Non-Lethal Dose-Response Models Replace Lethal Bioassays for Predicting the Hazard of Para-Aminopropiophenone to Australian Wildlife

Para-aminopropiophenone (PAPP) is a potent methaemoglobin (MetHb) forming agent used for the lethal control of exotic carnivores and mustelids. To assess the sensitivity of Australian wildlife to PAPP we developed an in vivo assay that did not use death as an endpoint. Sub-lethal dose-response data were modelled to predict PAPP doses required to achieve an endpoint set at 80% MetHb (MetHb₈₀). The comparative sensitivity of non-target mammals referenced to this endpoint was found to be highly variable, with southern brown bandicoots (Isoodon obesulus) the most sensitive species (MetHb₈₀ = 6.3 mg kg^-1) and bush rats (Rattus fuscipes) the most tolerant (MetHb₈₀ = 1035 mg kg^-1). Published LD₅₀ estimates were highly correlated with PAPP doses modelled to achieve the MetHb₈₀ endpoint (r² = 0.99, p < 0.001). Most dose-response data for native mammals were collected in the field or in semi-natural enclosures, permitting PAPP and placebo dosed animals to be fitted with tracking transmitters and transponders and released at their point of capture. A protracted morbidity and mortality was observed only in Australian ravens (Corvus coronoides). The combination of sub-lethal dose-response assay and survival data collected in the field provided more relevant information about the actual hazard of pest control agents to non-target wildlife species than laboratory-based lethal-dose bioassays. We discuss the need to replace lethal-dose data with biologically meaningful insights able to define a continuum of toxicological hazards that better serve the needs of conservation and veterinary scientists and wildlife managers.

Sensitivity of High Conservation Value Birds to Para-Aminopropiophenone (PAPP) Determined by Sub-Lethal Dose-Response Assay

Para-aminopropiophenone (PAPP) is a methaemoglobin (MetHb) forming compound used for the lethal control of invasive carnivores and mustelids. By measuring the dose-dependent inhibition of O₂ transport arising from the oxidation of haemoglobin (HbFe²⁺) to MetHb (HbFe³⁺), we determined the sensitivity of nine bird species to PAPP. A methaemoglobinaemia absorbance index (MAI) was validated in five common bird species to determine thresholds associated with a 99% probability of survival (ST₉₉) and a 50% probability of mortality (LT₅₀). Dose-response trials in high conservation value birds sought MAI values below the ST₉₉ threshold, projecting the LT₅₀ value and avoiding the need for lethal outcomes. Black-backed gull (LT₅₀ = 1784.7) and eastern rosella (LT₅₀ = 1074 mg kg^-1) were the most tolerant species, while brown kiwi (LT₅₀ = 8.4 mg kg^-1) and weka (LT₅₀ = 9.3 mg kg^-1) were the most sensitive. Takahē were of intermediate acute sensitivity (LT₅₀ = 51 mg kg^-1), although protracted impacts on haemoglobin were observed in takahē up to 72 h later and associated with PAPP doses as low as 25.6 mg kg^-1. In pukeko (LT₅₀ = 138.4 mg kg^-1), protracted declines in haemoglobin 72 h later occurred at doses as low as 29.5 mg kg^-1, while at higher doses (253 and 112 mg kg^-1), deaths resulted after 4-6 days. Based upon PAPP doses that caused acute and protracted responses, we provide estimates for the lowest observable adverse effect level (LOAEL) and no observable effects level (NOEL) for nine bird species.

Disparity of selenourea and selenocystine on methaemoglobinemia in non-diabetics and diabetics

