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Variable efficacy of N⁶-(1-iminoethyl)-L-lysine in acute cardiac transplant rejection

¹Division of Transplant Surgery, Department of Surgery ²Cardiovascular Center, ³Division of Nephrology, Department of Medicine, ⁴Biophysics Research Institute, ⁵Department of Pathology and ⁶Department of Biochemistry, Medical College of Wisconsin, Milwaukee, Wisconsin 53226

Submitted 15 April 2003 ; accepted in final form 1 October 2003

We examined the efficacy and mechanism of action of N⁶-(1-iminoethyl)-L-lysine (L-NIL), a highly selective inhibitor of inducible nitric oxide (NO) synthase (iNOS), on acute cardiac transplant rejection. L-NIL produced a concentration-dependent attenuation of plasma NO by-products and a decrease in nitrosylation of heme protein without altering protein levels of iNOS. At postoperative day 4, L-NIL did not alter the increased binding activities for transcription factors nuclear factor-B and activator protein-1. Whereas L-NIL decreased inflammatory cell infiltration, graft survival was only prolonged at the dose of 1.0 µg/ml that incompletely blocked NO production. Higher L-NIL concentrations (30 and 60 µg/ml) ablated the increased NO production but failed to improve graft survival and even potentiated NF-B binding activity examined at day 6. Alloimmune activation indicated by increased cytokine gene expression for interferon-, interleukin-6, and interleukin-10 was inhibited in grafts only by treatment with 1.0 µg/ml L-NIL. These findings suggest a complex role of NO in acute cardiac allograft rejection. Partial inhibition of iNOS is beneficial to graft survival, whereas total ablation may oppose any benefits to graft survival. These studies have important implications in understanding the dual role of NO in acute rejection and help to reconcile discrepancies in the literature.

inducible nitric oxide synthase; nuclear factor-B; activator protein-1; interferon-; interleukin-6; interleukin-10; electron paramagnetic resonance spectroscopy

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