase plasma nitrite levels via the enterosalivary circulatory system resulting in nitrate reduction to nitrite by microorganisms found within the oral cavity. In this review, we discuss the importance of nitrite anion in several disease models along with an appraisal of sodium nitrite therapy in the clinic, potential caveats of such clinical uses, and future possibilities of nitrite based therapies.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This review argues that inorganic nitrite is not an inert NO byproduct but a recyclable NO reservoir/salvage pathway, with sodium nitrite showing therapeutic potential across ischemic, inflammatory, cardiovascular, and infectious conditions. It surveys historical, biochemical, preclinical, and clinical evidence while cautioning that dose, route, tissue conditions, and trial design critically determine benefit.

Key findings

  • Nitrite is reduced back to NO under hypoxia/ischemia via deoxyhemoglobin/myoglobin, xanthine oxidase, acidic disproportionation, mitochondrial cytochrome c oxidase, and other mechanisms; plasma nitrite is usually 200–600 nM, up to 70–90% derives from eNOS, and exogenous nitrite half-life is 20–30 minutes.
  • Sodium nitrite is protective in preclinical ischemia-reperfusion (heart, liver, brain, kidney), chronic hindlimb ischemia/angiogenesis, sickle cell disease, hypertension/pulmonary hypertension, cerebral vasospasm, colitis, cystic fibrosis biofilm infections, and shock; effective doses range from high nanomolar/low micromolar for ischemia to high micromolar/low millimolar for colitis and cystic fibrosis.
  • Oral sodium nitrite has >98% bioavailability, peak plasma levels at 15–30 minutes, and a circulating half-life of 25–35 minutes; nitrate peaks at ~1.5 hours with an 8–13 hour half-life, and methemoglobinemia of 1–3% may occur at doses >2–3 mg/kg. For cyanide poisoning, sodium nitrite 30 mg/ml over 5–20 minutes (~300 mg total) raises metHb to ~20%.
  • The NTP 2-year study found no carcinogenicity in male or female F344/N rats or male B6C3F1 mice given 35–150 mg/kg sodium nitrite, with equivocal female B6C3F1 forestomach epithelial hyperplasia at 150 mg/kg; nitrite may also transiently increase tumor pO2 and improve radiotherapy efficacy.

Methods

  • Narrative review, not a systematic review or meta-analysis; it synthesizes historical accounts, NO/nitrite biochemistry, endogenous and exogenous nitrite sources, reduction pathways, disease models, and clinical trial information.
  • Draws on cited preclinical and human studies, including pharmacokinetic data from Hunault et al. and references to Clinicaltrials.gov tables (Tables 1–2 are referenced but not included in the supplied text).
  • No primary experiments, systematic search strategy, or formal quantitative synthesis are described.

Limitations

  • The paper states that many mechanisms remain incompletely understood, including nitrite-heme export/adduct formation, compartment-specific contributions to nitrite reduction, immune modulation, and effects on cancer; it calls for additional study and well-controlled trials.
  • It notes that the number of clinical trials involving sodium nitrite is relatively small and that trial designs vary widely, warning that poorly designed or executed trials could impede progress.
  • Evident from the text: as a narrative review, it lacks systematic search/inclusion criteria and formal risk-of-bias assessment; the referenced Tables 1–2 are not present in the provided text.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.freeradbiomed.2011.04.042

Cites

287 of 287 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

174 Not checked yet · 23 Own interpretation · 19 No basis given · 6 Partly supported · 2 Supported · 2 Sources not found · 1 Own result · accuracy not yet measured

Verify all 261 references — free account

Show all 144 claims

  • It may state two separate claims as one. 72
  • Probably not a substantial claim. 13
83 of 83
  • The paper relies on this without support.

    Findings from animal models of ischemia-reperfusion and other diseases are relevant to human patients.

    “indicating that nitrite therapy might be clinically useful for PAH”
    “suggesting that aerosolized sodium nitrite therapy might be beneficial for controlling CF associated bacterial infections.”
  • The paper relies on this without support.

    High doses of sodium nitrite are toxic in humans.

    “This is an important distinction given the fact that high doses of sodium nitrite can be toxic thus making nitrite therapy for certain diseases largely unrealistic.”
  • The paper relies on this without support.

    Nitrite/nitrate levels measured in plasma or tissues reflect NO bioavailability and functional NO signaling.

    “plasma nitrite levels may be an important indicator of vascular health and function in PAD patients”
  • The paper relies on this without support.

    Nitrite anion is an important source of bioactive NO under low pH conditions.

    “Nitrite anion is known to represent an important source of bioactive NO under low pH conditions.”
  • The paper relies on this without support.

    NO drives local vasodilation and increases perfusion.

    “The characteristic of NO, by driving local vasodilation and increasing perfusion, suggests that it may have therapeutic potential in tumors to allow transient increase in the delivery and efficacy of anti-cancer drugs.”
  • The paper relies on this without support.

    Inflammatory activity influences nearly every aspect of human disease.

    “In particular, recent developments regarding nitrite modulation of immune responses are very intriguing and merit further investigation as it is now known that inflammatory activity influences nearly every aspect of human disease.”
6 of 6

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Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

2 of 2

Citations

Cites

Show all 285 references

Research works printed but not linked: 3

  1. Duncan, 1995, Chemical generation of nitric oxide in the mouth from the enterosalivary circulation of dietary nitrate, Nat. Med., 1, 564-551, 10.1038/nm0695-546 · DOI · Paper page
  2. Li, 2009, The protective effect of nitrite on liver cold ischemia reperfusion injury, Liver Transpl., 15, S236
  3. Pearse, 1891, The treatment of paroxysmal nerve disorders, Practitioner, 46, 29

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Metadata

Authors
Kevil, C. G., Kolluru, G. K., Pattillo, C. B., & Giordano, T.
Affiliations
  • Louisiana State University (US)
  • Louisiana State University Health Sciences Center Shreveport (US)
Corresponding author
Kevil, Christopher G.
Venue
Free Radical Biology and Medicine
Publisher
Elsevier BV
Published
2011-08
Volume
51
Issue
3
Pages
576-593
ISSN
0891-5849 (ISSN-L)
OpenAlex
W2075903936
Cited by
113
References
285
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 7 · 2022: 6 · 2021: 6 · 2020: 3 · 2019: 10 · 2018: 8 · 2017: 8 · 2016: 6 · 2015: 17 · 2014: 11 · 2013: 10 · 2012: 14
FWCI
1.29
Type
journal article
Language
en
Open access
Locations
  • Free Radical Biology and Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
NIH (HL80482, HL094021, DK043785)
Topics
  • Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
Keywords
nitrite, nitric oxide, sodium nitrite, sodium nitrate, nitric oxide prodrug, nitric oxide bioavailability
MeSH terms
Animals, Autoimmune Diseases, Bacteria, Humans, Inflammation, Inorganic Chemicals, Ischemia, Mouth, Neoplasms, Nitric Oxide, Oxidation-Reduction, Sodium Nitrite

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