The nitrate-nitrite-nitric oxide pathway in physiology and therapeutics

Acute effects of isolated and combined dietary nitrate and caffeine ingestion on ergometer-based 1000 m time trial performance in highly trained kayakers

BACKGROUND

Dietary nitrate (BR) and caffeine (CAF) ingestion have been shown to increase sports performance. However, the isolated and combined effects of BR and CAF ingestion on time trial (TT) performance as well as the accompanying physiological and perceptual responses have never been investigated in highly trained kayak athletes. Therefore, the present study examined the impact of an isolated and combined supplementation with BR (140 ml beetroot concentrate, ~12.5 mmol nitrate) and CAF (3 mg/kg bodyweight) on 1000 m ergometer TT performance as well as the accompanying physiological (i.e. cardiorespiratory function, muscle oxygenation, muscle activity) and perceptual responses (i.e. fatigue, effort, and exercise-induced pain perception) in male highly trained kayakers. It was hypothesized that the isolated ingestion of BR and CAF would both improve ergometer-based 1000 m TT performance and induce supplement-specific physiological and perceptual responses. Considering the primary effects of BR on muscle function and of CAF on the central nervous system, it was further assumed that the combined ingestion will result in an additional performance increase and supplement-specific physiological and perceptual responses.

METHODS

Using a prospective, randomized, controlled, double-blind crossover design, 12 male highly trained kayak athletes from local clubs were investigated. They completed four measurement sessions resulting in four randomized conditions: (i) BR+CAF; (ii) BR+CAF placebo (BR+PLA); (iii) CAF+BR placebo (CAF+PLA); and (iv) BR placebo + CAF placebo (PLA+PLA). An air-braked instrumented kayak-ergometer was used to record 1000 m TT performance, power output, and stroke frequency. Heart rate (HR), oxygen uptake (VO2), maximum VO2 (VO2max), respiratory equivalent of O2 (VE/VO2), and carbon dioxide (VE/VCO2) were measured continuously. Furthermore, oxygenation of the deltoid muscle was measured with near-infrared spectroscopy (mNIRS) and muscle activity of nine unilateral muscles with surface electromyography (i.e. deltoideus, serratus anterior, triceps brachii caput lateralis, trapezius, infraspinatus, latissimus dorsi, obliquus externus, flexor carpi radialis, and vastus lateralis muscle) during the 1000 m TT. After the TT, fatigue, effort, and exercise-induced pain perception were queried. One- and two-way analysis of variance with repeated measures were conducted to determine differences between conditions for the entire 1000 m TT and predefined sections (0-50 m, 50-100 m, 100-150 m, 150-250 m, 250-500 m, 500-750 m, 750-1000 m), respectively (p ≤ 0.05).

RESULTS

The supplements did not have an ergogenic effect on TT performance compared to the PLA+PLA condition, either in isolation or in combination. The same applied to the majority of physiological parameters and the perceptual responses. Nevertheless, VE/VO2 was lower during the sections 150-250 m (-5.00%; p = 0.02) and 250-500 m (-3.49%; p = 0.03) in the BR+PLA condition, whereby VE/VCO2 was higher during the section 150-250 m (4.19%; p = 0.04) in the CAF+PLA compared to the PLA+PLA condition, respectively.

CONCLUSIONS

Data indicate that the isolated and combined ingestion of BR and CAF had no effect on 1000 m TT performance, the majority of physiological responses, and perceptual responses in highly trained kayakers. These findings might be related to the dosage and/or a ceiling effect due to the already efficient vascular, metabolic, and muscle function, including high amounts of endogenous produced nitric oxide, in athletes.

The effect of acute beetroot juice consumption prior to climbing on lower-body isokinetic and isometric strength, aerobic power, and muscle soreness among mountain climbers

BACKGROUND

Beetroot juice (BRJ) contains various bioactive compounds which can enhance athletes" performance. However, there is a limited number of studies assessing the effects of BRJ on climbers" performance and indicators of muscle soreness (MS). Thus, the present study aimed to investigate the effect of consuming beetroot juice acutely before climbing on lower-body isokinetic and isometric strength, aerobic power, and muscle soreness in mountain climbers.

METHODS

In a randomized, placebo-controlled, double-blinded study, 27 climbers (14 males and 13 females) were divided into three groups: Control (CON), Placebo (PLA), and Beetroot Juice (BRJ), with 9 participants in each group. The study evaluated swelling around the thigh (Sw-T), pressure pain threshold (PPT), isokinetic and isometric strength, horizontal jump (HJ), wall-sit, handgrip strength (HGS), flexibility, and the Queen's College Step test. Testing occurred in three sessions: baseline, climbing, and posttest. At baseline, all participants completed the full battery of tests at Shiraz University. One week later, during the climbing session, they consumed 70 mL of BRJ (400 mg nitrate), PLA, or water 2.5 hours before ascending to 3720 meters. Functional tests (HJ, wall-sit, and estimated VO₂max) were performed at the altitude. After completing these tests, participants immediately descended the mountain. DOMS was assessed using a visual analog scale (VAS) for the quadriceps, hamstrings, and gastrocnemius muscles at the following time points: 2 hours before climbing, and 0 (immediately), 12, 24, 48, and 72 hours after descending. The posttest session, held 72 hours after descending, repeated all baseline assessments.

RESULTS

The results revealed a statistically significant decrease in DOMS in the gastrocnemius muscles 24 hours post-descending in the BRJ group compared to the control group (p = 0.003, pEta2 = 0.204). However, no changes in DOMS were observed for the quadriceps (p = 0.090, pEta2 = 0.090) and hamstring (p = 0.254, pEta2 = 0.056) muscles. Moreover, notable improvements were observed in PPT (p = 0.001, pEta2 = 0.374), Estimated VO2max (p = 0.016, pEta2 = 0.291), HGS (p = 0.004, pEta2 = 0.270), flexibility (p = 0.003, pEta2 = 0.407), HJ (p = 0.008, pEta2 = 0.155), and isokinetic (peak torque, average power and rate of force development) and isometric (Maximum voluntary isometric contraction) strength indicators in the BRJ groups compare to the other groups (p˂0.05). However, no significant differences were observed in Sw-T between groups (p = 0.305).

CONCLUSIONS

The study suggested that acute consumption of BRJ before climbing improves climbers' lower-body isokinetic and isometric strength, power, and endurance performance, and it is associated with a reduced perception of muscle soreness.

Multifaceted role of nitric oxide in vascular dementia

Vascular dementia is a highly heterogeneous neurodegenerative disorder induced by a variety of factors. Currently, there are no definitive treatments for the cognitive dysfunction associated with vascular dementia. However, early detection and preventive measures have proven effective in reducing the risk of onset and improving patient prognosis. Nitric oxide plays an integral role in various physiological and pathological processes within the central nervous system. In recent years, nitric oxide has been implicated in the regulation of synaptic plasticity and has emerged as a crucial factor in the pathophysiology of vascular dementia. At different stages of vascular dementia, nitric oxide levels and bioavailability undergo dynamic alterations, with a marked reduction in the later stages, which significantly contributes to the cognitive deficits associated with the disease. This review provides a comprehensive review of the emerging role of nitric oxide in the physiological and pathological processes underlying vascular dementia, focusing on its effects on synaptic dysfunction, neuroinflammation, oxidative stress, and blood‒brain barrier integrity. Furthermore, we suggest that targeting the nitric oxide soluble guanylate cyclase-cyclic guanosine monophosphate pathway through specific therapeutic strategies may offer a novel approach for treating vascular dementia, potentially improving both cognitive function and patient prognosis. The review contributes to a better understanding of the multifaceted role of nitric oxide in vascular dementia and to offering insights into future therapeutic interventions.

Inhibition of hepatic gluconeogenesis in type 2 diabetes by metformin: complementary role of nitric oxide

Metformin is the first-line treatment for type 2 diabetes mellitus. Type 2 diabetes mellitus is associated with decreased nitric oxide bioavailability, which has significant metabolic implications, including enhanced insulin secretion and peripheral glucose utilization. Similar to metformin, nitric oxide also inhibits hepatic glucose production, mainly by suppressing gluconeogenesis. This review explores the combined effects of metformin and nitric oxide on hepatic gluconeogenesis and proposes the potential of a hybrid metformin-nitric oxide drug for managing type 2 diabetes mellitus. Both metformin and nitric oxide inhibit gluconeogenesis through overlapping and distinct mechanisms. In hepatic gluconeogenesis, mitochondrial oxaloacetate is exported to the cytoplasm via various pathways, including the malate, direct, aspartate, and fumarate pathways. The effects of nitric oxide and metformin on the exportation of oxaloacetate are complementary; nitric oxide primarily inhibits the malate pathway, while metformin strongly inhibits the fumarate and aspartate pathways. Furthermore, metformin effectively blocks gluconeogenesis from lactate, glycerol, and glutamine, whereas nitric oxide mainly inhibits alanine-induced gluconeogenesis. Additionally, nitric oxide contributes to the adenosine monophosphate-activated protein kinase-dependent inhibition of gluconeogenesis induced by metformin. The combined use of metformin and nitric oxide offers the potential to mitigate common side effects. For example, lactic acidosis, a known side effect of metformin, is linked to nitric oxide deficiency, while the oxidative and nitrosative stress caused by nitric oxide could be counterbalanced by metformin's enhancement of glutathione. Metformin also amplifies nitric oxide -induced activation of adenosine monophosphate-activated protein kinase. In conclusion, a metformin-nitric oxide hybrid drug can benefit patients with type 2 diabetes mellitus by enhancing the inhibition of hepatic gluconeogenesis, decreasing the required dose of metformin for maintaining optimal glycemia, and lowering the incidence of metformin-associated lactic acidosis.

