Activated protein C prevents endotoxin-induced hypotension in rats by inhibiting excessive production of nitric oxide.
BACKGROUND
Excessive production of nitric oxide (NO) by the inducible isoform of NO synthase (iNOS) is critically involved in endotoxin (ET)-induced hypotension. Tumor necrosis factor-alpha (TNF-alpha) plays an important role in induction of iNOS. Because activated protein C (APC), a physiological anticoagulant, inhibits TNF-alpha production, it might prevent hypotension by inhibiting excessive production of NO. In this study, we examined this possibility using a rat model of septic shock.


RESULTS
Intravenous administration of APC prevented both ET-induced hypotension and the increases in plasma levels of NO(2)(-)/NO(3)(-). The hypotension was also inhibited when APC was administered 30 minutes after ET administration. APC inhibited the increases in lung levels of iNOS activity by inhibiting expression of iNOS mRNA in animals given ET. APC significantly inhibited the increases in lung tissue levels of TNF-alpha and expression of TNF-alpha mRNA in animals given ET. Neither DEGR-F.Xa, a selective inhibitor of thrombin generation, nor DIP-APC, an active site-blocked APC, showed any effect on these ET-induced changes. Both inhibition of TNF-alpha production by leukocytopenia and treatment with anti-rat TNF-alpha antibody produced effects similar to those induced by APC. Aminoguanidine, a selective inhibitor of iNOS, inhibited both the hypotension and the increases in plasma levels of NO(2)(-)/NO(3)(-) in this animal model.


CONCLUSIONS
These observations strongly suggest that APC inhibits iNOS induction by decreasing TNF-alpha production, leading to the prevention of ET-induced hypotension. Furthermore, such effects of APC were not dependent on its anticoagulant effects but rather on its serine protease activity.
Isobe
H
H
Department of Laboratory Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.
Okajima
K
K
Uchiba
M
M
Mizutani
A
A
Harada
N
N
Nagasaki
A
A
Okabe
K
K
D000590:Amino Acid Chloromethyl Ketones / Q000737:chemistry; D000818:Animals; D000906:Antibodies / Q000494:pharmacology; D001794:Blood Pressure / Q000187:drug effects; D003619:Dansyl Compounds / Q000737:chemistry; D004731:Endotoxins / Q000008:administration & dosage*; D015951:Factor Xa / Q000737:chemistry / Q000494:pharmacology; D007022:Hypotension / Q000139:chemically induced / Q000378:metabolism / Q000517:prevention & control*; D007275:Injections, Intravenous; D007531:Isoflurophate / Q000737:chemistry; D007970:Leukopenia / Q000503:physiopathology; D008168:Lung / Q000187:drug effects / Q000201:enzymology / Q000378:metabolism; D008297:Male; D009566:Nitrates / Q000097:blood; D009569:Nitric Oxide / Q000378:metabolism*; D019001:Nitric Oxide Synthase / Q000187:drug effects / Q000235:genetics / Q000378:metabolism; D052247:Nitric Oxide Synthase Type II; D009573:Nitrites / Q000097:blood; D011486:Protein C / Q000737:chemistry / Q000494:pharmacology*; D012333:RNA, Messenger / Q000187:drug effects / Q000235:genetics / Q000378:metabolism; D051381:Rats; D017208:Rats, Wistar; D013047:Specific Pathogen-Free Organisms; D014409:Tumor Necrosis Factor-alpha / Q000235:genetics / Q000276:immunology / Q000378:metabolism
D000590:Amino Acid Chloromethyl Ketones; D000906:Antibodies; D003619:Dansyl Compounds; D004731:Endotoxins; D009566:Nitrates; D009573:Nitrites; D011486:Protein C; D012333:RNA, Messenger; D014409:Tumor Necrosis Factor-alpha; D007531:Isoflurophate; D009569:Nitric Oxide; C030824:dansylglutamyl-glycyl-arginine chloromethyl ketone; D019001:Nitric Oxide Synthase; D052247:Nitric Oxide Synthase Type II; C496318:Nos2 protein, rat; D015951:Factor Xa