Cell-free hemoglobin limits nitric oxide bioavailability in sickle-cell disease

CD Reiter, X Wang, JE Tanus-Santos, N Hogg… - Nature medicine, 2002 - nature.com
CD Reiter, X Wang, JE Tanus-Santos, N Hogg, RO Cannon, AN Schechter, MT Gladwin
Nature medicine, 2002nature.com
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 …
Abstract
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.
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