Glucose-triggered NO-evolving coating bestows orthopedic implants with enhanced anti-bacteria and angiectasis for safeguarding diabetic osseointegration

As a common chronic metabolic disease, diabetes mellitus (DM) features a hyperglycemic micromilieu around implants, resulting in the critical implantation failure and high complications such as peri-implantitis and angiectasis disorder. To address the plaguing issue, we devise and develop a glucose-unlocked NO-evolving orthopedic implant consisted of polyetheretherketone (PEEK), glucose oxidase (GOx) and l-arginine (Arg) with enhanced angiogenesis for boosting diabetic osseointegration. Upon hyperglycemic niche, GOx on implants catalytically exhaust glucose to H2O2, which immediately reacts with Arg to in situ liberate nitric oxide (NO), resulting in enhanced angiogenesis and angiectasis around PEEK implant. Besides, the engineered implant exhibits great anti-bacterial properties against both Gram-positive and Gram-negative bacteria, as well as fortifies osteogenicity of osteoblasts in terms of cell proliferation, alkaline phosphatase activity and calcium matrix mineralization. Intriguingly, in vivo evaluations utilizing diabetic infectious bone defect models of rat further authenticate that the engineered implants substantially augment bone remodeling and osseointegration at weeks 4 and 8 through dampening pathogens, anti-inflammatory as well as promoting angiectasis. Altogether, this work proposed a new tactic to remedy stalled diabetic osseointegration with hyperglycemic micromilieu-responsive therapeutic gas-evolving orthopedic implants.

The role of nutritional factors in exercise-induced bronchoconstriction: a narrative review

Exercise-induced bronchoconstriction (EIB) describes an acute narrowing of the airways that develops following vigorous physical activity. Clinical responses to current asthma therapy, such as leukotriene antagonists and corticosteroids, are heterogeneous, even with optimal treatment. Epidemiological studies indicate an increasing use of complementary and alternative medicine therapy in asthma patients due to the lack of efficacy of conventional treatment, concerns about potentially harmful side effects of pharmacological treatment, cost barriers to asthma care, and the accessibility of complementary and alternative medicine therapy. Plausible physiological mechanisms now exist for many nutrients as potential modifiers of EIB severity, primarily because of their role in inflammatory processes, airway smooth muscle function, and modulation of lung microvascular volume and pressure. Dietary supplementation as a treatment for EIB has generally shown evidence of significant yet incomplete inhibition of EIB with low-salt diets, omega-3 fatty acids, and vitamin C when supplemented for up to 3 weeks. However, larger, randomized, placebo-controlled, double-blinded trials are needed to clarify the effectiveness of nutritional intervention in individuals with EIB. Additionally, many studies have focused on nonathletes with EIB, and therefore, more studies are required to evaluate the efficacy of nutritional intervention on EIB in elite athletes. In conclusion, if dietary supplementation or restriction is prescribed, it should be seen as an option to lessen the reliance on pharmaceutical interventions and not as an alternative to established pharmacotherapies.

Exploring the therapeutic potential of beetroot juice in patients with peripheral artery disease: A Narrative review

Peripheral artery disease (PAD) is a circulatory disorder caused by atherosclerosis, leading to the narrowing or blockage of peripheral arteries, often affecting the arteries in the lower limbs. This condition can result in intermittent claudication and severe limb ischemia, significantly reducing patients' quality of life. In recent years, increasing evidence suggests that dietary interventions play a crucial role in the prevention and management of PAD, offering a safe and non-invasive treatment option. Beetroot, a natural root vegetable, demonstrates significant health benefits through its various bioactive compounds. It is rich in nitrate and betaine, which are metabolized in the body via the nitrate-nitrite- nitric oxide (NO) pathway, increasing the bioavailability of NO. NO is an important vasodilator that can improve blood flow and lower blood pressure. Additionally, the active compounds in beetroot may further enhance its health effects by altering the activity of the oral microbiome. This review explores the potential therapeutic effects of beetroot juice (BRJ) in the management of PAD. The findings indicate that BRJ can improve exercise performance, lower blood pressure, improve endothelial function, enhance skeletal muscle microvascular function and central autonomic nervous system function. Based on these findings, beetroot and its rich bioactive compounds hold promise as a novel supportive therapy for improving PAD.

Decreased endogenous nitric oxide production in acute decompensated heart failure with a reduced ejection fraction

AIMS

Heart failure represents a substantial burden to both patients and healthcare systems worldwide. Nitric oxide (NO) dysregulation may play a key role in patients transitioning from chronic to acute heart failure with a reduced ejection fraction (HFrEF). Plasma nitrite (NO2 -) is highly reflective of local nitric oxide production and has not been studied in acute HFrEF. This study aims to quantify measures of NO biology in patients with acute and chronic HFrEF.

METHODS AND RESULTS

We utilized gas-phase chemiluminescence to determine plasma NO2 - concentrations. Plasma asymmetric dimethylarginine (ADMA) and arterial stiffness were also measured. Plasma concentrations of NO2 - and ADMA, in addition to arterial stiffness, were compared in participants with chronic HFrEF (n = 25) and acute HFrEF (n = 24). We observed lower concentrations of plasma NO2 - in patients with acute HFrEF (P = 0.047). We also observed higher plasma concentrations of ADMA in participants with acute HFrEF (P < 0.001). Plasma NO2 - and ADMA also displayed a significant negative correlation in the total cohort (Rs = -0.38, P = 0.017). There was no significant difference between groups regarding arterial stiffness measures.

CONCLUSIONS

We present novel data with regard to plasma NO2 - in both acute and chronic HFrEF. Our results indicate that patients with acute HFrEF have a relative deficiency of plasma NO2 - whilst also displaying a relative increase in ADMA, a modulator of eNOS. Reduced NO bioavailability may therefore relate to impaired NO production in patients with acute decompensation, with implications for both treatment and prevention of episodes.

Thiocarboxylate and Acid Chloride Mediated Generation of Nitric Oxide from a Dinickel(II)-Bis(ONO) Complex Involving the Formation of Perthionitrite and O-Nitrosyl Carboxylate

A detailed study for the generation of nitric oxide (NO) upon reaction of a binuclear Ni(II)-bis(ONO) complex with carboxylic acids (RCOOH, R = Me, Ph), thiols (RSH, R = Ph, p-F-C6H4), benzeneselenol (PhSeH), thiocarboxylates (RC(O)S-, R = Me, Ph), thiocarboxylic acids (RC(O)SH, R = Me, Ph), and acid chlorides (RC(O)Cl, R = Me, Ph) has been presented. The reactions of the binuclear Ni(II)-bis(ONO) complex with thiols/selenols give access to unusual dinickel(II)-nitrito-thiolato/selenolato complexes, while the reactions with RC(O)S-, RC(O)SH, and RC(O)Cl offer new mechanistic insights into the generation of perthionitrite (SSNO-) and O-nitrosyl carboxylates (RC(O)ONO), the well-known NO-carrying species in biology. Interestingly, while the reaction of the binuclear Ni(II)-bis(ONO) complex with RC(O)S- involved nucleophilic attack of the latter to the coordinated NO2- to generate SSNO-, the reaction with RC(O)Cl proceeds via the hitherto unknown nucleophilic attack of the coordinated NO2- to the carbonyl carbon of RC(O)Cl to generate RC(O)ONO, which, in turn, produces NO. The present comparative study thus demonstrates new reactions of metal-coordinated NO2- and detailed mechanistic investigations supported by molecular structure determinations and spectroscopic studies and establishes the hitherto unknown reaction of coordinated nitrite with RC(O)Cl to be a highly efficient method for the generation of NO in excellent yield.

Exploring sodium nitrate supplementation in enhancing nitric oxide bioavailability and reducing oxidative stress: implications for blood pressure and endothelial dysfunction in hypertension

Hypertension, a chronic condition marked by elevated blood pressure, poses a significant health risk globally. This review explores the potential of sodium nitrate supplementation to enhance nitric oxide (NO) bioavailability and reduce oxidative stress in patients with hypertension. NO, known for its vasodilatory properties, plays a crucial role in maintaining endothelial function and cardiovascular health. Additionally, this study provides a comprehensive analysis of current research on the mechanisms through which sodium nitrate enhances nitric oxide (NO) levels, thereby improving endothelial function, reducing oxidative stress, and lowering blood pressure. The findings underline sodium nitrate's promising capacity to reduce dependence on conventional antihypertensive therapies, offering a cost-effective strategy for enhancing cardiovascular outcomes. Effective dosage ranges, such as 6-12 mmol/day (approximately 510-1020 mg nitrate), derived from dietary sources like leafy greens and beetroot juice, are proposed as practical solutions. Future studies are warranted to substantiate these benefits, refine dosing protocols, and establish guidelines for safe and effective clinical application. Integrating sodium nitrate into treatment frameworks could significantly advance hypertension management, improve patient quality of life, and reduce healthcare expenditures.

Nitrate supplementation affects taste by changing the oral metabolome and microbiome

Nitrate, an inorganic anion found in various foods is also present in saliva and has emerged as a potential prebiotic for the oral microbiome. Salivary glands concentrate nitrate from the bloodstream and release it into the oral cavity via the anion transporter sialin SLC17A5. In previous studies dietary nitrate supplementation altered oral bacteria composition, favouring genera like Rothia and Neisseria while reducing Streptococcus, Veillonella, Prevotella, and Actinomyces. The present study hypothesized that taste intensity might adapt to changes in the oral microbiome caused by nitrate supplementation. Participants underwent taste tests before, during, and after supplementation. All subjects showed greater levels of salivary nitrate during supplementation and had higher levels of Neisseria compared to before. Subjects were then grouped according to taste tests (before vs. during) as responders (ANOVA p < 0.05, n = 7), and non-responders (ANOVA p > 0.05, n = 6) and their salivary metabolome and oral microbiome further analysed. Responders had significantly less 5-amino pentanoate, formate, propionate and butyrate in saliva while non-responders showed no metabolite changes between before and during supplementation. In contrast, non-responders had increased Capnocytophaga gingivalis and altered lysosomal degradation pathways. Overall, nitrate supplementation shifted the oral microbiome composition in all subjects and when taste intensity was altered this correlated to bacteria-derived short-chain fatty acid production. This suggests taste perception is affected by the oral microbiome.

