title: Inhaled nitric oxide inhibits human platelet aggregation, P-selectin expression, and fibrinogen binding in vitro and in vivo.
abstract: BACKGROUND
  Recent data suggest that inhaled NO can inhibit platelet aggregation. This study investigates whether inhaled NO affects the expression level and avidity of platelet membrane receptors that mediate platelet adhesion and aggregation.
  
  
  RESULTS
  In 30 healthy volunteers, platelet-rich plasma was incubated with an air/5% CO2 mixture containing 0, 100, 450, and 884 ppm inhaled NO. ADP- and collagen-induced platelet aggregation, the membrane expression of P-selectin, and the binding of fibrinogen to the platelet glycoprotein (GP) IIb/IIIa receptor were determined before (t0) and during the 240 minutes of incubation. In addition, eight patients suffering from severe adult respiratory distress syndrome (ARDS) were investigated before and 120 minutes after the beginning of administration of 10 ppm inhaled NO. In vitro, NO led to a dose-dependent inhibition of both ADP-induced (3+/-3% at 884 ppm versus 70+/-6% at 0 ppm after 240 minutes; P<.001) and collagen-induced (13+/-5% versus 62+/-5%; P<.01) platelet aggregation. Furthermore, P-selectin expression (36+/-7% of t0 value; P<.01) and fibrinogen binding (33+/-11%; P<.01) were inhibited. In patients with ARDS, after two who did not respond to NO inhalation with an improvement in oxygenation had been excluded, an increase in plasma cGMP, prolongation of in vitro bleeding time, and inhibition of platelet aggregation and P-selectin expression were observed, and fibrinogen binding was also inhibited (19+/-7% versus 30+/-8%; P<.05).
  
  
  CONCLUSIONS
  NO-dependent inhibition of platelet aggregation may be caused by a decrease in fibrinogen binding to the platelet GP IIb/IIIa receptor.
authors.affiliation: Department of Anesthesiology, University of Heidelberg, Germany. andrevgries@krzmail.krz.uni-heidelberg.de
authors.forename: A
authors.initials: A
authors.lastname: Gries
authors.forename: C
authors.initials: C
authors.lastname: Bode
authors.forename: K
authors.initials: K
authors.lastname: Peter
authors.forename: A
authors.initials: A
authors.lastname: Herr
authors.forename: H
authors.initials: H
authors.lastname: Böhrer
authors.forename: J
authors.initials: J
authors.lastname: Motsch
authors.forename: E
authors.initials: E
authors.lastname: Martin
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D001760:Bleeding Time; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology; D004305:Dose-Response Relationship, Drug; D005340:Fibrinogen / Q000378:metabolism*; D005434:Flow Cytometry; D006801:Humans; D066298:In Vitro Techniques; D007958:Leukocyte Count; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage*; D019007:P-Selectin / Q000378:metabolism*; D010974:Platelet Aggregation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010976:Platelet Count; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000378:metabolism; D012128:Respiratory Distress Syndrome / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D019007:P-Selectin; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D009569:Nitric Oxide; D005340:Fibrinogen