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The Biology of Nitrogen Oxides in the Airways
Abstract
Nitrogen oxides (NOx), regarded in the past primarily as toxic air pollutants, have recently been shown to be bioactive species formed endogenously in the human lung. The relationship between the toxicities and the bioactivities of NOx must be understood in the context of their chemical interactions in the pulmonary microenvironment. Nitric oxide synthase (NOS) is a newly identified enzyme system active in airway epithelial cells, macrophages, neutrophils, mast cells, autonomic neurons, smooth muscle cells, fibroblasts, and endothelial cells. The chemical products of NOS in the lung vary with disease states, and are involved in pulmonary neurotransmission, host defense, and airway and vascular smooth muscle relaxation. Further, certain patients with pulmonary hypertension, adult respiratory distress syndrome and asthma may experience physiologic improvement with NOx therapy, including inhalation of nitric oxide (NO.) gas. Both endogenous and exogenous NOx react readily with oxygen, superoxide, water, nucleotides, metalloproteins, thiols, amines, and lipids to form products with biochemical actions ranging from bronchodilation and bacteriostasis (S-nitrosothiols) to cytotoxicity and pulmonary capillary leak (peroxynitrite), as well as those with frank mutagenic potential (nitrosamines). Recent discoveries demonstrating the relevance of these species to the lung have provided new insights into the pathophysiology of pulmonary disease, and they have opened a new horizon of therapeutic possibilities for pulmonary medicine.
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“The hallmark feature of PAH and other forms of PH is reduced bioavailability of NO signaling and poor endothelial responsiveness to triggers of vasodilatation[28–34].”
From Enterosalivary nitrate metabolism and the microbiome: Intersection of microbial metabolism, nitric oxide and diet in cardiac and pulmonary vascular health (2017) · cites this paper as [28]
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Zhao, H., Zhao, M., Wang, Y., Li, F., & Zhang, Z. (2015) · Journal of Histochemistry & Cytochemistry · doi:10.1369/0022155415610168 · Cited by 72
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BackgroundS -nitrosothiol repletion by an inhaled gas regulates pulmonary function
Moya, M. M., Gow, A. J., McMahon, T., Toone, E. J., Cheifetz, I. M., Goldberg, R. N., & Stamler, J. S. (2001) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.091109498 · Cited by 69
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Carossa, S., Pera, P., Doglio, P., Lombardo, S., Colagrande, P., Brussino, L., Rolla, G., & Bucca, C. B. (2001) · European Journal of Clinical Investigation · doi:10.1046/j.1365-2362.2001.00902.x · Cited by 66
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Antus, B., & Kardos, Z. (2015) · Current Medicinal Chemistry · doi:10.2174/092986732205150112104411 · Cited by 67
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Dolhnikoff, M., MORIN, J., & Ludwig, M. S. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.5.9801068 · Cited by 63
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“of FENO was performed according to the guidelines for off-line measurements ( 25 ).”
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“When oxygen reacts to the NO surplus produced during the inflammatory process, generates nitrogen oxides byproducts such as peroxynitrite, N2O3 and N2O4, which are powerful nitrosating agents [61].”
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“In the lungs NO is produced by several cell types, including airway epithelium, macrophages, and intrapulmonary vascular endothelium ( 12 ).”
BackgroundChildhood asthma: exhaled nitric oxide in relation to clinical symptoms
Artlich, A., Busch, T., Lewandowski, K., Jonas, S., Gortner, L., & Kj, F. (1999) · European Respiratory Journal · doi:10.1183/09031936.99.13614029 · Cited by 58
“In adults, the increase is mainly due to increased production in the lower airways [9, 10] although at present it is not clear whether the increased exhaled NO in asthmatics reflects a beneficial response counterbalancing bronchoconstrictor stimuli or contributes to increased tissue damage and perpetuation of immune r…”
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“Endogenous nitric oxide (NO) plays a central role in the regulation of airway tone as well as in asthmatic airway in¯ammation (Barnes & Belvisi, 1993; Gaston et al., 1994; Barnes & Liew, 1995), and may be importantly involved in the development of allergen-induced AHR (De Boer et al., 1996;…”
BackgroundNitric oxide: a new concept in chronic sinusitis pathogenesis
Naraghi, M., Deroee, A. F., Ebrahimkhani, M. R., Kiani, S., & Dehpour, A. R. (2007) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2006.10.014 · Cited by 58
“When peroxynitrite is protonated in the acidic environment of sinusitis, peroxynitrous acid is formed and leads to the production of cytotoxic agents such as hydroxyl and nitric dioxide [17,18].”
