Differential inducible nitric oxide synthase activity in circulating neutrophils vs. mononuclears of septic shock patients.

Objective: To compare nitric oxide synthase (NOS) activity in circulating neutrophils and mononuclear cells of patients with septic shock to healthy subjects.

Design And Setting: Prospective study in the general intensive care unit (30 beds) of a university affiliated-hospital and the A.C. Burton Vascular Biology Research Laboratory.

Patients: Six septic patients and seven healthy volunteers.

Measurements And Results: We measured NOS in circulating neutrophils and mononuclears. Constitutive (cNOS) and inducible (iNOS) activities were analyzed by the [3H]L-arginine-L-citrulline assay. Plasma NOx- was determined by chemiluminescence. NOx- was higher in septic vs. controls (median 110, IQR 39-250 vs. 23, 14-46 microM; p<0.05). cNOS in septic cells was unmeasurable. iNOS in septic neutrophils was higher (median 34.9, IQR 10.4-95.8 vs. controls 2.5, 0-2.7 U; p<0.05) while iNOS in septic mononuclears was unaltered (median 16.4, IQR 9.1-52.6 vs. controls 8.9, 5.9-20.3 U; p=0.240).

Conclusions: Increased iNOS activity was found in circulating neutrophils of septic shock patients compared to healthy volunteers. Moreover, differential iNOS activity was evident in circulating neutrophils vs. mononuclears of patients with septic shock. Further investigations are warranted to confirm this differential iNOS activity and to explore its significance.