title: Detrimental effect of nitric oxide synthase inhibition during endotoxemia may be caused by high levels of tumor necrosis factor and interleukin-6.
abstract: BACKGROUND
  Nitric oxide (NO) production increases during sepsis and endotoxemia. Inhibition of NO synthase has been suggested as a therapeutic modality in sepsis and endotoxemia, but in recent reports NO synthase inhibition increased mortality rate. The mechanism of this phenomenon is not known. Other studies have shown that high levels of tumor necrosis factor (TNF) and interleukin-6 (IL-6) contribute to death during sepsis and endotoxemia. We tested the effect of NO synthase inhibition on survival in endotoxemic rats and hypothesized that inhibition of NO synthase during endotoxemia increases circulating levels of TNF and IL-6.
  
  
  METHODS
  Rats were treated with subcutaneous injection of saline solution or 100 mg/kg of the NO synthase inhibitor N-nitro-L-arginine 1 hour before intravenous injection of endotoxin (15 mg/kg) or saline solution. Survival was followed for 24 hours. Plasma nitrite-nitrate (NO2/NO3), TNF, and IL-6 levels were determined at intervals.
  
  
  RESULTS
  Endotoxin caused a significant increase in levels of plasma NO2-/NO3-, TNF, and IL-6 and a 33% mortality rate. Pretreatment with N-nitro-L-arginine increased mortality rate to 74%, decreased NO2/NO3, and substantially increased TNF and IL-6 levels.
  
  
  CONCLUSIONS
  Inhibition of NO synthase increases mortality rate during endotoxemia. The detrimental effect of NO synthase inhibition during endotoxemia may be caused by excessive production of TNF and IL-6.
authors.affiliation: Department of Surgery, University of Cincinnati Medical Center, Ohio.
authors.forename: G
authors.initials: G
authors.lastname: Tiao
authors.forename: J
authors.initials: J
authors.lastname: Rafferty
authors.forename: C
authors.initials: C
authors.lastname: Ogle
authors.forename: J E
authors.initials: JE
authors.lastname: Fischer
authors.forename: P O
authors.initials: PO
authors.lastname: Hasselgren
mesh_terms: D000594:Amino Acid Oxidoreductases / Q000037:antagonists & inhibitors*; D000818:Animals; D001120:Arginine / Q000031:analogs & derivatives / Q000633:toxicity; D004731:Endotoxins / Q000097:blood / Q000633:toxicity*; D015850:Interleukin-6 / Q000096:biosynthesis*; D008297:Male; D009566:Nitrates / Q000097:blood; D019001:Nitric Oxide Synthase; D009573:Nitrites / Q000097:blood; D019335:Nitroarginine; D051381:Rats; D017207:Rats, Sprague-Dawley; D014409:Tumor Necrosis Factor-alpha / Q000096:biosynthesis*
chemical_list: D004731:Endotoxins; D015850:Interleukin-6; D009566:Nitrates; D009573:Nitrites; D014409:Tumor Necrosis Factor-alpha; D019335:Nitroarginine; D001120:Arginine; D019001:Nitric Oxide Synthase; D000594:Amino Acid Oxidoreductases