BackgroundInhaled Nitric Oxide Primes Lung Macrophages to Produce Reactive Oxygen and Nitrogen Intermediates
Weinberger, B. I., Fakhrzadeh, L., Heck, D. E., Laskin, J. D., Gardner, C. R., & Laskin, D. L. (1998) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.158.3.9708014 · Cited by 59
“However, in contrast to inhaled ozone or nitrogen dioxide, which induce marked inflammatory responses (7, 9), we did not observe increased numbers of macrophages or neutrophils in the lung after nitric oxide exposure.”
Microanalysis of Lung Airway Surface Fluid by Capillary Electrophoresis with Conductivity Detection
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“…regulations, which are suggested to include those of vascular tone, bronchial tone, neurotransmission, or immune defense (Moncada et al., 1991; Gaston et al., 1994), impairment of expression and activity of eNOS, if any, may contribute to tissue injury in sepsis by hindrance of physiologic…”
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“The level of exhaled NO (eNO) can vary considerably between individuals, but is consistently found to be increased in asthmatic patients and atopic subjects [2, 5, 6, 9, 16 , 40].”
BackgroundInfluentialAirway smooth muscle: immunomodulatory cells that modulate airway remodeling?
Panettieri, R. A. (2003) · Respiratory Physiology & Neurobiology · doi:10.1016/s1569-9048(03)00153-8 · Cited by 57
Gaston, B. M., May, W. J., Sullivan, S., Yemen, S., Marozkina, N. V., Palmer, L. A., Bates, J. N., & Lewis, S. J. (2014) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01050.2013 · Cited by 54
Self-citationNitrogen Chemistry and Lung Physiology
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“The signaling molecule NO plays a key role in physiologic processes in the pulmonary epithelium, mediating neurotransmission, smooth muscle relaxation, bacteriostasis, ciliary motility, mucin secretion, and lung liquid production in the perinatal period (6,7).”
BackgroundThe role of nitric oxide synthase/nitric oxide in vascular smooth muscle control
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cGMP stimulates sodium and chloride currents in rat tracheal airway epithelia
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Role of NO generation in beta-adrenoceptor-mediated stimulation of rabbit airway ciliary motility
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“NO has a very short half-life in physiologic systems, of 0.1 s to 5 s ( 13 ), and labeling studies show that plasma [NO32 1 NO22] reflects a large fraction of NO metabolites or adducts in the body (27, 28).”
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“In the respiratory tract, NO is produced by a variety of cells, including, neurons, epithelial cells, macrophages, and inflammatory cells (6), and NO may play a crucial role in inflammatory airway diseases such as asthma.”
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“ROS and their reactions with lung epithelial cells participate in the pathophysiology of several lung diseases, including IPF, ARDS, and lung cancer (Gaston et al., 1994; Shi et al., 2001).”
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“Nitrites and nitrates are stable end-products of the nitric oxide (NO) metabolism and their levels reflect activity of inducible nitric oxide synthetase expressed by neutrophils, eosinophils, and other inflammatory cells in the respiratory tract [35].”
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“Exogenous sources of NO, such as cigarette smoke, contribute to subcellular damage through the formation of N-nitrosoamines and N-nitrosamides, contributing to elevated expression of head and neck cancers [7,33-36].”
