Cited by 19Nitric Oxide and Endothelin EffectsAngiogenesis and VEGF in CancerNeutrophil, Myeloperoxidase and Oxidative Mechanisms

Dietary nitrate, nitric oxide, and restenosis

Open access
Cooke, John P., Ghebremariam, Yohannes T.·2011·Journal of Clinical Investigation

Abstract

Endothelium-derived NO controls the contractility and growth state of the underlying vascular smooth muscle cells and regulates the interaction of the vessel wall with circulating blood elements. Acute injury of the vessel wall denudes the endothelial lining, removing homeostatic regulation and precipitating a wave of events leading to myointimal hyperplasia. In this issue of the JCI, Alef and colleagues provide evidence that in the injured vessel wall, the disruption of the NOS pathway is countered by induction of xanthine oxidoreductase, an enzyme capable of producing NO from nitrite. In addition, they link low dietary nitrite levels to increased severity of myointimal hyperplasia following vessel injury in mice.

AI snapshot

Written from the paper’s full text.

TL;DR

This commentary discusses how dietary nitrite/nitrate can be converted to NO in the injured vessel wall, countering NOS dysfunction and limiting myointimal hyperplasia. It highlights Alef et al.’s findings that sodium nitrite reduces restenosis-like injury in animal models via xanthine oxidoreductase and warns that direct nitrite/nitrate supplementation needs more clinical evidence.

Key findings

  • In the injured vessel wall, NOS pathway disruption is countered by induction of xanthine oxidoreductase (XOR), which can produce NO from nitrite.
  • Sodium nitrite reduced myointimal hyperplasia after vascular injury by 50%–80%, depending on route of administration, and was associated with a 10-fold increase in NO generation by injured vessels; this effect was not attenuated by the NOS inhibitor L-NAME.
  • XOR antagonism with allopurinol blocked the antiproliferative action of sodium nitrite in vitro and abrogated the therapeutic effect of dietary nitrite on injured murine carotid artery; reduced dietary nitrogen oxides aggravated myointimal hyperplasia, and dietary tungsten also increased its severity.
  • The commentary notes potential harms of dietary nitrite/nitrate supplementation, including methemoglobinemia and formation of potentially carcinogenic nitrosamines, and states that direct supplementation seems inadvisable until larger randomized clinical trials provide more guidance.

Methods

  • Design: narrative commentary/review on Alef et al. and the nitrate–nitrite–NO pathway, not a primary experimental study.
  • Data discussed: rat carotid artery balloon angioplasty injury, cultured vascular smooth muscle cells, murine carotid artery injury, and dietary nitrite/nitrate manipulations.
  • Analysis: synthesis of cited experimental findings and proposed mechanisms, including XOR-mediated nitrite reduction to NO.

Limitations

  • The paper states that direct dietary supplementation with nitrite or nitrate salts may cause methemoglobinemia, interfere with blood oxygenation, and contribute to nitrosamine formation; it calls for larger randomized clinical trials before supplementation is advised.
  • Evident from the text: this is a commentary without primary data, so its conclusions depend on the cited Alef et al. study and other referenced work.
  • Evident from the provided text: it contains unrelated anaphylaxis passages, suggesting the file is composite or corrupted.

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

Integrity signals

Registry

Crossref · 10.1172/jci57193

Cites

31 of 31 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 40 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Low dietary nitrite levels are linked to increased severity of myointimal hyperplasia following vessel injury in mice.

    “In addition, they link low dietary nitrite levels to increased severity of myointimal hyperplasia following vessel injury in mice.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

  • Premisecitation

    Cardiovascular risk factors such as hypercholesterolemia and diabetes mellitus impair the synthesis and bioactivity of endothelium-derived NO.

    “Cardiovascular risk factors (e.g., hypercholesterolemia, diabetes mellitus) impair the synthesis and bioactivity of endothelium-derived NO (4, 5).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source

      Not checked in the free run.

    • cites [5] source

      Not checked in the free run.

  • Premisecitation

    In the injured vessel wall, disruption of the NOS pathway is countered by induction of xanthine oxidoreductase, an enzyme capable of producing NO from nitrite.