Electronic structure of aqueous nitrite and nitrate ions from resonant inelastic X-ray scattering

In a comparative synchrotron X-ray absorption, non-resonant X-ray emission and resonant inelastic X-ray scattering investigation of aqueous nitrite and nitrate ions, we access both their unoccupied and occupied valence electronic structures. Complementary information is gained through the sensitivity to specific orbitals at the nitrogen and the oxygen 1s absorption edges. In particular, scattering through the pronounced 1s → π* resonances in combination with the scattering anisotropy and symmetry selection rules allow for an unambiguous assignment of molecular orbitals to their detected spectroscopic fingerprints. The nuclear dynamics in the 1s core-excited states are discussed in the context of the vibrational substructure of the detected spectral lines and signatures of core-excited state symmetry breaking are characterized through an analysis of the excitation energy detuning dependent spectra in combination with the involved potentials. A comparison between TD-DFT based spectrum simulations for isolated molecules and sampled structures from a QM/MM simulation reveals signatures of symmetry breaking induced by the solute-solvent interactions and a different response of spectral signatures of in- and out-of-plane orbitals to the solution environment.

The effect of dietary nitrate supplementation on resistance exercise performance: A dose-response investigation

Dietary nitrate (NO3-) can enhance skeletal muscle contractile function and explosive-type exercise by modulating type II muscle fibers; however, limited attention has been directed at exploring the optimal dosing guidelines and potential performance-enhancing effects of NO3- supplementation during resistance-type exercise. The purpose of our investigation was to examine potential dose-response effects of concentrated NO3--rich beetroot juice on neuromuscular performance during resistance exercise. Eighteen resistance-trained men were assigned in a double-blind, randomized, crossover design, to four conditions to consume beetroot juice containing: negligible NO3- (PL); ~ 6 mmol NO3- (BR-LOW); ~ 12 mmol NO3- (BR-MOD); and ~ 24 mmol NO3- (BR-HIGH). Participants completed 1 set of vertical countermovement jumps (CMJ), 2 sets × 3 repetitions of barbell back squats, and 2 sets × 3 repetitions of barbell bench press 2.5 h post-supplementation. Plasma [NO3-] increased in a dose-dependent manner (P < 0.01). Plasma [nitrite] ([NO2-]) increased in all BR conditions compared to PL (P < 0.05), such that BR-MOD vs. BR-LOW (P < 0.01) and BR-LOW vs. PL (P < 0.01), but BR-HIGH was not different compared to BR-MOD (P > 0.05). Performance was not different between conditions in CMJ, 50% one-repetition maximum (1RM) and 75%1RM back squats, or 50%1RM and 75%1RM bench press (P > 0.05). The change in plasma [NO2-] was significantly correlated with peak power (r = - 0.65, P = 0.003), mean power (r = - 0.52, P = 0.03), and mean velocity (r = - 0.48, P = 0.04) during 50%1RM back squats following BR-LOW vs. PL but not in other conditions (P > 0.05). This study indicates that dietary NO3- does not impact resistance exercise performance at any of the doses assessed in the current study.

Functional Nonheme Diiron(II) Complexes Catalyze the Direct Reduction of Nitrite to Nitric Oxide in Relevance to the Diiron Protein YtfE

The present work reports the functional modeling chemistry of YtfE, which features a nonheme diiron active site and mediates the direct reduction of NO2- to NO. The model complex, [Fe2(HPTP)Cl2]1+ (1), reduces NO2- to NO in a 100% yield within 12 h and generates [Fe4(HPTP)2(μ-O)3(μ-OH)]3+ (2). Similar to YtfE, the reaction involves stepwise oxidation of two Fe(II) centers and product (NO) inhibition, of which the latter produces [Fe2(HPTP)(NO)2Cl2]1+ (3). Complex 3 could also be synthesized by the reaction of [Fe2(HPTP)(NO)2(ClO4)]2+ (4) and chloride. Complex 1 catalyzes the reduction of NO2- to NO in the presence of PhS-, albeit with a low TON of 5, due to the formation of an insoluble product, [Fe2(HPTP)(μ-SPh)Cl2] (5). Another model complex [Fe2(HPTP)(OPr)]1+ (6), reduced NO2- to NO in an 80% yield after 24 h, generated [Fe2(HPTP)(OPr)(NO)2]1+ (7), and offered a TON of 19. The third model complex, [Fe2(HPTP)(ClO4)2]1+ (8), could reduce NO2- to NO in a 100% yield but only after 48 h. A comparison of these results establishes that easy oxidation of the Fe(II) centers, easy accessibility of the Fe(II) centers for the coordination of NO2-, and easy release of NO from the in situ generated dinitrosyl diiron complex increase the efficiency of the functional model complexes of YtfE.

MyD88-mediated signaling in intestinal fibroblasts regulates macrophage antimicrobial defense and prevents dysbiosis in the gut

Fibroblasts that reside in the gut mucosa are among the key regulators of innate immune cells, but their role in the regulation of the defense functions of macrophages remains unknown. MyD88 is suggested to shape fibroblast responses in the intestinal microenvironment. We found that mice lacking MyD88 in fibroblasts showed a decrease in the colonic antimicrobial defense, developing dysbiosis and aggravated dextran sulfate sodium (DSS)-induced colitis. These pathological changes were associated with the accumulation of Arginase 1+ macrophages with low antimicrobial defense capability. Mechanistically, the production of interleukin (IL)-6 and CCL2 downstream of MyD88 was critically involved in fibroblast-mediated support of macrophage antimicrobial function, and IL-6/CCL2 neutralization resulted in the generation of macrophages with decreased production of the antimicrobial peptide cathelicidin and impaired bacterial clearance. Collectively, these findings revealed a critical role of fibroblast-intrinsic MyD88 signaling in regulating macrophage antimicrobial defense under colonic homeostasis, and its disruption results in dysbiosis, predisposing the host to the development of intestinal inflammation.

Nitrate ameliorates alcohol-induced cognitive impairment via oral microbiota

Alcohol use is associated with cognitive impairment and dysregulated inflammation. Oral nitrate may benefit cognitive impairment in aging through altering the oral microbiota. Similarly, the beneficial effects of nitrate on alcohol-induced cognitive decline and the roles of the oral microbiota merit investigation. Here we found that nitrate supplementation effectively mitigated cognitive impairment induced by chronic alcohol exposure in mice, reducing both systemic and neuroinflammation. Furthermore, nitrate restored the dysbiosis of the oral microbiota caused by alcohol consumption. Notably, removing the oral microbiota led to a subsequent loss of the beneficial effects of nitrate. Oral microbiota from donor alcohol use disordered humans who had been taking the nitrate intervention were transplanted into germ-free mice which then showed increased cognitive function and reduced neuroinflammation. Finally, we examined 63 alcohol drinkers with varying levels of cognitive impairment and found that lower concentrations of nitrate metabolism-related bacteria were associated with higher cognitive impairment and lower nitrate levels in plasma. These findings highlight the protective role of nitrate against alcohol-induced cognition impairment and neuroinflammation and suggest that the oral microbiota associated with nitrate metabolism and brain function may form part of a "microbiota-mouth-brain axis".

Baseline habitual dietary nitrate intake and Alzheimer's Disease related neuroimaging biomarkers in the Australian Imaging, Biomarkers and Lifestyle study of ageing

BACKGROUND

Dietary nitrate, as a nitric oxide (NO) precursor, may support brain health and protect against dementia.

OBJECTIVE

Our primary aim was to investigate whether dietary nitrate is associated with neuroimaging markers of brain health linked with Alzheimer's disease (AD).

PARTICIPANTS

Study participants were cognitively unimpaired individuals from the Australian Imaging, Biomarkers and Lifestyle Study of Ageing (AIBL) who had β-amyloid positron emission tomography (PET) scans (n = 554) and magnetic resonance imaging (MRI) scans (n = 335) and had completed a Food Frequency Questionnaire at baseline.

METHODS

Source-specific nitrate intakes were estimated using comprehensive nitrate food composition databases. Rates of cerebral β-amyloid (Aβ) deposition, measured using PET, and rates of brain atrophy, measured using MRI, were assessed between baseline and 126-months follow-up, at intervals of 18 months. Multivariable-adjusted linear mixed effect models were used to examine associations between baseline source-specific nitrate intake and rates of (i) cerebral Aβ deposition and (ii) brain atrophy, over the 126 months of follow-up. Analyses were carried out following stratification of the sample by established dementia Alzheimer's disease (AD) risk factors including sex and presence or absence of the apolipoprotein E (APOE) ε4 allele.

RESULTS

In women carriers of the APOE ε4 allele, higher plant sourced nitrate intake (median intake 121 mg/day), was associated with a slower rate of cerebral Aβ deposition [β: 4.47 versus 8.99 Centiloid (CL) /18 months, p < 0.05] and right hippocampal atrophy [-0.01 versus -0.03 mm3 /18 months, p < 0.01], after multivariable adjustments. Moderate intake showed protective associations in men carriers and in both men and women non-carriers of APOE ε4.

CONCLUSIONS

Associations were observed between plant-derived nitrate intake and cerebral Aβ deposition, particularly in high-risk populations (women and APOE ε4 carriers). Associations were also observed for brain volume atrophy, however these exhibited subgroup variability without clear patterns relative to sex and APOE ε4 allele carriage. These findings suggest a potential link between plant-sourced nitrate and AD related neuroimaging markers of brain health improved brain health, but further validation in larger studies is required.

