Cited by 382Nitric Oxide and Endothelin EffectsCardiovascular Health and Disease PreventionPhytochemicals and Antioxidant Activities

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Dietary inorganic nitrate reverses features of metabolic syndrome in endothelial nitric oxide synthase-deficient mice

Open access

Abstract

The metabolic syndrome is a clustering of risk factors of metabolic origin that increase the risk for cardiovascular disease and type 2 diabetes. A proposed central event in metabolic syndrome is a decrease in the amount of bioavailable nitric oxide (NO) from endothelial NO synthase (eNOS). Recently, an alternative pathway for NO formation in mammals was described where inorganic nitrate, a supposedly inert NO oxidation product and unwanted dietary constituent, is serially reduced to nitrite and then NO and other bioactive nitrogen oxides. Here we show that several features of metabolic syndrome that develop in eNOS-deficient mice can be reversed by dietary supplementation with sodium nitrate, in amounts similar to those derived from eNOS under normal conditions. In humans, this dose corresponds to a rich intake of vegetables, the dominant dietary nitrate source. Nitrate administration increased tissue and plasma levels of bioactive nitrogen oxides. Moreover, chronic nitrate treatment reduced visceral fat accumulation and circulating levels of triglycerides and reversed the prediabetic phenotype in these animals. In rats, chronic nitrate treatment reduced blood pressure and this effect was also present during NOS inhibition. Our results show that dietary nitrate fuels a nitrate–nitrite–NO pathway that can partly compensate for disturbances in endogenous NO generation from eNOS. These findings may have implications for novel nutrition-based preventive and therapeutic strategies against cardiovascular disease and type 2 diabetes.

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TL;DR

Dietary sodium nitrate supplementation in eNOS-deficient mice increased bioactive nitrogen oxides and reversed several features of metabolic syndrome, including visceral fat, circulating triglycerides, and a prediabetic glucose phenotype. Chronic nitrate also lowered blood pressure in rats, with the effect still present during NOS inhibition.

Key findings

  • Acute nitrate (0.1 mmol·kg−1 i.p.) increased plasma nitrite and tissue nitros(yl)ation products in eNOS-deficient mice; chronic nitrate increased tissue S-nitrosothiols/nitros(yl)ation products without significantly changing plasma/tissue nitrate and nitrite versus controls.
  • In aged eNOS−/− mice, chronic sodium nitrate (0.1 mmol·kg−1·d−1; 85 mg·L−1, 1 mM in drinking water for 8–10 wk) reduced body weight over a 7-wk observation period, reduced visceral fat, and lowered circulating triglycerides.
  • After 10 wk of nitrate supplementation, glucose tolerance was almost normalized in eNOS−/− mice; fasting blood glucose, HbA1c, and the proinsulin/insulin ratio were lower than in untreated eNOS−/− mice. Nitrate had no effect on glucose tolerance in young wild-type or nNOS-deficient mice.
  • In rats, chronic nitrate (same dose for 8 wk) lowered mean arterial pressure throughout a 3-d observation period, and this difference persisted after L-NAME (1 g·L−1); L-NAME’s pressor effect was delayed by 12 h in nitrate-treated animals. No firm evidence of increased mitochondrial biogenesis or tissue cGMP was found.

Methods

  • Aged eNOS-deficient mice (mean 16 mo, range 14–22 mo) were randomized to sodium nitrate in drinking water (85 mg·L−1, 1 mM) for 8–10 wk or control; acute experiments used 0.1 mmol·kg−1 i.p. Rats received the same nitrate dose for 8 wk for telemetric blood pressure measurements, followed by L-NAME (1 g·L−1).
  • Nitrate, nitrite, and nitros(yl)ation products were measured by chemiluminescence. Glucose tolerance tests were performed after 14 h fasting with i.p. glucose (2 g·kg−1); HbA1c, insulin, and proinsulin were measured after 14 h fasting. Body weight was recorded weekly for 7 wk; visceral adipose tissue and triglycerides were measured at termination.
  • Statistics used mean ± SEM with 5–15 animals per group; two-tailed independent Student’s t test, ANOVA with Bonferroni or Dunnett’s post hoc tests, and P < 0.05 considered significant.

Limitations

  • The paper states that the reason for the 12-h delay in the L-NAME blood-pressure response in nitrate-treated rats is not known, and that the importance of enterosalivary nitrate cycling and bacteria-derived nitrite formation in mice is yet to be determined.
  • The paper states that long-term human intervention studies are warranted and that the exact mechanisms underlying metabolic syndrome remain unsettled; it also notes that failure to detect increased tissue cGMP does not exclude cGMP-mediated effects.
  • Evident from the text: findings are from animal models (aged eNOS-deficient mice and rats), not humans; sample sizes were modest (5–15 per group), and the eNOS-deficient model may not fully represent human metabolic syndrome.

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Integrity signals

Registry

Crossref · 10.1073/pnas.1008872107

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  • The paper relies on this without support.

    The effects of sodium nitrate are attributable to nitrate rather than to sodium or other components of the treatment.

    “NaNO3 was added to the drinking water during 8 to 10 wk at a concentration of 85 mg·L−1 (1 mM).”
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Metadata

Authors
Carlström, M., Larsen, F. J., Nyström, T., Hezel, M., Borniquel, S., Weitzberg, E., & Lundberg, J. O.
Affiliations
  • Uppsala University (SE)
  • Karolinska Institutet (SE)
Venue
Proceedings of the National Academy of Sciences
Published
2010-09-27
Volume
107
Issue
41
Pages
17716-17720
ISSN
  • 0027-8424 (ISSN-L)
  • 1091-6490
OpenAlex
W2074172668
Cited by
382
References
43
Citations by year
2026: 9 · 2025: 14 · 2024: 18 · 2023: 21 · 2022: 24 · 2021: 15 · 2020: 31 · 2019: 22 · 2018: 25 · 2017: 33 · 2016: 33 · 2015: 30 · 2014: 31 · 2013: 22 · 2012: 29
FWCI
16.23
Type
journal article
Language
en
Open access
Locations
  • Proceedings of the National Academy of Sciences (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Wenner-Gren Foundation
  • European Commission
  • Kommunfullmäktige, Stockholms Stad
  • Karolinska Institutet
  • Vetenskapsrådet
  • Svenska Läkaresällskapet
Topics
  • Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Disease Prevention
  • Health Sciences › Medicine › Biochemistry (medical) › Phytochemicals and Antioxidant Activities
Keywords
dietary nitrate, sodium nitrate, metabolic syndrome, endothelial nitric oxide synthase, nitrate-nitrite-NO pathway, visceral fat accumulation, triglycerides, prediabetes, blood pressure, cardiovascular disease prevention, type 2 diabetes, eNOS-deficient mice
MeSH terms
Analysis of Variance, Animals, Blood Pressure, Body Weight, Mice, Mutant Strains, Nitrates, Nitrogen Oxides, Triglycerides, Dietary Supplements, Metabolic Syndrome, Intra-Abdominal Fat, Mice, Rats, Nitric Oxide Synthase Type III

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