    “In this issue of the JCI, Alef and colleagues provide evidence that in the injured vessel wall, the disruption of the NOS pathway is countered by induction of xanthine oxidoreductase, an enzyme capable of producing NO from nitrite.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

    • Rests on an assumption: XOR is an enzyme capable of producing NO from nitrite.
  • Premisecitation

    Endothelium-derived NO suppresses endothelial expression of adhesion molecules and chemokines that would otherwise initiate vascular inflammation.

    “Finally, endotheliumderived NO suppresses the endothelial expression of adhesion molecules and chemokines that would otherwise initiate vascular inflammation (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Premisecitation

    Vascular injury induced the expression of vascular iNOS.

    “They also confirmed that vascular injury induced the expression of vascular iNOS.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

  • May combine two claims. 12
  • Classified as probably not a substantial claim. 4
  • May combine two claims.

    Premisecitation

    Endothelium-derived NO controls the contractility and growth state of the underlying vascular smooth muscle cells and regulates the interaction of the vessel wall with circulating blood elements.

    “Endothelium-derived NO controls the contractility and growth state of the underlying vascular smooth muscle cells and regulates the interaction of the vessel wall with circulating blood elements.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    NO activates soluble guanylate cyclase to produce cGMP, which participates in signaling pathways involving phosphorylation.

    “NO activates soluble guanylate cyclase to produce cGMP, which participates in signaling pathways involving phosphorylation (1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [1] Kots, 2009, Handb Exp Pharmacol. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Endothelium-derived NO suppresses platelet adhesion, leukocyte infiltration, and VSMC proliferation and migration.

    “Endothelium-derived NO suppresses platelet adhesion, leukocyte infiltration, and VSMC proliferation and migration (3).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Endothelial synthesis of NO is highly regulated in response to hemodynamic and humoral factors.

    “The endothelial synthesis of this potent molecule is highly regulated, in response to hemodynamic (e.g., shear stress) as well as humoral (e.g., serotonin) factors (3).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    NO regulates the activities of enzymes and signaling proteins by S-nitrosylation of thiol moieties.

    “Furthermore, NO regulates the activities of enzymes and signaling proteins by S-nitrosylation of thiol moieties (2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The adverse effect of cardiovascular risk factors on the NOS pathway is mediated by asymmetric dimethylarginine and by vascular generation of superoxide anion, which degrades NO to peroxynitrite.

    “Their adverse effect on the NOS pathway is mediated by asymmetric dimethylarginine (ADMA; the endogenous antagonist of NO synthesis) and by the vascular generation of superoxide anion (O 2 -), which degrades NO to peroxynitrite anion (ONOO -) (4, 5).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [4] source

      Not checked in the free run.

    • cites [5] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    After vascular injury, NO biosynthesis as reflected by vascular nitrosothiols was not increased except in the presence of an arginase inhibitor, indicating that l-arginine had become rate limiting for NO production.

    “However, NO biosynthesis (as reflected by vascular nitrosothiols) was not increased, except in the presence of an arginase inhibitor, indicating that l-arginine had become rate limiting for NO production.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Subsequent activation of oxidant-sensitive transcriptional pathways increases VSMC proliferation and migration, contributing to the myointimal lesion.

    “Subsequent activation of oxidant-sensitive transcriptional pathways increases VSMC proliferation and migration (10), contributing to the myointimal lesion.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] source

      Not checked in the free run.

  • May combine two claims.

    Premiseown data

    The benefit of sodium nitrite was associated with a 10-fold increase in NO generation by injured vessels, an effect not attenuated by the NOS inhibitor L-NAME.

    “This benefit was associated with a 10-fold increase in NO generation by the injured vessels, an effect that was not attenuated by the NOS inhibitor N-nitro-l-arginine methyl ester (L-NAME).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The XOR antagonist allopurinol blocked the antiproliferative action of sodium nitrite in vitro and abrogated the therapeutic effect of dietary nitrite on the injured murine carotid artery.

    “They observed that the XOR antagonist allopurinol blocked the antiproliferative action of sodium nitrite in vitro and abrogated the therapeutic effect of dietary nitrite on the injured murine carotid artery.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Alef, 2011, J Clin Invest. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    These findings are consistent with previous observations that nitrite may be converted to NO in tissues and in blood, particularly in states of hypoxia and acidosis.