Is there a link between the abundance of nitrate-reducing bacteria and arterial hypertension? A systematic review

CONTEXT

Nitric oxide is a vasodilator molecule that acts on blood pressure (BP) control, and its production can occur through the reduction of nitrates by oral or intestinal nitrate-reducing bacteria. However, the relationship between nitrate-reducing bacteria and arterial hypertension (HTN) remains under debate.

OBJECTIVE

Systematically review if there is an association between the abundance of oral and intestinal nitrate-reducing bacteria and the occurrence of HTN in humans.

DATABASES AND ELIGIBILITY CRITERIA

MEDLINE, Scopus, Cochrane Library, EMBASE, LILACS, Web of Science, Livivo, ProQuest Dissertations, and Google Scholar were searched for eligible articles until February 10th, 2024. Studies were included if they: (1) were observational studies or clinical trials; (2) included adults (≥18 years old) with HTN (systolic BP ≥ 130 mmHg and/or diastolic BP > 80 mmHg and/or use of BP lowering medication); (3) compared (or not) to no-HTN adults; and (4) used next-generation sequencing microbiome analysis to identify bacterial taxa in the oral and/or gut nitrate-reducing bacteria.

RESULTS

The search identified 9365 articles, and 28 were included in the study after applying the inclusion and exclusion criteria; 23 articles assessed the gut microbiota, 4 assessed the oral microbiota, and 1 assessed both. Depletion of nitrate-reducing bacteria was not consistently shown in the studies. The included studies reported reduction, increase, and no change in the nitrate-reducing bacteria genera or species in oral or gut microbiota.

CONCLUSION

We found no association between the abundance of oral and gut nitrate-reducing bacteria and the occurrence of HTN in humans.

REGISTRATION

PROSPERO identification number CRD42022315891.

Mediterranean diet and diabetic microvascular complications: a systematic review and meta-analysis

BACKGROUND

Diabetic microvascular complications, including diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN), contribute significantly to morbidity and healthcare burdens among individuals with diabetes. The Mediterranean diet (MD) has been associated with improved metabolic health, but its role in mitigating microvascular complications remains unclear. This systematic review and meta-analysis aimed to assess the impact of MD adherence on the risk and progression of these complications.

METHODS

A comprehensive search of PubMed, Web of Science, Embase, and Scopus was conducted through February 12, 2025 to identify studies evaluating MD adherence and diabetic microvascular complications. Meta-analysis was performed where possible, with effect sizes reported as odds ratios (ORs) or hazard ratios (HRs) with 95% confidence intervals (CIs).

RESULTS

Fourteen studies, encompassing 138 to 71,392 participants, were included. Meta-analysis indicated a significant reduction in DR risk among individuals adhering to the MD (HR: 0.69, 95% CI: 0.49-0.97, p = 0.03; OR: 0.32, 95% CI: 0.12-0.82, p = 0.02). A lower likelihood of DN development was observed (HR: 0.85, 95% CI: 0.73-0.99, p = 0.04; OR: 0.49, 95% CI: 0.25-0.96, p = 0.04). However, results for diabetic neuropathy were inconclusive due to study heterogeneity. Sensitivity analyses revealed notable heterogeneity and publication bias was detected in some analyses.

CONCLUSION

Adherence to the Mediterranean diet is associated with a reduced risk of diabetic nephropathy and retinopathy, supporting its potential as a dietary intervention for diabetes management. However, the evidence for neuropathy remains inconclusive. Future well-controlled randomized trials are needed to strengthen causal inferences and refine clinical recommendations for MD-based interventions in diabetic microvascular complications.

Elevated Plasma Nitrate Levels in Patients with Acute Coronary Syndrome

Acute coronary syndrome (ACS) encompasses a spectrum of coronary artery diseases, including unstable angina, non-ST segment elevation myocardial infarction, and ST-segment elevation MI. At present, ACS is a major cause of mortality and morbidity in the community. The diagnosis of ACS is of critical importance for guiding appropriate therapeutic strategies, although this can be onerous if the standard presenting manifestations are lacking. While high-sensitivity cardiac troponin (hs-cTn) is a proven biomarker of ACS, additional markers to support the clinical diagnosis could be valuable. Since nitrate metabolism is crucial to the vasomotion of coronary arteries, in this study, we compared the plasma nitrate levels in consecutive patients with ACS and healthy volunteers. Systemic hemodynamic parameters were also compared between the groups. The pulse wave velocity of individuals with ACS was higher than that in healthy volunteers, thereby verifying the association between coronary artery disease and a loss of vascular elasticity in the circulatory system. Notably, median plasma nitrate levels were significantly higher in patients with ACS compared to healthy volunteers. Although plasma nitrate levels seem to be higher in patients with ACS, whether this finding is incidental, contributory, or a consequential factor in the pathogenesis of ACS remains to be determined.

Eight weeks of high-intensity interval training alters the tongue microbiome and impacts nitrate and nitrite levels in previously sedentary men

Nitric oxide (∗NO) is a key signalling molecule, produced enzymatically via ∗NO synthases (NOS) or following the stepwise reduction of nitrate to nitrite via oral bacteria. Exercise training upregulates NOS expression and improves systemic health, but its effect on oral health, and more particularly the oral microbiome, has not been investigated. We used an exercise training study design to investigate changes in the tongue dorsum microbiome, and in nitrate and nitrite levels in the saliva, plasma and muscle, before, during and after an exercise training period. Eleven untrained males (age 25 ± 5 years, mass 64.0 ± 11.2 kg, stature 171 ± 6 cm, V˙ O2peak 2.25 ± 0.42 l min-1) underwent 8-weeks of high-intensity interval training (HIIT), followed by 12-weeks of detraining. The tongue dorsum microbiome was examined using Pac-Bio long-read 16S rRNA sequencing. Nitrate and nitrite levels were quantified with high-performance liquid chromatography. Grouped nitrite-producing species did not change between any timepoints. However, HIIT led to changes in the microbiome composition, increasing the relative abundance of some, but not all, nitrite-producing species. These changes included a decrease in the relative abundance of nitrite-producing Rothia and a decrease in Neisseria, alongside changes in 6 other bacteria at the genus level (all p ≤ 0.05). At the species level, the abundance of 9 bacteria increased post-training (all p ≤ 0.05), 5 of which have nitrite-producing capacity, including Rothia mucilaginosa and Streptococcus salivarius. Post-detraining, 6 nitrite-producing species remained elevated relative to baseline. Nitrate increased in plasma (p = 0.03) following training. Nitrite increased in the saliva after training (p = 0.02) but decreased in plasma (p = 0.03) and muscle (p = 0.002). High-intensity exercise training increased the abundance of several nitrite-producing bacteria and altered nitrate and nitrite levels in saliva, plasma, and muscle. Post-detraining, several nitrite-producing bacteria remained elevated relative to baseline, but no significant differences were detected in nitrate or nitrite levels. Switching from a sedentary to an active lifestyle alters both the microbiome of the tongue and the bioavailability of nitrate and nitrite, with potential implications for oral and systemic health.

The effect of dietary supplements on core temperature and sweating responses in hot environmental conditions: a meta-analysis and meta-regression

Dietary supplements are widely used among individuals exposed to hot environments, but whether their consumption confers any thermoregulatory effect is unclear. Therefore, we systematically evaluated the effect of dietary supplementation on key aspects of thermoregulation [core temperature (Tcore) and sweating responses] in the heat. Three databases were searched in April 2024. After screening, 124 peer-reviewed articles were identified for inclusion within three separate meta-analyses: 1) peak Tcore; 2) whole body sweat rate (WBSR); 3) local sweat rate (LSR). The moderating effect of several variables (e.g., training and heat acclimation status), known to influence thermoregulatory function, were assessed via subanalysis and meta-regression. There was no overall effect of the differing supplement types on WBSR (P = 0.405) and LSR (P = 0.769), despite taurine significantly increasing WBSR (n = 3, Hedges' g = 0.79, P = 0.006). Peak Tcore was significantly affected by supplement type (P = 0.011), primarily due to caffeine's "small" significant positive effect (n = 30; Hedges' g = 0.44, P < 0.001) and taurine's (n = 3, Hedges' g = -0.66, P = 0.043) and oligonol's (n = 3; Hedges' g = -0.50, P = 0.014) "medium" significant negative effects. Dietary supplements, such as amino acids (e.g., taurine), some antioxidants and anti-inflammatories (e.g., oligonol) conferred the greatest thermoregulatory benefits during heat exposure. Taurine ingestion in such conditions may lower heat strain, which is likely through its augmentation of thermal sweating. Conversely, caffeine intake may potentially pose the greatest risk in the heat due to its effect on Tcore.NEW & NOTEWORTHY The effects of dietary supplements on core temperature and sweating responses when ingested in the heat varied greatly. Some supplements demonstrated the potential to improve thermoregulatory capacity (e.g., select amino acids, anti-oxidants and anti-inflammatories), while others had no or even deleterious effects on thermal balance (e.g., caffeine). These findings have implications for those ingesting dietary supplements for their health and/or performance effects during exposure to hot environmental conditions. Certain supplements should possibly be avoided in the heat, while others may elicit a thermoregulatory benefit.

The endothelial surface layer-glycocalyx - Universal nano-infrastructure is fundamental to physiology, cell traffic and a complementary neural network

The glycocalyx and its associated endothelial surface layer which lines all cell membranes and most tissues, dwarfs the phospholipid membrane of cells in extent. Its major components are sulphated polymers like heparan and chondroitin sulphates and hyaluronic acid. These form a fuzzy layer of unknown structure and function. It has become increasingly clear that the ESL-GC complex must play many roles. We postulate it has a self-organised infrastructure that directs cell traffic, acts in defence against pathogens and other cells, and in diseases like diabetes, and heart disease, besides being a playground for a host of biochemical activity. Based on an analogous sulphated polymeric system Nafion, the fuel cell polymer, we suggest a model for the structure of the ESL-GC complex and how it functions. Taken together with parallel developments in physical chemistry, in nanobubbles, their stability in physiological media, and reactivity, we believe the model may throw light on a variety of phenomena, diabetes and some other diseases.