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Citation classics: Top 50 cited articles in ‘respiratory system’
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“NO is synthesized from L-arginine by two main isoforms of the NO synthase: the constitutive and the inducible isoform [20].”
BackgroundAirway smooth muscle relaxation.
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Clinical Applications of Nitric Oxide
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Combining partial liquid ventilation with nitric oxide to improve gas exchange in acute lung injury
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“The toxicity of nitrogen oxides has recently been reviewed [ 23 ].”
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“iNOS has been suggested to be an important biomarker of inflammation, as its overexpression leads to excessive production of NO, which contributes to the pathophysiology of inflammation and the resultant tissue damage [10].”
Physiological and pathophysiological roles of nitric oxide
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“NO is produced by various cells within the respiratory tract, and plays an important role in the pathophysiology of inflammatory airway disease [6, 7].”
Airway diffusing capacity of nitric oxide and steroid therapy in asthma
Shin, H., Rose-Gottron, C. M., Cooper, D. M., Newcomb, R. L., & George, S. C. (2004) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00575.2003 · Cited by 48
“Expression of inducible NOS (iNOS) in the airways of subjects with asthma has been demonstrated (12, 36, 50), which could potentially increase Aaw; however, this possible mechanism would likely be sensitive to corticosteroid therapy, which is not the observation.”
BackgroundClinical applications of lung function tests: A revisit
Liang, B., Lam, D. C.-L., & Feng, Y. (2012) · Respirology · doi:10.1111/j.1440-1843.2012.02149.x · Cited by 47
Prevention and Societal Impact of Drug and Alcohol Abuse
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Pulmonary inflammatory mediators after sevoflurane and thiopentone anaesthesia in pigs
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“There are many cells in the lungs that are capable of producing NO (18).”
BackgroundInfluentialAddition of Nitric Oxide to Oxygen Improves Cardiopulmonary Function in Patients With Severe COPD
Germann, P., Ziesche, R., Leitner, C., Röder, G., Urak, G., ZIMPFER, M., & Sladen, R. N. (1998) · CHEST Journal · doi:10.1378/chest.114.1.29 · Cited by 47
Increased exhaled nitric oxide on days with high outdoor air pollution is of endogenous origin
Steerenberg, P. A., Snelder, J. B., Fischer, P. H., et al. (1999) · European Respiratory Journal · doi:10.1034/j.1399-3003.1999.13b19.x · Cited by 48
“iNOS is induced by various pro-inflammatory cytokines such as tumour necrosis factor (TNF)a, interleukin (IL)-1b and interferon (IFN)-c [3].”
BackgroundNitric oxide and pulmonary hypertension
Sim, J.-Y. (2010) · Korean Journal of Anesthesiology · doi:10.4097/kjae.2010.58.1.4 · Cited by 46
“Additionally, although it is known that chronic exposure to NO can lead to respiratory tract hypersensitivity, bronchitis and cancer, there have not been many reports of pulmonary toxicity in response to short-term exposure [63].”
Effects of Nitric Oxide Inhalation on Pulmonary Serial Vascular Resistances in ARDS
Rossetti, M., Guénard, H. J.-P., & Gabinski, C. (1996) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.154.5.8912751 · Cited by 46
Inter-relationship of plasma markers of oxidative stress and thyroid hormones in schizophrenics
Akiibinu, M. O., Ogundahunsi, O. A., & Ogunyemi, E. O. (2012) · BMC Research Notes · doi:10.1186/1756-0500-5-169 · Cited by 45
“The synergistic effects of impaired synthesis, exhaustion of NO during anti-oxidative activities and diversion of the NO to the peroxynitrite (ONOO) pathway could contribute to its deregulated levels in certain disease conditions [10-12].”
BackgroundSarcoidosis-Associated Pulmonary Hypertension and Lung Transplantation for Sarcoidosis
Lynch, J. P., Fishbein, M. C., McGraw, C. J., et al. (2014) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0034-1376863 · Cited by 45
Moodley, Y. P., Chetty, R., & Lalloo, U. (1999) · European Respiratory Journal · doi:10.1034/j.1399-3003.1999.14d17.x · Cited by 45
“vascular smooth muscle relaxation, bacteriostasis and neurotransmission [1, 2, 20, 21].”