    “These findings are consistent with previous observations that nitrite may be converted to NO in tissues and in blood, particularly in states of hypoxia and acidosis (12,13).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [12] Feelisch, 2008, J Biol Chem. source

      Not checked in the free run.

    • cites [13] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Conversion of nitrite to NO by XOR and/or other metabolic pathways could replace or augment endothelial production of NO and thereby inhibit processes known to contribute to atherosclerosis, restenosis, and vascular inflammation.

    “The conversion of nitrite to NO by the enzyme XOR (and/or other metabolic pathways as discussed above) could replace or augment endothelial production of NO and thereby inhibit processes known to contribute to atherosclerosis, restenosis, and vascular inflammation.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Dietary nitrite and nitrate can contribute to the formation of potentially carcinogenic nitrosamines, although the epidemiological association of dietary nitrogen oxides with cancer has been questioned.

    “Furthermore, dietary nitrite and nitrate can contribute to the formation of potentially carcinogenic nitrosamines, although the epidemiological association of dietary nitrogen oxides with cancer has been questioned (19).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NO increases local blood flow and protects the gastric mucosa.

    “In any event, NO increases local blood flow and protects the gastric mucosa (15).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [15] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Dietary supplementation of nitrites can cause methemoglobinemia and interfere with oxygenation of the blood.

    “Dietary supplementation of nitrites can cause methemoglobinemia and interfere with oxygenation of the blood.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] source

      Not checked in the free run.

    • cites [18] source

      Not checked in the free run.

15 of 15
  • The paper relies on this without support.

    Acute injury of the vessel wall denudes the endothelial lining and removes homeostatic regulation, precipitating myointimal hyperplasia.

    “Acute injury of the vessel wall denudes the endothelial lining, removing homeostatic regulation and precipitating a wave of events leading to myointimal hyperplasia.”
  • The paper relies on this without support.

    After vascular injury, activated VSMCs and infiltrating immune cells express inducible NOS.

    “Although the endothelial source of NO generation is lost, the activated VSMCs and the infiltrating immune cells express the inducible form of NOS (iNOS).”
  • The paper relies on this without support.

    Superoxide anion combines with NO to form the cytotoxic radical peroxynitrite.

    “Superoxide anion combines with NO to form the cytotoxic radical ONOO -.”
  • The paper relies on this without support.

    Ornithine-derived polyamines stimulate VSMC proliferation.

    “Ornithine serves as a precursor for polyamines that are known to stimulate VSMC proliferation.”
  • The paper relies on this without support.

    NO is derived from the metabolism of l-arginine by NOS.

    “NO is derived from the metabolism of l-arginine by NOS.”
  • The paper relies on this without support.

    XOR is an enzyme capable of producing NO from nitrite.

    “XOR is an enzyme that is capable of producing NO from nitrite.”
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Authors
Cooke, J. P., & Ghebremariam, Y. T.
Affiliations
Stanford Cardiovascular Institute (US)
Corresponding author
Cooke, John P.
Venue
Journal of Clinical Investigation
Published
2011-04-01
Volume
121
Issue
4
Pages
1258-1260
ISSN
0021-9738 (ISSN-L)
OpenAlex
W1981465993
Cited by
19
References
31
Citations by year
2026: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2015: 3 · 2014: 1 · 2013: 3 · 2012: 1
FWCI
1.53
Type
journal article
Language
en
Open access
Locations
  • Journal of Clinical Investigation (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Tobacco-Related Disease Research Program
  • National Institutes of Health
  • Stanford Bio-X
  • National Heart, Lung, and Blood Institute (U01HL100397, RC2HL103400, K12HL087746)
  • Stanford Cardiovascular Institute, School of Medicine, Stanford University
Topics
  • Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Angiogenesis and VEGF in Cancer
  • Life Sciences › Immunology and Microbiology › Immunology › Neutrophil, Myeloperoxidase and Oxidative Mechanisms
Keywords
dietary nitrate, nitric oxide, restenosis, xanthine oxidoreductase, nitrite, myointimal hyperplasia, vascular injury, endothelium, nitric oxide synthase, vascular smooth muscle cells
MeSH terms
Animals, Diet, Endothelium, Vascular, Homeostasis, Hyperplasia, Models, Biological, Nitrates, Nitric Oxide, Nitrites, Tunica Intima, Coronary Restenosis, Mice

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