S-Nitrosothiols, Nitric Oxide and Platelet and Vascular Dysfunction in Cirrhosis

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S-Nitrosothiols, Nitric Oxide and Platelet and Vascular Dysfunction in Cirrhosis 2809700626 S-Nitrosothiols, nitric oxide and platelet and vascular dysfunction in cirrhosis Richard Ollosson Royal Free and University College Medical School Submission for Hepatology PhD 1 UMI Number: U592344 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U592344 Published by ProQuest LLC 2013. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Acknowledgements My thanks to Professor Kevin Moore for the opportunity to undertake this work, for his expert guidance throughout and allowing me the freedom to follow my own directions. Thanks also to Dr David Harry and Dr Alireza Mani for their support and their time and to the Sir Jules Thom Trust for funding this project. Finally, my thanks to my family for their constant love and support. 2 Abstract Elevated plasma concentration of the known platelet inhibiting species S-nitrosothiols are correlated for the first time to platelet dysfunction in the bile duct ligated (BDL) cirrhotic rat. Further, a BDL model of cirrhosis has been established and characterised in a strain of analbuminaemic rats and a correlation made between a protection against S- nitrosothiol formation conferred by analbuminaemia and less dysfunction in platelet aggregation following induction of endotoxaemia and cirrhosis. Also, it has been demonstrated that the majority of signal previously attributed to S- nitrosothiols during chemiluminescent detection in the plasma from endotoxaemic cirrhotic rats is mercury stable and is therefore attributed to N-nitrosamine formation. The identity of the mercury stable fraction of NO carrying species in plasma has been partially characterised and found to be carried either on albumin or on an albumin associated molecule. It has also been established that when the conjectured N-nitrosamine is synthesised in vitro and incubated with platelets, it is found to have an inhibitory effect on platelet aggregation similar to that found from S-nitrosothiols. Hypo-reactivity of isolated aortic rings to vasoconstrictors has also been confirmed in the rat model of BDL cirrhosis. However, the injection of cirrhotic rats with lipoic acid (a thiol antioxidant shown to ameliorate the development of the hyperdynamic circulation in 3 the bile duct ligated rat), had no effect on the reactivity of isolated aortic rings as was initially hypothesised. Finally, an adaptation of the Ellman’s reaction for analysis of total reduced thiol concentration in plasma was validated and used to assess plasma reduced thiol concentration in cirrhotic rats. It was found that chronic, 25 day bile duct ligation results in a drop in free thiol concentration in the plasma of 75% over sham operated rats. 4 Abstract......................................................................................3 List of Figures......................................................................... 10 List of Tables.......................................................................... 12 List of Equations..................................................................... 12 List of Abbreviations..............................................................13 1. Introduction......................................................................... 19 1.1. Nitric oxide .........................................................................................................................19 1.1.1. Formation o f nitric oxide (nitric oxide synthase) ................................................. 19 1.1.1.1. Regulation of NOS activity ..............................................................................21 1.1.1.1.1. Transcriptional regulation of NOS ..........................................................21 1.1.1.1.2. Calcium/Calmodulin .................................................................................23 1.1.1.1.3. Caveolin.......................................................................................................23 1.1.2. Nitric oxide metabolism ........................................................................................... 24 1.2. S-Nitrosothiols.................................................................................................................. 25 1.2.1. Formation o f S-nitrosothiols................................................................................... 25 1.2.1.1. Chemical synthesis............................................................................................ 25 1.2.1.2. Endogenous S-nitrosothiol formation ............................................................ 26 1.2.2. Stability o f S-nitrosothiols .......................................................................................28 1.2.3. Release of nitric oxide from S-nitrosothiols .........................................................29 1.2.3.1. Photolysis and transition metal stability ........................................................29 1.2.3.2. Transnitrosation reactions................................................................................30 1.2.3.2.1. Interaction of protein and low molecular weight thiols and S- nitrosothiols.................................................................................................................. 31 1.2.3.2.2. Transfer of S-nitrosothiol activity across membranes ..........................32 1.3. An important note on S-nitrosothiol and NO bioactivity...........................................35 1.4. NO, S-nitrosothiols and vasodilatation.......................................................................... 35 1.4.1. NO, guanylate cyclase and cGMP .......................................................................... 35 1.4.2. cGMP and vasodilatation.........................................................................................36 1.4.3. Nitric oxide and ED R F .............................................................................................37 1.4.4. Effect of NOS inhibitors on vascular tone ............................................................ 38 1.4.5. NO and S-nitrosothiol regulation o f vascular tone ...............................................39 1.5. NO and S-nitrosothiols and platelet aggregation.........................................................41 1.5.1. cGMP dependent inhibition o f platelet aggregation............................................ 41 1.5.2. cGMP independent inhibition o f platelet aggregation.........................................43 1.5.3. Platelet NO synthase ................................................................................................. 45 1.5.4. Regulation o f NOS activity in platelets .................................................................47 1.6. Other biologically relevant nitric oxide carrying molecules ..................................... 50 1.6.1. Nitric oxide and iron proteins .................................................................................. 50 1.6.2. N-nitrosation ............................................................................................................... 50 1.6.3. O-nitrosation - nitrite ................................................................................................ 52 1.7. Detection of S-nitrosothiols and other NO-carrying species..................................... 52 1.7.1. Saville reaction.........................................................................................................53 5 1.7.2. Chemiluminescent S-nitrosothiol detection ........................................................53 1.7.2.1. Photolytic cleavage of the S-nitrosothiol bond..............................................54 1.7.2.2. Chemical cleavage of the S-nitrosothiol bond ...............................................57 1.8. Cirrhosis.............................................................................................................................. 62 1.8.1. Outline and causes of cirrhosis ................................................................................ 62 1.8.2. Bile duct ligation model o f cirrhosis in the rat......................................................62 1.8.1. Complications o f cirrhosis.......................................................................................64 1.8.1. Sepsis-like syndrome in cirrhosis............................................................................64 1.8.2. Cytokine induction in cirrhosis ...............................................................................64 1.8.4. Impaired haemostasis in liver disease.................................................................. 65 1.8.4.1. Bacterial infection and haemostasis in liver disease.................................... 6 6 1.8.4.2. Coagulation factor abnormalities in liver disease .........................................67 1.8.4.4. Platelet dysfunction in liver disease ............................................................. 6 8 1.8.4.4.1. Platelet aggregation dysfunction in liver disease ..................................6 8 1.8.4.4.2. Intrinsic or humoral dysfunction of platelet aggregation
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