Organoselenium drugs like selenourea (SeU) and selenocystine (SeC) are found to exhibit several medicinal properties and have reported roles in the field of cancer prevention. However, studies related to their interactions with the major erythroid protein, haemoglobin (HbA) are still in dearth despite being of prime importance. In view of this, it was considered essential to investigate the interaction of these two anticancer drugs with Hb. Both the drugs showed significant changes in absorption spectra of Hb at wavelength of maximum absorption (λmax) 630 nm. SeU itself had no effect on the absorbance value at 630 nm with respect to time even with 400 µM concentration. However, it was rapidly converted to nanoselenium in presence of nitrite and there was an increase in the absorbance rate at 630 nm from 3.39 × 10-3 min-1 (without nitrite) to 8.94 × 10-3 min-1 in presence of nitrite (200 µM) owing to the generation of reactive oxygen species in the medium. Although the generation and increase in peak intensity at 630 nm in Hb generally indicates the formation and rise in the levels of methaemoglobin (metHb), nanoselenium was observed to follow a different path. Instead of causing oxidation of Fe2+ to Fe3+ responsible for metHb formation, nanoselenium was found to interact with the protein part, thereby causing changes in its secondary structure which is reflected in the increasing absorbance at 630 nm. SeC, however, showed a different effect. It was shown to act as a novel agent to reduce nitrite-induced metHb formation in a dose-dependent manner. The efficiency of SeC was again found to be less in diabetic blood samples as compared to the non-diabetic ones. For similar ratio of metHb to SeC (1:8), % reduction of metHb was found to be 27.46 ± 0.82 and 16.1 ± 2.4 for non-diabetic and diabetic samples, respectively, with a two tailed P-value much <0.05 which implies that the data are highly significant.

Risk assessment of nitrate and nitrite in feed

The European Commission asked EFSA for a scientific opinion on the risks to animal health related to nitrite and nitrate in feed. For nitrate ion, the EFSA Panel on Contaminants in the Food Chain (CONTAM Panel) identified a BMDL 10 of 64 mg nitrate/kg body weight (bw) per day for adult cattle, based on methaemoglobin (MetHb) levels in animal's blood that would not induce clinical signs of hypoxia. The BMDL 10 is applicable to all bovines, except for pregnant cows in which reproductive effects were not clearly associated with MetHb formation. Since the data available suggested that ovines and caprines are not more sensitive than bovines, the BMDL 10 could also be applied to these species. Highest mean exposure estimates of 53 and 60 mg nitrate/kg bw per day in grass silage-based diets for beef cattle and fattening goats, respectively, may raise a health concern for ruminants when compared with the BMDL 10 of 64 mg nitrate/kg bw per day. The concern may be higher because other forages might contain higher levels of nitrate. Highest mean exposure estimates of 2.0 mg nitrate/kg bw per day in pigs' feeds indicate a low risk for adverse health effects, when compared with an identified no observed adverse effect level (NOAEL) of 410 mg nitrate/kg bw per day, although the levels of exposure might be underestimated due to the absence of data on certain key ingredients in the diets of this species. Due to the limitations of the data available, the CONTAM Panel could not characterise the health risk in species other than ruminants and pigs from nitrate and in all livestock and companion animals from nitrite. Based on a limited data set, both the transfer of nitrate and nitrite from feed to food products of animal origin and the nitrate- and nitrite-mediated formation of N-nitrosamines and their transfer into these products are likely to be negligible.

Inhibition of Fenton reaction is a novel mechanism to explain the therapeutic effect of intra-articular injection of PRP in patients with chronic haemophilic synovitis

INTRODUCTION AND AIM

Haemarthroses cause major morbidity in haemophilia resulting in chronic haemophilic synovitis (CHS) and arthropathy. Oxidation of haemoglobin-coupled iron released in synovium after haemolysis induces chondrocytes death and cartilage damage, allowing postulate using iron-chelating drugs as potential therapeutic tool for haemophilic joint damage. Considering that albumin, the most abundant plasma protein, is a physiologic iron chelator, we aim to demonstrate that impediment of haemoglobin oxidation is exerted by plasma as a mechanism involved in the therapeutic effect of intra-articular injection of platelet-rich plasma in CHS.

METHODS

Oxidation of haemoglobin (Hb) to methaemoglobin (MeHb) through Fenton reaction was induced in vitro by addition of potassium ferricyanide in the presence or absence of peripheral blood-derived platelets-rich or platelets-poor plasma (PRP/PPP) or albumin. The relevance of in vitro findings was analysed in synovial fluid (SF) samples from one patient with CHS obtained before and after 6 months of PRP intra-articular injection.

RESULTS

MeHb formation was completely impaired either by of PPP, PRP or albumin indicating that PRP exerts an anti-oxidative effect, probably due by plasma albumin. Analysis of SF samples revealed the presence of MeHb levels and haemosiderin-laden macrophages in SF obtained before PRP treatment. Reduction of synovial MeHb, normalization of cellular composition and improvement of health joint haemophilic score, pain and bleeding episodes were registered after 6 months of PRP intra-articular injection.

CONCLUSION

Inhibition of Fenton reaction and the consequent normalization of joint cellular composition is a noncanonical mechanism underlying the therapeutic effect of PRP intra-articular injection in CHS.