Inhibition of LPS-induced NO production by plant essential oils

Essential oils (EOs), derived from medicinal plants, has been reported to possess various bioactivities to treat inflammatory diseases. Therefore, it is urgent to investigate the effect and the mechanism of EOs essential oils as naturally anti-inflammatory agents. The present study indicated thirty-one EOs had different inhibition on lipopolysaccharide (LPS)-induced nitric oxide (NO) production. Moreover, the most potent EOs against NO production in BV2 cells were chuan-xiong, schizonepeta tenuifolia, lemongrass and zedoary turmeric with IC50 values of 12.59, 23.12, 22.76 and 21.88 μg/mL, respectively. The further studies revealed that ligustilide, tributyl citrate and longifolene, the main constituents of chuan-xiong EO, schizonepeta tenuifolia EO and zedoary turmeric EO, were responsible for their activities against NO production with IC50 values of 8.75, 6.05 and 20.32 μg/mL. Above all, theses EOs were confirmed to be promising anti-inflammatory agents.

Adropin as a protective agent against renal ischemia-reperfusion injury induced by suprarenal aortic cross-clamping in rats

BACKGROUND

The development of protective therapeutic strategies against acute kidney injury associated with suprarenal aneurysms, renal artery occlusive disease, and suprarenal aortic reconstruction is of paramount importance. Adropin is a peptide hormone that has been shown to protect vascular endothelial cells and reduce oxidative stress, apoptosis, and inflammation. Therefore, in addition to its metabolic and vascular effects, adropin has potential as a therapeutic agent in renal ischemia-reperfusion injury. This study aims to investigate the protective effects of adropine on kidney ischemia-reperfusion (IR) injury under the suprarenal aortic cross clamp.

METHODS

Male Sprague Dawley rats were divided into six groups, with seven rats in each group for the study design. The control and ischemia reperfusion (IR) induced groups were designated as the two groups while the other four groups (TR1 to TR4 ) were administered varying doses of adropin at 0.5 mg/kg, 1 mg/kg, 1.5 mg/kg, and 2 mg/kg for each group. After a 60 min ischemic period, a 24-hour reperfusion period was implemented to assess the outcomes of adropin treatment on renal IR. Histopathological analysis was performed in conjunction with determination of apoptosis, and malondialdehyde (MDA) levels. In addition, serum concentrations of adropin, superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), as well as endothelial nitric oxide synthase (eNOS) were measured in order to further define the biochemical reactions of the treatment.

RESULTS

MDA levels were significantly elevated in the IR group compared to the control group, while the activities of eNOS, SOD, and GSH-Px enzymes were significantly decreased (P < 0.05). MDA levels in the treatment groups were lower than those in the IR group, whereas eNOS, SOD, and GSH-Px levels were higher (P < 0.05). Statistically, the lowest adropin levels were observed in the IR group, while the highest levels were noted in the TR4 group (P < 0.05). Histopathological examination revealed a reduction in tissue damage in the treatment groups compared to the IR group.

CONCLUSION

The histological and biochemical findings from this study indicate that adropin provides protective effects against renal ischemia-reperfusion injury in a dose-dependent manner.

The Impact of the Exposome on Alzheimer's Disease: The Influence of Nutrition

Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by cognitive decline, memory loss, and behavioural changes. While genetic predispositions and pathological processes have been the traditional focus, this review highlights the fundamental role of environmental factors, particularly nutrition, within the exposome framework in modulating the risk and progression of AD. The exposome, which includes the totality of environmental exposures in an individual's lifetime, provides a comprehensive approach to understanding the complex aetiology of AD. In this review, we explore the impact of dietary factors and cyclic nucleotide pathways (cAMP/cGMP) on AD, emphasizing the potential of dietary interventions as therapeutic strategies. We investigate key aspects of how nutrition affects the accumulation of β-amyloid, the aggregation of tau proteins, and neuroinflammation. We also examine the impact of specific nutrients on cognitive performance and the risk of AD. Additionally, we discuss the potential of nutraceuticals with anti-phosphodiesterase activity and the role of various animal models of AD (such as 5xFAD, 3xTg-AD, Tg2576, and APP/PS1 mice) in demonstrating the effects of dietary interventions on disease onset and progression.

Salivary-Gland-Mediated Nitrate Recirculation as a Modulator for Cardiovascular Diseases

Cardiovascular diseases (CVDs), which include multiple disorders of the heart and blood vessels, are the leading causes of death. Nitric oxide (NO) is a vasodilator that regulates vascular tension. Endogenous NO is produced via the L-arginine-nitric oxide synthase (NOS) pathway. In conditions of cardiovascular dysfunction, NOS activity is impaired, leading to NO deficiency. In turn, the reduction in NO bioactivity exacerbates the pathogenesis of CVDs. Exogenous intake of inorganic nitrate supplements endogenous production via the nitrate-nitrite-NO pathway to maintain the NO supply. Salivary glands play an essential role in the conversion of nitrate to NO, with approximately 25% of circulating nitrate being absorbed and secreted into saliva. As a result, salivary nitrate concentrations can exceed that in the blood by more than tenfold. This recycled nitrate in saliva serves as a reservoir for NO and performs NO-like functions when endogenous NO production is insufficient. In this review, we summarize the emerging benefits of dietary nitrate in CVDs, with a particular focus on salivary-gland-mediated nitrate recirculation in maintaining NO bioavailability and cardiovascular homeostasis. Salivary-gland-mediated nitrate recirculation provides a novel perspective for potential intervention of CVDs.

Targeted delivery of polymeric NO-donor micelles to hepatic stellate cells for restoration of liver function and inhibition of hepatic fibrosis

Liver fibrosis is a prevalent liver disease associated with significant morbidity, and the activation of hepatic stellate cells (HSCs) serves as the primary causative factor driving the progression of liver fibrosis. However, capillarization of liver sinusoidal endothelial cells (LSECs) induced by hepatic fibrosis can reduce nitric oxide (NO) production and bioavailability, which consequently loses the ability to retain HSCs dormant, leading to amplified HSCs activation. Herein, an elaborate micelle (VN-M@BN) loaded with benazepril (BN) was constructed by self-assembly of polymeric NO donor, aiming for the controlled release of NO in liver fibrosis lesions thereby impeding the progression of liver fibrosis. VN-M@BN with the vitamin A (VA) ligand modification was designed to target HSCs for efficient liver fibrosis inhibition. Controlled NO release significantly downregulated α-smooth muscle actin (α-SMA) and induced apoptosis of activated HSCs, thus enhancing the inhibition effects of BN towards HSCs. Furthermore, the in suit antifibrotic treatment results confirmed that VN-M@BN possessed good circulatory stability and targetability to liver fibrotic tissues, thereby effectively ameliorating the collagen deposition and fibrosis process in damaged liver tissues. The NO-based targeted nanodrug system enabled precise delivery of therapeutic drugs to activated HSCs, thereby synergizing the efficacy in treating liver fibrosis with minimal adverse effects.

Sodium nitrate regulates senescence accompanied by aortic atherosclerosis in ApoE-/- mice through the miR-34a/FGF-21 axis

Introduction

Increasing evidence indicates that cellular senescence is a significant risk factor for atherosclerosis (AS).

Methods

In the present study, we used an apolipoprotein E knockout (ApoE-/-) mouse model to address the effect of sodium nitrate on senescence accompanied by atherosclerosis. After sodium nitrate intervention, the degree of AS pathological and cellular senescence changes was evaluated in mouse aortic. At the same time, an H2O2-induced human arterial endothelial cell (HAoEC) senescence model was established to verify the role of miR-34a in AS-associated senescence.

Results

We observed that sodium nitrate decreased the Oil Red O-positive area, reduced the serum cholesterol (CHO) and triglyceride (TG) concentrations, and relieved inflammatory reactions in ApoE-/- mice. Moreover, the SA-β-Gal-positive area, the expression of cell cycle regulation-related genes and miR-34a in the aorta decreased after sodium nitrate treatment. Furthermore, sodium nitrate upregulated the expression of FGF21 by inhibiting the expression of miR-34a, thereby rescuing the senescent phenotype of HAoECs. These results suggested that sodium nitrate could rescue the endothelial cell senescence phenotype and alleviate aortic atherosclerosis in ApoE-/- mice by regulating the miR-34a/FGF21 axis.

Discussion

These findings might lead to the introduction of a new therapy for senescence-related diseases in the future.

Nitrite reverses nitroglycerin tolerance via repletion of a nitrodilator-activated nitric oxide store in vascular smooth muscle cells

Repeated use of nitroglycerin results in a loss of its vasodilatory efficacy which limits its clinical use for the treatment of angina pectoris. This tolerance phenomenon is a defining characteristic of all compounds classified as nitrodilators, which includes NTG as well as S-nitrosothiols and dinitrosyl iron complexes. These compounds vasodilate via activation of soluble guanylate cyclase, although they do not release requisite amounts of free nitric oxide (NO) and some do not even cross the plasma membrane. Here we demonstrate that nitrodilators cause vasodilation via mobilization of NO moiety from a nitrodilator-activated NO store (NANOS) pre-formed in the vascular smooth muscle cell, similar to the mechanism by which UV light is also known to cause vasodilation and tolerance. Intraperitoneal nitrite prevented NTG tolerance in coronary arteries of rats that received NTG transdermal patches for 4 days, and potentiated NTG- and GSNO- mediated mesenteric vasodilation in intact rats. Consistent with the incorporation of nitrite into the depletable NANOS, incubation of arteries with 15N-nitrite resulted in the accumulation of high molecular weight 15N-NO-containing compounds in arteries, and subsequent exposure to NTG, GSNO, or UV light resulted in efflux of 15N-NO species. In addition, H2O2 and metal/metalloproteins synergistically facilitated NO release from nitrite, while the oxidative stress associated with inflammation and nitrite synergistically potentiated the nitrodilator-mediated vasodilation. In conclusion, NTG mediates vasodilation via activation of a depletable intracellular store of NO that can be replenished by nitrite, thereby preventing tolerance.

