Cell-free hemoglobin limits nitric oxide bioavailability in sickle-cell disease.
Although the deleterious vasoconstrictive effects of cell-free, hemoglobin-based blood substitutes have been appreciated, the systemic effects of chronic hemolysis on nitric oxide bioavailability have not been considered or quantified. Central to this investigation is the understanding that nitric oxide reacts at least 1,000 times more rapidly with free hemoglobin solutions than with erythrocytes. We hypothesized that decompartmentalization of hemoglobin into plasma would divert nitric oxide from homeostatic vascular function. We demonstrate here that plasma from patients with sickle-cell disease contains cell-free ferrous hemoglobin, which stoichiometrically consumes micromolar quantities of nitric oxide and abrogates forearm blood flow responses to nitric oxide donor infusions. Therapies that inactivate plasma hemoglobin by oxidation or nitric oxide ligation restore nitric oxide bioavailability. Decompartmentalization of hemoglobin and subsequent dioxygenation of nitric oxide may explain the vascular complications shared by acute and chronic hemolytic disorders.
Reiter
Christopher D
CD
Critical Care Medicine Department of the Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland, USA.
Wang
Xunde
X
Tanus-Santos
Jose E
JE
Hogg
Neil
N
Cannon
Richard O
RO
Schechter
Alan N
AN
Gladwin
Mark T
MT
D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood*; D001682:Biological Availability; D006418:Heme / Q000378:metabolism; D006433:Hemocyanins / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism*; D006461:Hemolysis; D006801:Humans; D008875:Middle Aged; D009569:Nitric Oxide / Q000378:metabolism*; D010084:Oxidation-Reduction
D006454:Hemoglobins; C021724:oxy-beta-hemocyanin; D009569:Nitric Oxide; D006418:Heme; D006433:Hemocyanins