Dietary nitrate and presence of protozoa increase nitrate and nitrite reduction in the rumen of sheep

Nitrate ( NO 3 - ) supplementation is an effective methane (CH₄ ) mitigation strategy for ruminants but may produce nitrite ( NO 2 - ) toxicity. It has been reported that rumen protozoa have greater ability for NO 3 - and NO 2 - reduction than bacteria. It was hypothesised that the absence of ruminal protozoa in sheep may lead to higher NO 2 - accumulation in the rumen and a higher blood methaemoglobin (MetHb) concentration. An in vivo experiment was conducted with defaunated (DEF) and faunated (FAU) sheep supplemented with 1.8% NO 3 - in DM. The effects of rumen protozoa on concentrations of plasma and ruminal NO 3 - and NO 2 - , blood MetHb, ruminal volatile fatty acid (VFA) and ruminal ammonia (NH₃ ) were investigated. Subsequently, two in vitro experiments were conducted to determine the contribution of protozoa to NO 3 - and NO 2 - reduction rates in DEF and FAU whole rumen digesta (WRD) and its liquid (LIQ) and solid (SOL) fractions, incubated alone (CON), with the addition of NO 3 - or with the addition of NO 2 - . The results from the in vivo experiment showed no differences in total VFA concentrations, although ruminal NH₃ was greater (p < .01) in FAU sheep. Ruminal NO 3 - , NO 2 - and plasma NO 2 - concentrations tended to increase (p < .10) 1.5 hr after feeding in FAU relative to DEF sheep. In vitro results showed that NO 3 - reduction to NH₃ was stimulated (p < .01) by incoming NO 3 - in both DEF and FAU relative to CON digesta. However, adding NO 3 - increased (p < .05) the rate of NO 2 - accumulation in the SOL fraction of DEF relative to both fractions of FAU digesta. Results observed in vivo and in vitro suggest that NO 3 - and NO 2 - are more rapidly metabolised in the presence of rumen protozoa. Defaunated sheep may have an increased risk of NO 2 - poisoning due to NO 2 - accumulation in the rumen.

Simultaneous exposure to nitrate and low pH reduces the blood oxygen-carrying capacity and functional performance of a freshwater fish

Human activities present aquatic species with numerous of environmental challenges, including excessive nutrient pollution (nitrate) and altered pH regimes (freshwater acidification). In isolation, elevated nitrate and acidic pH can lower the blood oxygen-carrying capacity of aquatic species and cause corresponding declines in key functional performance traits such as growth and locomotor capacity. These factors may pose considerable physiological challenges to organisms but little is known about their combined effects. To characterise the energetic and physiological consequences of simultaneous exposure to nitrate and low pH, we exposed spangled perch (Leiopotherapon unicolor) to a combination of nitrate (0, 50 or 100 mg L-1) and pH (pH 7.0 or 4.0) treatments in a factorial experimental design. Blood oxygen-carrying capacity (haemoglobin concentration, methaemoglobin concentrations and oxygen equilibrium curves), aerobic scope and functional performance traits (growth, swimming performance and post-exercise recovery) were assessed after 28 days of exposure. The oxygen-carrying capacity of fish exposed to elevated nitrate (50 and 100 mg L-1) was compromised due to reductions in haematocrit, functional haemoglobin levels and a 3-fold increase in methaemoglobin concentrations. Oxygen uptake was also impeded due to a right shift in oxygen-haemoglobin binding curves of fish exposed to nitrate and pH 4.0 simultaneously. A reduced blood oxygen-carrying capacity translated to a lowered aerobic scope, and the functional performance of fish (growth and swimming performance and increased post-exercise recovery times) was compromised by the combined effects of nitrate and low pH. These results highlight the impacts on aquatic organisms living in environments threatened by excessive nitrate and acidic pH conditions.

