Diaphragm Force and Mitochondrial Function Following Enhanced Nitric Oxide Availability During Mechanical Ventilation

Abstract

During mechanical ventilation (MV), force developed by the diaphragm decreases over time much faster than locomotor muscles, known as ventilator-induced diaphragm dysfunction (VIDD). VIDD is accompanied by an increase in intramyofiber protein S-nitrosylation, a modification of cysteines by nitric oxide (NO). During the treatment of acute respiratory distress syndrome (ARDS), inhaled NO is commonly used to improve gas exchange, but little is known about the effects of increased NO availability to the diaphragm during MV and the intracellular mechanisms to protect against excessive S-nitrosylation. We hypothesize that the enzyme S-nitrosoglutathione reductase (GSNOR) protects against excessive protein S-nitrosylation in diaphragm myofibers in conditions where NO availability is enhanced during MV, thereby preserving contractile function. We tested this hypothesis by enhancing NO availability and blocking GSNOR activity in mice during MV. Mice were treated with GSNOR inhibitor (SPL-334; GSNORi) or both GSNORi and NO donor isosorbide dinitrate (GSNORi-ISDN) together, and mechanically ventilated for 2h. E x vivo diaphragm force and mitochondrial respiration were measured. Male (C57BL/6J) 3-4 month old mice (n=27) were anesthetized and subjected to MV for 0 (non-MV), 2, 4, or 6h (150 breaths/min, 10 cmH2O PIP, 3.5 cmH2O PEEP. 8 mL/kg VT). Alternatively, mice were treated with PBS/10% DMSO (DMSO, n=6) or 25 μg SPL-334 in PBS/DMSO (GSNORi, n=6) or 25 μg SPL-334 + 1.7 mg ISDN in PBS/DMSO (GSNORi-ISDN; n=6), and then subjected to MV for 2 h. After MV, mice were euthanized, and diaphragm strips were used for force, and permeabilized fiber bundles for mitochondrial oxidative phosphorylation and H2O2 generation measurements. Peak tetanic force was decreased by MV ~23% at 4 h and ~40% at 6 h (P=0.0183 and P=0.0062, respectively, one-way ANOVA, Tukey post-test) vs 0 h. However, peak force was not different between DMSO, GSNORi and GSNORi-ISDN at 2 h MV. Coupled-phosphorylating mitochondrial respiration (Kruskal-Wallis H=2.2, p=0.35) was not different but H2O2 flux was highest in GSNORi-ISDN vs DMSO and GSNORi (Kruskal-Wallis H=6.6, p=0.03). GSNORi and ISDN treatment during MV did not produce any changes to VIDD and to mitochondrial respiration, but increased ROS production. If exogenous NO is not provided, inhibiting GSNOR in vivo alone does not affect diaphragm function ex vivo during short MV. Support: TRDRP (T32IR5221 and T29KT0397CA, to L.N.) and SDSU 2023 SEED Grant (to L.N.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.