We determined the concentration of nitric oxide metabolites (NO 2 − +NO 3 − ), expressed as NOx, in several clinical conditions. Regarding this, we have examined 25 subjects with arterial hypertension, 41 subjects with chronic kidney disease in conservative treatment, 106 subjects with metabolic syndrome subdivided according to the presence (n = 43) or not (n = 63) of diabetes mellitus, 48 subjects with obstructive sleep apnea syndrome (OSAS), 14 women with systemic sclerosis complicated with Raynaud's phenomenon, 42 dialyzed subjects and 105 young subjects with acute myocardial infarction (AMI). In subjects with arterial hypertension, chronic kidney disease, metabolic syndrome, systemic sclerosis, as well as, in dialyzed and AMI subjects, we found at baseline a NOx increase. In dyalized subjects after a standard dialysis session, we observed a decrease in NOx. The increase in NOx in juvenile AMI was significantly influenced by cigarette smoking and less by cardiovascular risk factors and the extent of coronary lesions; at 3 and 12 months later than the initial event, we observed a decrease of NOx that remains significantly higher than the control group. In subjects with OSAS no difference in NOx was noted in comparison with normal controls, although their subdivision according to the apnea/hypopnea index operates a clear distinction regarding NOx concentration.
G. Caimi et al. / NOx in several clinical conditionsNO interacts with the superoxide anion (O 2 − ) to produce peroxynitrite and other oxidants involved in tissue injury. Considering this pathophysiological aspect, NOS inhibitors have been administrated in some critical conditions, such as congestive heart failure [64], refractory cardiogenic shock [21], cardiogenic shock complicating an acute myocardial infarction [26,58,70] and septic shock [44]. Among the NOS inhibitors, the L-monomethylarginine (L-NMM), a non-selective NOS inhibitor, has been investigated the most. The TRIUMPH study [70] has been conducted in 130 centers and in 8 countries in North America and Europe, enrolling 398 patients with acute myocardial infarction (AMI) and cardiogenic shock; it has demonstrated, however, that the use of tilarginine acetate has no effect on mortality of these patients. Other authors [65] have consequently suggested avoiding further trials with non-selective inhibitors of NOS in the cardiovascular area. Whereas the considerations about the possible coming of NO are interesting. As it is known, NO metabolites, such as nitrite (NO 2 − ) and nitrate (NO 3 − ), usually evaluated together and expressed as NOx, may play a positive role in stable clinical conditions, because they can be reduced to NO once again [20,49,53,54]. All the NO produced, including those generated by red blood cells subjected to several stimuli, such as mechanical and shear stress [71][72][73], act on the cardiovascular system contributing to the modulation of blood flow and vascular tone and regulating vascular relaxation without, however, recognizing the pivotal role played in this microcir...