A pilot and feasibility study investigating the abundance and activity of nitrate-reducing bacteria in women with pre-eclampsia

BACKGROUND

Oral health may influence blood pressure control by modulating the abundance and activity of nitrate-reducing bacteria, which are essential for enhancing nitrite and nitric oxide (NO) bioavailability. This study aimed to investigate the oral health and microbiome composition of women with pre-eclampsia (PET) compared to healthy controls (CN).

METHODS

Ten PET and eleven CN women participated in this study, respectively. An oral health examination was conducted in all the participants. Saliva and blood samples were collected for analysis of the oral microbiome and NO biomarkers.

RESULTS

Higher plaque levels were observed in the PET group compared to the CN group (P = 0.038). The relative abundance of oral bacteria at the genus level did not differ between groups, however, the activity of oral nitrate-reducing bacteria (P = 0.088) and salivary nitrite levels (P = 0.100) appeared lower in the PET group, though not statistically significant. Plasma nitrate levels were significantly lower in the PET group compared to the CN group (P = 0.024).

CONCLUSION

Women with PET showed poorer oral health and potential lower activity of nitrate-reducing bacteria and salivary nitrite, indicating a need for further investigation into treatments targeting oral health and the microbiome in women with PET.

No evidence of improvements in energy metabolism after 1 week of nitrate and citrulline co-supplementation in elite rowers

PURPOSE

Citrulline (CIT) and beetroot extract (BR) supplements positively impacts exercise performance in elite rowers. However, its influence on metabolic outcomes such as whole-body volumes of oxygen consumption (VO2) and carbon dioxide production (VCO2), substrate oxidation, energy expenditure (EE), and gross efficiency remains unknown. We studied the effects of 1 week of daily co-supplementation of 3.5 g BR (500 mg NO3-) plus 6 g CIT on VO2 and VCO2 kinetics, substrate utilization, EE, and gross efficiency in elite male rowers compared to a placebo and to a BR supplementation.

METHODS

Twenty elite rowers participated in this randomized, double-blind, placebo-controlled crossover trial completing 1 week of supplementation in each group of study: Placebo (PLAG); BRG; and BR-CITG. Efficiency (70% VO2max) and performance (incremental maximal) tests were performed, and gas-exchange data were collected via indirect calorimetry.

RESULTS

Analysis of covariance (ANCOVA) showed no mean between-condition differences on respiratory exchange ratio (RER), EE, and gross efficiency in the efficiency test (all P > 0.06), and in the performance test (all P > 0.28). Moreover, in both tests no interaction Time × Supplement effects were observed for VO2, VCO2, RER, EE, substrate oxidation, and, gross efficiency (all P > 0.12).

CONCLUSION

After 1 week, no effects on energy metabolism and substrate utilization were observed after the daily co-ingestion of BR extract plus CIT supplement, therefore longer (> 7 days) and higher doses of supplementation might be needed to influence metabolism.

Advances in Electrochemical Nitrite Reduction toward Nitric Oxide Synthesis for Biomedical Applications

Nitric oxide (NO) is an essential molecule in biomedicine, recognized for its antibacterial properties, neuronal modulation, and use in inhalation therapies. The effectiveness of NO-based treatments relies on precise control of NO concentrations tailored to specific therapeutic needs. Electrochemical generation of NO (E-NOgen) via nitrite (NO2 -) reduction offers a scalable and efficient route for controlled NO production, while also addressing environmental concerns by reducing NO2 - pollution and maintaining nitrogen cycle balance. Recent developments in catalysts and E-NOgen devices have propelled NO2 - conversion, enabling on-demand NO production. This review provides an overview of NO2 - reduction pathways, with a focus on cutting-edge Fe/Cu-based E-NOgen catalysts, and explores the development of E-NOgen devices for biomedical use. Challenges and future directions for advancing E-NOgen technologies are also discussed.

Spatiotemporal Characteristics Determining the Multifaceted Nature of Reactive Oxygen, Nitrogen, and Sulfur Species in Relation to Proton Homeostasis

Significance: Reactive oxygen species (ROS), reactive nitrogen species (RNS), and reactive sulfur species (RSS) act as signaling molecules, regulating gene expression, enzyme activity, and physiological responses. However, excessive amounts of these molecular species can lead to deleterious effects, causing cellular damage and death. This dual nature of ROS, RNS, and RSS presents an intriguing conundrum that calls for a new paradigm. Recent Advances: Recent advancements in the study of photosynthesis have offered significant insights at the molecular level and with high temporal resolution into how the photosystem II oxygen-evolving complex manages to prevent harmful ROS production during the water-splitting process. These findings suggest that a dynamic spatiotemporal arrangement of redox reactions, coupled with strict regulation of proton transfer, is crucial for minimizing unnecessary ROS formation. Critical Issues: To better understand the multifaceted nature of these reactive molecular species in biology, it is worth considering a more holistic view that combines ecological and evolutionary perspectives on ROS, RNS, and RSS. By integrating spatiotemporal perspectives into global, cellular, and biochemical events, we discuss local pH or proton availability as a critical determinant associated with the generation and action of ROS, RNS, and RSS in biological systems. Future Directions: The concept of localized proton availability will not only help explain the multifaceted nature of these ubiquitous simple molecules in diverse systems but also provide a basis for new therapeutic strategies to manage and manipulate these reactive species in neural disorders, pathogenic diseases, and antiaging efforts.

Dose-response relationship between dietary nitrate intake and nitric oxide congeners in various blood compartments and skeletal muscle: Differential effects on skeletal muscle torque and velocity

Plasma nitrate (NO3-) and nitrite (NO2-) increase in a dose-dependent manner following NO3- ingestion. To explore if the same dose-response relationship applies to other nitric oxide (NO) congeners in different blood compartments and skeletal muscle, as well as the subsequent physiological responses, we provided 11 healthy participants with NO3- depleted beetroot juice (placebo), and beetroot juice (BR) containing 6.4, 12.8 and 19.2 mmol NO3- in a randomised, crossover design. Blood and muscle samples were collected, and resting blood pressure (BP) was assessed, before and at 2.5-3 h post-ingestion. Muscle contractile function was assessed using a 5-min all-out maximal voluntary isometric knee extension test at 3.5 h post-ingestion. We found that plasma and skeletal muscle [NO3-], and whole blood S-nitrosothiols ([RSNOs]) increased dose-dependently, while plasma [NO2-] did not increase further with doses above 6.4 mmol NO3-. No significant increases in skeletal muscle [NO2-] were found following ingestion of any of these doses. Resting BP was only reduced after ingestion of 19.2 mmol NO3-. Mean peak torque and mean torque impulse during the first 10 muscle contractions were significantly enhanced following ingestion of both 12.8 mmol and 19.2 mmol NO3- compared to placebo, while the mean absolute rate of torque development (RTD) at 0-50 ms and 0-100 ms was significantly improved following ingestion of 6.4 mmol NO3- compared to placebo and 19.2 mmol NO3-. Significant correlations were found between changes in red blood cell [RSNOs] and changes in absolute RTD at 0-50 ms (rs = -0.70, P = 0.02) and 0-100 ms (rs = -0.84, P < 0.01) following the ingestion of 6.4 mmol NO3-. Our findings suggest that a high dose of 12.8 mmol NO3- is necessary to improve muscle contractile torque, while a lower dose of 6.4 mmol NO3- is sufficient to enhance muscle contractile velocity, at least for the type of exercise employed in the present study.

Multiday Beetroot Juice Ingestion Improves Some Aspects of Neuromuscular Performance in Semi-Professional, Male Handball Players: A Randomized, Double-Blind, Placebo-Controlled, Crossover Study

The aim of this study was to examine the effects of multiday beetroot juice ingestion on neuromuscular performance in semi-professional, male handball players. Twelve handball players competing in the second Spanish national division received 70 ml of beetroot juice (6.4 mmol of nitrate [NO3-]) or 70 ml of a placebo beetroot juice (0.04 mmol NO3-) for three consecutive days in a randomized, double-blind, crossover manner with a 1-week washout between conditions. Following supplementation in each condition, players completed a neuromuscular test battery involving handball throwing, isometric handgrip strength, countermovement jump, change-of-direction speed, and repeated-sprint assessments, with side effects also measured. Countermovement jump (4.7%; p = .038; Hedge's gav = 0.29) and isometric handgrip strength (7.8%; p = .021; gav = 0.59) were significantly superior with beetroot juice ingestion compared to the placebo. In contrast, nonsignificant differences were evident between conditions for all other neuromuscular performance variables (p > .05; gav = 0.00-0.27). Red urine production was the only side effect, demonstrating a significantly higher prevalence (p = .046) with beetroot juice ingestion. Three days of beetroot juice supplementation may be a useful nutritional strategy in semi-professional, male handball players given its ergogenic benefit to some aspects of neuromuscular performance.

Inter-individual differences in the blood pressure lowering effects of dietary nitrate: a randomised double-blind placebo-controlled replicate crossover trial

PURPOSE

Dietary nitrate supplementation increases nitric oxide (NO) bioavailability and reduces blood pressure (BP). Inter-individual differences in these responses are suspected but have not been investigated using robust designs, e.g., replicate crossover, and appropriate statistical models. We examined the within-individual consistency of the effects of dietary nitrate supplementation on NO biomarkers and BP, and quantified inter-individual response differences.

