Nitric oxide (NO) regulates platelet activation by cGMP-dependent mechanisms and by mechanisms that are not completely defined. Platelet activation includes exocytosis of platelet granules, releasing mediators that regulate interactions between platelets, leukocytes, and endothelial cells. Exocytosis is mediated in part by N-ethylmaleimide-sensitive factor (NSF), an ATPase that disassembles complexes of soluble NSF attachment protein receptors. We now demonstrate that NO inhibits exocytosis of dense granules, lysosomal granules, and ␣-granules from human platelets by Snitrosylation of NSF. Platelets lacking endothelial NO synthase show increased rolling on venules, increased thrombosis in arterioles, and increased exocytosis in vivo. Regulation of exocytosis is thus a mechanism by which NO regulates thrombosis.␣-granules ͉ nitric oxide N itric oxide (NO) plays a major role in vascular homeostasis, regulating vascular tone, leukocyte trafficking, and platelet adhesion and aggregation (1-4). NO regulates thrombosis in part by inhibition of platelet adhesion and aggregation (2, 5, 6). One well described pathway by which NO regulates platelet activation is mediated by guanylate cyclase (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). NO activates guanylate cyclase in platelets, leading to an increase in cGMP (25)(26)(27). Targets of cGMP in platelets include cGMP-regulated phosphodiesterases (PDEs) PDE2 and PDE5, cGMP-dependent protein kinase type I, and perhaps cAMP-dependent protein kinases as well (28). The cGMP pathway mediates many of the effects of NO on platelet activation, such as inhibition of platelet aggregation. Thus, cGMP is a major mediator of NO signal transduction in platelets.NO also regulates platelets by cGMP-independent pathways. For example, certain NO donors inhibit platelet aggregation in a cGMP-independent manner (12,(29)(30)(31). Furthermore, NO activates platelet ADP-ribosyltransferase in a cGMP-independent manner (32). Finally, NO inhibits Ca 2ϩ mobilization in platelets independent of cGMP (33). Thus, NO inhibits platelet activation by both cGMP-dependent and less well characterized cGMPindependent pathways.Exocytosis of platelet granules is an important process by which platelets mediate thrombosis and vascular inflammation. The three types of platelet granules: dense granules, ␣-granules, and lysosomal granules, contain molecules that are released into the blood or are translocated to the platelet surface after exocytosis. Dense granules, the first to be released upon activation, contain small molecules such as serotonin, ATP and ADP, which are involved in platelet recruitment and activation. Contents of the ␣-granule include von Willebrand factor, P-selectin, and -thromboglobulin, which promote platelet adherence, aggregation, and rolling on vessel walls. Lysosomal granules are the last to be released and contain degradative enzymes (34,35).Platelet granule exocytosis is mediated by a set of proteins that regulate vesicle trafficking (35)(36)(37)(38). Soluble N-...