Impact of Naja nigricollis Venom on the Production of Methaemoglobin

Snakebite envenomation is an affliction currently estimated to be killing upwards of 100,000 people annually. Snakebite is associated with a diverse pathophysiology due to the magnitude of variation in venom composition that is observed worldwide. The haemolytic (i.e., lysis of red blood cells) actions of snake venoms are well documented, although the direct impact of venoms on haemoglobin is not fully understood. Here we report on the varied ability of a multitude of snake venoms to oxidise haemoglobin into methaemoglobin. Moreover, our results demonstrate that the venom of an elapid, the black necked spitting cobra, Naja nigricollis, oxidises oxyhaemoglobin (Fe²⁺) into methaemoglobin (Fe³⁺) in a time- and concentration-dependent manner that is unparalleled within the 47 viper and elapid venoms evaluated. The treatment of venom with a reducing agent, dithiothreitol (DTT) is observed to potentiate this effect at higher concentrations, and the use of denatured venom demonstrates that this effect is dependent upon the heat-sensitive proteinaceous elements of the venom. Together, our results suggest that Naja nigricollis venom appears to promote methaemoglobin production to a degree that is rare within the Elapidae family, and this activity appears to be independent of proteolytic activities of venom components on haemoglobin.

Atomic force microscopy study of red blood cell membrane nanostructure during oxidation-reduction processes

The morphology and functional state of red blood cells (RBCs) mainly depends on the configuration of the spectrin network, which can be broken under the influence of intoxication because of oxidation processes in the cells. Measurement of these processes is a complex problem. The most suitable and prospective method that resolves this problem is atomic force microscopy (AFM). We used AFM to study the changes in the spectrin matrix and RBC morphology during oxidation processes caused by ultraviolet (UV) irradiation in RBC suspension. The number of discocytes decreased from 98% (in control) to 12%. We obtained AFM images of the spectrin matrix in RBC ghosts. Atomic force microscopy allows for the direct observation and quantitative measurement of the disturbances in the structure of the spectrin matrix during oxidation processes in RBCs. The typical section size of the spectrin network changed from approximately 80 to 200 nm (in control) to 600 nm and even to 1000 nm after UV irradiation. An AFM study showed that incubation of RBCs with Cytoflavin® after UV irradiation preserved the forms of RBCs almost at control levels; 89% of the cells remained as discocytes. To quantify the intensity of the oxidation-reduction processes, the percentage of haemoglobin derivatives was measured. The content of methaemoglobin varied in the range of 1% to 70% during the experiments. These evidence-based studies are important for the fundamental research of interactions during redox processes in RBCs at the molecular level.

EMLA anaesthetic cream for debridement of burns: a study of plasma concentrations of lidocaine and prilocaine and a review of the literature

The lidocaine-prilocaine cream (EMLA^TM) effectively reduces the pain from debridement of chronic leg ulcers. Studies have demonstrated that when applied to leg ulcers, plasma concentrations of the local anaesthetics are well below the threshold for CNS toxicity. However, there are minimal pharmacokinetic data available from EMLA application to burn wounds. This study evaluated EMLA cream for debridement of burns with regard to plasma concentrations of lidocaine and prilocaine, and reviewed the published literature on safety and efficacy of lidocaine-prilocaine applied epicutaneously to burns. Eight patients aged 22-59 received 5 g of EMLA 5% cream applied to 25 cm² large 2^nd degree burn areas for 30 min. Venous blood samples drawn at set intervals up to 120 min after cream application were analyzed for total plasma concentrations of lidocaine and prilocaine. Pain from debridement was assessed on a 4-point verbal scale and a 100-mm visual analog scale (VAS) with the end points "no pain" and "severe pain". A literature search on the use of lidocaine-prilocaine cream on burn wounds was performed in PubMed. The results showed that six patients felt no pain and two patients mild pain. The median VAS score was 11 (range 2-59). Peak plasma concentrations of lidocaine (mean 205 ng/ml) and prilocaine (mean 97 ng/ml) were observed after 15-60 min. Two published studies and two case reports of overdose of lidocaine-prilocaine cream applied to burns in paediatric patients were retrieved. Peak plasma concentrations of lidocaine and prilocaine combined after application of 5 g EMLA to burns 25 cm² large for 30 min in adults are far below those associated with toxicity. Bioavailability estimation suggests 5 to 30% of the prilocaine dose applied to burns is percutaneously absorbed. The analgesic efficacy appears satisfactory for debridement of 2^nd degree burns.