METHODS

Fifteen healthy males visited the laboratory four times. On two visits, participants consumed 140 ml nitrate-rich beetroot juice (~ 14.0mmol nitrate) and, on the other two visits, they consumed 140 ml nitrate-depleted beetroot juice (~ 0.03mmol nitrate). Plasma nitrate and nitrite concentrations were measured 2.5 h post-supplementation. BP was measured pre- and 2.5 h post-supplementation. Between-replicate correlations were quantified for the placebo-adjusted post-supplementation plasma nitrate and nitrite concentrations and pre-to-post changes in BP. Within-participant linear mixed models and a meta-analytic approach estimated participant-by-condition treatment response variability.

RESULTS

Nitrate-rich beetroot juice supplementation elevated plasma nitrate and nitrite concentrations and reduced systolic (mean:-7mmHg, 95%CI: -3 to -11mmHg) and diastolic (mean:-6mmHg, 95%CI: -2 to -9mmHg) BP versus placebo. The participant-by-condition interaction response variability from the mixed model was ± 7mmHg (95%CI: 3 to 9mmHg) for systolic BP and consistent with the treatment effect heterogeneity t = ± 7mmHg (95%CI: 5 to 12mmHg) derived from the meta-analytic approach. The between-replicate correlations were moderate-to-large for plasma nitrate, nitrite and systolic BP (r = 0.55 to 0.91).

CONCLUSIONS

The effects of dietary nitrate supplementation on NO biomarkers and systolic BP varied significantly from participant to participant. The causes of this inter-individual variation deserve further investigation.

TRIAL REGISTRATION

https://clinicaltrials.gov/study/NCT05514821 .

Different Inactivation Mechanisms of Staphylococcus aureus and Escherichia coli in Water by Reactive Oxygen and Nitrogen Species Generated from an Argon Plasma Jet

The atmospheric pressure plasma jet (APPJ) is a promising technology for inactivating waterborne pathogens by generating diverse reactive species under ambient conditions. However, uncertainties regarding the bacterial inactivation mechanisms persist due to varying findings in prior research. This study aimed to clarify the inactivation mechanisms of two representative bacteria, Staphylococcus aureus (S. aureus, Gram-positive) and Escherichia coli (E. coli, Gram-negative), using an argon-based APPJ (Ar-APPJ) system in a controlled medium, primarily deionized water. We identified several reactive oxygen and nitrogen species (RONS), including hydrogen peroxide, peroxynitrous acid/peroxynitrite (ONOOH/ONOO-), hydroxyl radical (•OH), and hydroperoxyl radical/superoxide radical, and evaluated their roles in bacterial inactivation. Inactivation experiments and quantification of suspected RONS revealed that ONOOH was the primary lethal agent for S. aureus, while •OH predominantly inactivated E. coli. Assessment of cell membrane integrity and intracellular RONS levels showed that E. coli, with its thinner cell wall, was more vulnerable to surface damage caused by •OH. In contrast, for S. aureus, with its thicker cell wall, intracellular attack by penetrated ONOOH, being significantly more diffusive than •OH, was more effective, as •OH alone could not induce sufficient surface damage. These findings advance our understanding of bacterial inactivation by the Ar-APPJ and provide valuable insights for designing effective water disinfection strategies utilizing this technology.

Molecular Imaging of Nitric Oxide Surrogates with Organelle-Specific Fluorescent Probes

Nitric oxide is an important signalling molecule responsible for maintaining body's homeostasis. Any dysregulation in NO can lead to many pathological conditions like atherosclerosis, cancers, neurodegenerative disorders, hypertension and inflammation. Several, sensing technologies are used for sensing NO. Among these, fluorescent imaging is considered to be one of the most efficient. Till date, approximately 123 fluorescent probes are reported related to nitric oxide (NO) sensing fluorescent probes for the sensitive, selective, and real-time detection of NO at both the cellular and subcellular levels. In the past five years, around 41 fluorescent probes and four review articles have been published, specifically focusing on the detection of nitric oxide. Despite considerable advancements in this area, no systematic review has summarized various organelle-targeting NO-sensing fluorescent probes. Herein, we summarized last five years from 2019 to 2024 along with the key pioneering research in this field covering divergent roles of NO across various cellular organelles. We have included 41 probes by classifying into different organelle targeting sections. We strongly believe this review will provide an advanced summary of NO specific fluorescent probes and their applications for monitoring the progression of diseases in in vitro to in vivo models such as drosophila, zebrafish, mouse models.

Biomaterial-based vascularization strategies for enhanced treatment of peripheral arterial disease

Peripheral arterial disease (PAD) poses a global health challenge, particularly in its advanced stages known as critical limb ischemia (CLI). Conventional treatments often fail to achieve satisfactory outcomes. Patients with CLI face high rates of morbidity and mortality, underscoring the urgent need for innovative therapeutic strategies. Recent advancements in biomaterials and biotechnology have positioned biomaterial-based vascularization strategies as promising approaches to improve blood perfusion and ameliorate ischemic conditions in affected tissues. These materials have shown potential to enhance therapeutic outcomes while mitigating toxicity concerns. This work summarizes the current status of PAD and highlights emerging biomaterial-based strategies for its treatment, focusing on functional genes, cells, proteins, and metal ions, as well as their delivery and controlled release systems. Additionally, the limitations associated with these approaches are discussed. This review provides a framework for designing therapeutic biomaterials and offers insights into their potential for clinical translation, contributing to the advancement of PAD treatments.

Tadalafil Ameliorates Chronic Ischemia-Associated Bladder Overactivity in Fructose-Fed Rats by Exerting Pelvic Angiogenesis and Enhancing p-eNOS Expression

Metabolic syndrome (MetS) can contribute to a chronic ischemia-relative overactive bladder (OAB). Using fructose-fed rats (FFRs), a rat model of MetS, we investigated the effects of tadalafil (a phosphodiesterase-5 inhibitor) on MetS-associated chronic bladder ischemia and bladder overactivity. Phenotypes of the OAB, including increased micturition frequency and a shortened intercontractile interval in cystometry, were observed in FFRs, together with reduced bladder blood perfusion (in empty bladders) via laser color Doppler imaging and elevated serum nitrite levels, suggesting chronic ischemia-related bladder dysfunction. Treatment with tadalafil (2 mg/kg) promoted pelvic angiogenesis, as shown by magnetic resonance imaging, and increased VEGF and p-eNOS overexpression in the bladder. This treatment restored bladder perfusion and alleviated bladder overactivity without significantly altering most MetS parameters. At the molecular level, FFRs exhibited increased ischemia markers (NGF, HIF-2α, and AMPK-α2) and decreased p-AMPK-α2, along with elevated proinflammatory mediators (ICAM-1, nuclear NF-κB, COX-2, IL-1β, IL-6, and TNF-α), enhanced mitochondria biogenesis (PGC-1α, TFAM, and mitochondria DNA copy number), oxidative stress (decreased nuclear NRF2, increase MnSOD and 8-OHdG staining), and tissue fibrosis (increased TGF-β1, collagen I, and fibronectin). Tadalafil treatment improved these effects. Together, these findings suggest that tadalafil may promote VEGF-associated angiogenesis, enhance p-eNOS staining in the bladder vasculature, normalize bladder perfusion in microcirculation, and reduce serum nitrite levels. Consequently, tadalafil mitigates the adverse effects of chronic ischemia/hypoxia, improving bladder overactivity. We elucidated the mechanisms underlying the tadalafil-mediated amelioration of MetS-associated OAB symptoms.

Association of early life exposure to PM2.5 and its components with offspring neurodevelopment: A prospective birth cohort study

Emerging data have explored early life fine particulate (PM2.5) exposure and its relationship with offspring neurodevelopment. However, the findings remain inconsistent, and the roles of specific PM2.5 components are unclear. We investigated these associations and explored the potential interactive role of children's physical activity (PA). A total of 1547 mother-child pairs from the Shenzhen Birth Cohort were included. Neurodevelopment was assessed at seven time points (1, 3, 6, 8, 12, 18, and 24 months) using the Ages and Stages Questionnaire. An established spatiotemporal model was used to estimate early life exposure to PM2.5 and five components [sulfate (SO42), nitrate (NO3-), ammonium (NH4+), organic matter (OM), and black carbon (BC)]. Associations of individual and joint exposure to components with neurodevelopment were analyzed using generalized estimating equation and quantile-based g-computation models with a binomial distribution. Most mothers (79.1%) were under 35 at delivery, and 43.6% of the children were boys. During the early postnatal period, a 5 μg/m3 increase in PM2.5 was associated with higher adjusted odds ratios (aORs) for developmental delays in gross motor (1.24, 95%CI:1.12, 1.37), fine motor (1.11, 95%CI:1.04, 1.20), and problem-solving (1.12, 95%CI:1.03, 1.22) domains. Similar associations were observed for individual PM2.5 components. Each quintile increase in early postnatal exposure to PM2.5 mixtures was correlated with higher aORs for these domains, with NO3- constituting the largest weight. No significant associations were found for the prenatal period. The children's PA showed no interaction. These findings underscore the need to reduce PM2.5 exposure, particularly its toxic components, to minimize developmental risks.

The emerging role of nitric oxide in the synaptic dysfunction of vascular dementia

With an increase in global aging, the number of people affected by cerebrovascular diseases is also increasing, and the incidence of vascular dementia-closely related to cerebrovascular risk-is increasing at an epidemic rate. However, few therapeutic options exist that can markedly improve the cognitive impairment and prognosis of vascular dementia patients. Similarly in Alzheimer's disease and other neurological disorders, synaptic dysfunction is recognized as the main reason for cognitive decline. Nitric oxide is one of the ubiquitous gaseous cellular messengers involved in multiple physiological and pathological processes of the central nervous system. Recently, nitric oxide has been implicated in regulating synaptic plasticity and plays an important role in the pathogenesis of vascular dementia. This review introduces in detail the emerging role of nitric oxide in physiological and pathological states of vascular dementia and summarizes the diverse effects of nitric oxide on different aspects of synaptic dysfunction, neuroinflammation, oxidative stress, and blood-brain barrier dysfunction that underlie the progress of vascular dementia. Additionally, we propose that targeting the nitric oxide-sGC-cGMP pathway using certain specific approaches may provide a novel therapeutic strategy for vascular dementia.

