Reduced nitric oxide release causes nitrate tolerance in the intact coronary circulation

We investigated the possible involvement of reduced nitric oxide (NO) formation in development of nitrate tolerance in an intact organ circulation. NO formation was measured spectrophotometrically on-line in the coronary effluent of Langendorff hearts of rabbits. Short-term (3 min) infusion of glyceryl trinitrate (GTN, 40 μM) or a sydnonimine (SIN-1, 2.3 μM), the active metabolite of molsidomine, into the coronary inflow tract resulted in a decrease in coronary vascular resistance and NO release into the coronary effluent. Pretreatment with 250 μM GTN for 30 min resulted in considerably reduced NO formation and coronary vasodilation, whereas NO release and coronary vasodilation subsequent to SIN-1 remained unchanged, In hearts pretreated with 250 μM SIN-1 for 30 min, there was no effect on GTN- or SIN-l-induced vasodilation and NO release. Studies of cyclic GMP formation in rat lung fibroblasts further indicated that GTN bioconversion rather than desensitization of the soluble guanylate cyclase in involved in GTN tolerance. These data suggest metabolic. endothelium-independent NO release from GTN during passage through the coronary circulation. This NO release is reduced in nitratetolerant cells and appears to be the major cause of nitrate tolerance in intact circulatory systems.