Linseed plus nitrate in the diet for fattening bulls: effects on methane emission, animal health and residues in offal

The combination of linseed and nitrate is known to decrease enteric methane emission in dairy cows but few studies have been carried out in fattening cattle for animal liveweight gain, enteric methane emission, animal health and presence of residues in beef products. To address this gap, 16 young bulls received a control (C) diet between weaning at 9 months and 14 months, then were split into two groups of eight balanced on feed intake, BW gain and methane emission to receive either the C diet or a diet moderately supplemented with extruded linseed and calcium nitrate (LN) for 2 months before being slaughtered. On a dry matter (DM) basis, the C diet contained 70% baled grass silage and 30% concentrate mainly made of maize, wheat and rapeseed meal. In the LN diet, rapeseed meal and a fraction of cereals were replaced by 35% extruded linseed and 6% calcium nitrate; linseed fatty acids and nitrate supply in the LN diet were 1.9% and 1.0%, respectively. Methane emission was measured continuously using the GreenFeed system. Methaemoglobin was determined every week in peripheral blood from bulls receiving the LN diet. Nitrate and nitrite concentrations were determined in rumen, liver and tongue sampled at slaughter. Dry matter intake tended to be lower for LN diet (P=0.10). Body weight gain was lower for LN diet (P=0.01; 1.60 and 1.26 kg/day for C and LN diet, respectively). Daily methane emission was 9% lower (P<0.001) for LN than C diet (249 and 271 g/day, respectively) but methane yield did not differ between diets (24.1 and 23.2 g/kg DM intake for C and LN diet, respectively, P=0.34). Methaemoglobin was under the limit of detection (<2% of total haemoglobin) for most animals and was always lower than 5.6%, suggesting an absence of risk to animal health. Nitrite and nitrate concentrations in offal did not differ between C and LN diets. In conclusion, a moderate supply of linseed and nitrate in bull feed failed to decrease enteric methane yield and impaired bull liveweight gain but without adverse effects for animal health and food safety.

Clostridium perfringens sepsis complicated by right ventricular cardiogenic shock

Clostridium perfringens sepsis has been ascribed a dismal prognosis when associated with massive intravascular haemolysis. We present a 71-year-old woman's fatal case which was compounded by isolated right ventricular cardiogenic shock. In this context, combined use of transthoracic echocardiography and pulmonary artery catheter monitoring is able to yield an individualized hemodynamic resuscitation. We discuss key aspects related to right and left heart mechanical efficiency, hypothesize as to the pulmonary hypertension mechanism of our case and set to emphasize a physiologically based framework for right ventricular failure hemodynamic management.

First reported case of Haemoglobin-M Hyde Park in a Malay family living in Malaysia

Haemoglobin (Hb)-M Hyde Park, also known as Hb-M Akita is a rare type of hereditary Hb M due to autosomal dominant mutation of CAC>TAC on codon 92 of β globin gene resulting in the replacement of histidine by tyrosine on β globin chain. This variant Hb has a tendency to form methaemoglobin (metHb). The iron ion in metHb is oxidized to ferric (Fe3+) which is unable to carry oxygen and the patients manifest as cyanosis clinically. A 9-year-old Malay girl was incidentally found to be cyanotic when she presented to a health clinic. Laboratory investigations revealed raised methaemoglobin levels and Hb analysis findings were consistent with Hb-M Hyde Park. β gene sequencing confirmed a point mutation of CAC>TAC on codon 92 in one of the β genes. The family study done on the individuals with cyanosis showed similar findings. A diagnosis of heterozygous Hb-M Hyde Park was made. Patients with this variant Hb usually presented with cyanosis with mild haemolysis and maybe misdiagnosed as congenital heart disease. No further treatment is needed as patients are relatively asymptomatic. Although the disease is harmless in the heterozygous carriers but the offspring of the carriers may suffer severe haemolytic anaemia when the offspring also inherit other β haemoglobinopathies/thalassemia. This can happen due to high prevalence of β thalassemia carrier (3.5-4 %) found in Malaysia. At the time of writing, this is the first case of hereditary Hb-M Hyde Park diagnosed in a Malay family living in Malaysia.

Impact of adding nitrate or increasing the lipid content of two contrasting diets on blood methaemoglobin and performance of two breeds of finishing beef steers