Oxidative and nitrosative stress in bipolar affective disorder and its familial aggregation

Introduction

Bipolar disorder (BD) is one of the most encountered disorders in psychiatric clinics. Despite extensive research and advancements in BD treatment, little is known about the disease's primary etiopathogenesis and relationship with different pathophysiological traits. The present study is aimed to evaluate the pathophysiological role of oxidative and nitrosative stress in BD patients and identify their familial aggregation.

Methods

Blood samples from healthy individuals, drug-naive symptomatic BD patients, and their first-degree relatives were obtained, and intracellular reactive oxygen/nitrogen species (ROS/RNS), total nitrites, neuronal nitric oxide synthase (nNOS) mRNA expression, myeloperoxidase (MPO) activity in polymorphonuclear neutrophils (PMNs), and serum cortisol levels were assessed.

Results

ROS, MPO activity, total-nitrite content, nNOS expression in PMNs, and serum cortisol concentration were considerably more in BD patients than in healthy volunteers. All these variables showed a substantial correlation with the YMRS score for disease severity and the presence of one or more manic episodes. Additionally, a positive correlation was noted between the MPO activity and serum cortisol levels of BD patients and their first-degree relatives.

Conclusions

The results of the present study advance our knowledge about the role of oxidative and nitrosative stress in BD pathophysiology and its familial aggregation. Additionally, the study demonstrates a direct correlation between the disease severity and levels of ROS/RNS, MPO, total nitrite, and nNOS transcripts in PMNs. However, future research with larger and more diverse participant populations is required to understand these pathways for use as potential biomarkers for a deeper understanding of BD pathophysiology and to improve therapeutic strategies.

Proton Pump Inhibitor Use and Incident Cardiovascular Disease in Older Postmenopausal Women

BACKGROUND

Epidemiological studies have been inconsistent regarding an association between proton pump inhibitor (PPI) use and risk of primary cardiovascular disease (CVD) events.

METHODS

We studied 85,189 postmenopausal women (mean age 63 years at baseline) without known CVD at enrollment into the Women's Health Initiative Observational Study (1993-1998). PPI use was determined from medication inventories at baseline and Year-3. CVD events were physician adjudicated and defined as a composite of coronary heart disease, stroke, and CVD mortality. Follow up was from baseline to September 2010. Multivariable Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for incident CVD according to baseline PPI use (no/yes), use duration (non-user, < 1 year, 1-3 years, > 3 years), and time-varying based on updated Year-3 information. Propensity score adjustment was used to control for residual confounding.

RESULTS

At baseline, 1747 (2.1%) women reported using PPIs. During a mean follow-up of 11 years, 5778 (6.8%) cases of primary CVD were identified. PPI users had significantly higher risk of CVD compared with non-users in the fully adjusted model (HR: 1.21, 95% CI: 1.02-1.43), and after propensity score adjustment (HR: 1.27, 95% CI: 1.21-1.32). Longer PPI use duration was associated with incrementally higher CVD risk (HRs: < 1 year: 1.11, 1-3 years: 1.27, > 3 years: 1.33; p for trend = 0.02).

CONCLUSIONS

PPI use was associated with higher risk of incident primary CVD in older postmenopausal women. These findings underscore the importance of guideline-directed PPI use to avoid unwanted adverse events.

Endothelial Cells and the Blood-Brain Barrier: Critical Determinants of Ineffective Reperfusion in Stroke

Ineffective reperfusion remains a critical challenge in neurointerventional treatment following ischemic stroke, with the integrity of the blood-brain barrier (BBB) being a key determinant of patient outcomes. This review explores the distinctive characteristics and roles of brain endothelial cells (ECs) in the context of stroke and ineffective reperfusion. We examine the unique properties of brain ECs compared to their counterparts in other tissues, focusing on their pathophysiological changes, functional impairments and the inflammatory cascades that follow stroke. Differences in gene expression between brain ECs and those in other organs offer deeper insights into their role in neuroprotective therapies. Additionally, drawing parallels between brain ECs and ECs from organs with similar ischemia-reperfusion injury profiles may inspire novel therapeutic approaches. This review highlights the critical importance of understanding the nuanced roles of ECs in BBB regulation, which ultimately impacts reperfusion outcomes.

Mitochondria-Derived Vesicles and Inflammatory Profiles of Adults with Long COVID Supplemented with Red Beetroot Juice: Secondary Analysis of a Randomized Controlled Trial

In a recent clinical trial, beetroot juice supplementation for 14 days yielded positive effects on systemic inflammation in adults with long COVID. Here, we explored the relationship between circulating markers of mitochondrial quality and inflammation in adults with long COVID as well as the impact of beetroot administration on those markers. We conducted secondary analyses of a placebo-controlled randomized clinical trial testing beetroot juice supplementation as a remedy against long COVID. Analyses were conducted in 25 participants, 10 assigned to placebo (mean age: 40.2 ± 11.5 years, 60% women) and 15 allocated to beetroot juice (mean age: 38.3 ± 7.7 years, 53.3% women). Extracellular vesicles were purified from serum by ultracentrifugation and assayed for components of the electron transport chain and mitochondrial DNA (mtDNA) by Western blot and droplet digital polymerase chain reaction (ddPCR), respectively. Inflammatory markers and circulating cell-free mtDNA were quantified in serum through a multiplex immunoassay and ddPCR, respectively. Beetroot juice administration for 14 days decreased serum levels of interleukin (IL)-1β, IL-8, and tumor necrosis factor alpha, with no effects on circulating markers of mitochondrial quality control. Significant negative associations were observed between vesicular markers of mitochondrial quality control and the performance on the 6 min walk test and flow-mediated dilation irrespective of group allocation. These findings suggest that an amelioration of mitochondrial quality, possibly mediated by mitochondria-derived vesicle recycling, may be among the mechanisms supporting improvements in physical performance and endothelial function during the resolution of long COVID.

Effectiveness and safety of the use of sodium nitrite in patients with hypertension and pulmonary hypertension: a scoping review

Evidence suggests that sodium nitrite may be effective in the treatment of hypertension and pulmonary hypertension. However, its use remains debated due to safety concerns. In response, a scoping review was conducted to map current knowledge on the efficacy and safety of sodium nitrite in patients with hypertension or pulmonary hypertension, addressing the question: What evidence supports the effectiveness and safety of using sodium nitrite in these patients? The databases MEDLINE (PubMed), EMBASE, Scopus, Web of Science, and LILACS were searched for clinical studies on hypertensive patients at any disease stage without restrictions on age, sex, ethnicity, publication date, or status. The primary outcomes analyzed were the efficacy and safety of sodium nitrite. A total of nine articles were included, eight from databases and one from gray literature. Sample sizes ranged from 5 to 36 patients, with sodium nitrite doses between 240 µg/kg/h and 325 mg. Five studies showed positive results for treating essential hypertension. Regarding safety, only one study raised concerns about adverse effects, probably due to the high dose that was used. In pulmonary hypertension patients classified as groups 2, 3, and 5, four studies suggested sodium nitrite was effective and safe, but it was ineffective in group 1. The studies included several significant limitations that should be considered. As such, the current evidence is insufficient to definitively confirm the efficacy and safety of sodium nitrite in hypertensive patients. Further research with larger sample sizes is necessary to obtain more conclusive results.

Exhaled Breath Analysis: From Laboratory Test to Wearable Sensing

Breath analysis and monitoring have emerged as pivotal components in both clinical research and daily health management, particularly in addressing the global health challenges posed by respiratory and metabolic disorders. The advancement of breath analysis strategies necessitates a multidisciplinary approach, seamlessly integrating expertise from medicine, biology, engineering, and materials science. Recent innovations in laboratory methodologies and wearable sensing technologies have ushered in an era of precise, real-time, and in situ breath analysis and monitoring. This comprehensive review elucidates the physical and chemical aspects of breath analysis, encompassing respiratory parameters and both volatile and non-volatile constituents. It emphasizes their physiological and clinical significance, while also exploring cutting-edge laboratory testing techniques and state-of-the-art wearable devices. Furthermore, the review delves into the application of sophisticated data processing technologies in the burgeoning field of breathomics and examines the potential of breath control in human-machine interaction paradigms. Additionally, it provides insights into the challenges of translating innovative laboratory and wearable concepts into mainstream clinical and daily practice. Continued innovation and interdisciplinary collaboration will drive progress in breath analysis, potentially revolutionizing personalized medicine through entirely non-invasive breath methodology.

A terpyridine-based copper complex for electrochemical reduction of nitrite to nitric oxide

In biological systems, nitrite reductase enzymes (NIRs) are responsible for reduction of nitrite (NO2-) to nitric oxide (NO). These NIRs have mostly Cu- or Fe-containing active sites, surrounded by amine-containing ligands. Therefore, mononuclear Cu complexes with N-donor ligands are highly relevant in the development of NIR model systems and in the mechanistic investigation of the nitrite reduction reaction. Herein, we report on a terpyridine-based CuII complex with square planar geometry for H+-assisted electrochemical reduction of NO2-. Through electrochemical measurements, spectroscopic characterization and isotope-labelling experiments we propose a mechanistic reaction pathway involving an unstable HNO2 state. The CuI intermediate, formed electrochemically, was isolated and its molecular structure was deduced, showing linkage isomerism of the nitrite ligand. Moreover, qualitative and quantitative product analysis by GC-MS shows N2O formed as a side product along with the main product NO. Furthermore, by obtaining single crystals and conducting structural analysis we were able to determine the structural arrangement and redox state of the complex after electrochemical treatment.