BackgroundInfluentialOvercoming Gaps in the Management of Asthma in Older Patients
Barua, P., & O???Mahony, M. S. (2005) · Drugs & Aging · doi:10.2165/00002512-200522120-00004 · Cited by 46
Janssen-Heininger, Y. M. W., Soultanakis, R. P., Steece, K., Heerdt, E., Singh, R., Joseph, J., & Kalyanaraman, B. (1998) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.1998.275.6.l1100 · Cited by 45
Basu, S., Wang, X., Gladwin, M. T., & Kim‐Shapiro, D. B. (2008) · Methods in enzymology on CD-ROM/Methods in enzymology · doi:10.1016/s0076-6879(07)00808-7 · Cited by 44
Vasopressin release during endotoxaemic shock in mice lacking inducible nitric oxide synthase
Cárnio, E. C., Stabile, A. M., Batalhão, M. E., Silva, J. S., Antunes‐Rodrigues, J., Branco, L. G. S., & Magder, S. A. (2005) · Pflügers Archiv - European Journal of Physiology · doi:10.1007/s00424-005-1400-z · Cited by 44
“These constitutive isoforms, particularly the endothelial isoform, are known to be activated by LPS and may contribute to increased NO production during sepsis (Gaston et al. 1994).”
BackgroundPulmonary surfactant inhibits LPS-induced nitric oxide production by alveolar macrophages
Miles, P. R., Bowman, L. L., Rao, K. M. K., et al. (1999) · American Journal of Physiology-Lung Cellular and Molecular Physiology · doi:10.1152/ajplung.1999.276.1.l186 · Cited by 44
Takeno, S., Osada, R., Furukido, K., Chen, J. H., & Yajin, K. (2001) · Clinical & Experimental Allergy · doi:10.1046/j.1365-2222.2001.01093.x · Cited by 44
Moodley, Y. P., & Lalloo, U. (2001) · CHEST Journal · doi:10.1378/chest.119.5.1449 · Cited by 43
Cultural barriers to asthma management
Enarson, D. A., & Ait-Khaled, N. (1999) · Pediatric Pulmonology · doi:10.1002/(sici)1099-0496(199910)28:4 · Cited by 31
Metadata
- Authors
- Gaston, B., Drazen, J. M., Loscalzo, J., & Stamler, J. S.
- Affiliations
- Boston Children's Hospital (US)
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 1994-02-01
- Volume
- 149
- Issue
- 2
- Pages
- 538-551
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2054510493
- Cited by
- 918
- References
- 0
- Citations by year
- 2025: 6 · 2024: 4 · 2023: 4 · 2022: 10 · 2021: 13 · 2020: 5 · 2019: 6 · 2018: 10 · 2017: 9 · 2016: 15 · 2015: 16 · 2014: 19 · 2013: 27 · 2012: 16
- FWCI
- 37.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01hl040411-02, 5p50hl019170-20, 5r01hl043344-04)
- National Heart, Lung, and Blood Institute (HL43344, HL-40411, HL 19170)
- Topics
- Health Sciences › Medicine › Physiology (medical) › Nitric Oxide and Endothelin Effects
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Asthma and respiratory diseases
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Redox biology and oxidative stress
- Keywords
- nitrogen oxides, nitric oxide, nitric oxide synthase, airway epithelial cells, S-nitrosothiols, peroxynitrite, nitrosamines, pulmonary hypertension, acute respiratory distress syndrome, asthma, nitric oxide inhalation therapy, bronchodilation, host defense, smooth muscle relaxation
- MeSH terms
- Amino Acid Oxidoreductases, Animals, Humans, Lung, Lung Diseases, Nitric Oxide, Nitrogen Oxides, Nitrous Oxide, Nitric Oxide Synthase
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