Adding nitrate to the diet or increasing the concentration of dietary lipid are effective strategies for reducing enteric methane emissions. This study investigated their effect on health and performance of finishing beef cattle. The experiment was a two×two×three factorial design comprising two breeds (CHX, crossbred Charolais; LU, Luing); two basal diets consisting of (g/kg dry matter (DM), forage to concentrate ratios) 520 : 480 (Mixed) or 84 : 916 (Concentrate); and three treatments: (i) control with rapeseed meal as the main protein source replaced with either (ii) calcium nitrate (18 g nitrate/kg diet DM) or (iii) rapeseed cake (RSC, increasing acid hydrolysed ether extract from 25 to 48 g/kg diet DM). Steers (n=84) were allocated to each of the six basal diet×treatments in equal numbers of each breed with feed offered ad libitum. Blood methaemoglobin (MetHb) concentrations (marker for nitrate poisoning) were monitored throughout the study in steers receiving nitrate. After dietary adaptation over 28 days, individual animal intake, performance and feed efficiency were recorded for a test period of 56 days. Blood MetHb concentrations were low and similar up to 14 g nitrate/kg diet DM but increased when nitrate increased to 18 g nitrate/kg diet DM (P0.05). Neither basal diet nor treatment affected carcass quality (P>0.05), but CHX steers achieved a greater killing out proportion (P<0.001) than LU steers. Thus, adding nitrate to the diet or increasing the level of dietary lipid through the use of cold-pressed RSC, did not adversely affect health or performance of finishing beef steers when used within the diets studied.

A double-blind, randomized clinical study to determine the efficacy of benzocaine 10% on histamine-induced pruritus and UVB-light induced slight sunburn pain

INTRODUCTION

This study aims to explore the efficacy of the topical application of 10% benzocaine for treating pruritus and pain as compared to vehicle ointment.

METHODS

Twenty male subjects were treated in a randomized double-blind fashion with the investigational medicinal product (IMPD) and vehicle. Immediately after the injection of 100 µg histamine on both arms, subjects received topical treatment and pruritus was subsequently assessed with visual analogue scale (VASpruritus) and Eppendorfer questionnaire. Ultraviolet B radiation (UVB) was administered on the back to induce slight sunburn. Twelve hours after UVB application again the IMPD was applied on the right or left upper back and vehicle on the other side and pain related to sunburn was measured with VASpain and pressure algometry.

RESULTS

A trend towards better reduction of pruritus was shown for benzocaine in VASpruritus. For the VASpain significant differences in group comparison (p = 0.02) were observed. Algometer measurements showed onset of pain reduction in the verum group after 20 min whereas in the vehicle-treated area pain relief occurred only after 60 min after application.

CONCLUSIONS

The topically administered ointment containing 10% benzocaine was found superior over vehicle for treating pain, but not pruritus.

Influence of nitrovasodilators and endothelin-1 on rheology of human blood in vitro

1. The shear stress of flowing blood profoundly influences the release of endothelium-dependent vasodilative and constrictive factors. Conversely, the influence of these mediators such as nitric oxide (NO) or endothelin-1 (ET-1) on blood rheology remains elusive. In the present study the influence of nitrovasodilators and ET-1 on red blood cell (RBC) shape and whole blood viscosity were investigated. 2. Incubation of whole blood with sodium-nitroprusside (SNP, 10-5 - 10-2 M), glyceryl trinitrate (GTN, 0.0001 - 0.1 mg mL-1), S-nitroso-N-acetylpenicillamine (SNAP, 10-6 - 10-3 M), and the active metabolite of molsidomine (SIN-1, 10-6 - 10-3 M), but not molsidomine (10-6 - 10-3 M), resulted in significantly increased amounts of methaemoglobin, indicating a relevant interaction with RBCs. Treatment with SNP at 10-2 M induced a marked echinocytosis (morphological index: 2.23+/-0.98 vs -0.17+/-0.10; P<0.001) and increased blood viscosity (haematocrit 45%) at a high shear rate of 94.5 s-1 (6.46+/-0.60 vs 5.07+/-0.35 mPa.s; P<0.01) and a low shear rate of 0.1 s-1 (88.6+/-36.8 vs 42.1+/-11.7 mPa.s; P<0.01). Echinocytosis was probably due to cyanide accumulation. SIN-1 at 10-3 M slightly decreased high shear viscosity (4.88+/-0.28 vs 4. 95+/-0.30 mPa.s; P<0.05). SNAP at 10-3 M slightly increased both high (5.14+/-0.23 vs 5.05+/-0.24 mPa.s; P<0.01) and low shear (53.9+/-7.2 vs 51.2+/-5.9 mPa.s; P<0.05) viscosity. Molsidomine and GTN failed to influence whole blood viscosity. ET-1 (10-9 - 10-6 M) had no effect on RBC shape and viscosity. 3. We conclude that the most important modulators of vascular tone, NO and ET-1, do not affect RBC shape and blood viscosity, which is important from both a physiological and a pharmacological point of view.