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L-NMMA is the archetypal competitive NOS inhibitor to which other inhibitors are often compared. It is a relatively non-selective inhibitor of all NOS isoforms. The Ki values for nNOS (rat), eNOS (human), and iNOS (mouse) are approximately 0.18, 0.4, and 6 µM, respectively.
Cardiogenic shock complicating acute myocardial infarction (MI) remains a common and lethal disorder despite aggressive use of early revascularization. Systemic inflammation, including expression of inducible nitric oxide synthase (NOS) and generation of excess nitric oxide, is believed to contribute to the pathogenesis and inappropriate vasodilatation of persistent cardiogenic shock. Preliminary, single-center studies suggested a beneficial effect of NOS inhibition on hemodynamics, renal function, and survival in patients with cardiogenic shock.
Alexander, J. H., Reynolds, H. R., Stebbins, A. L., Dzavik, V., Harrington, R. A., Van de Werf, F., & Hochman, J. S. (2007). Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. Jama, 297(15), 1657-1666.
Syncope is sudden transient loss of consciousness and postural tone with spontaneous recovery; the most common form is vasovagal syncope(VVS). We previously demonstrated impaired post-synaptic adrenergic responsiveness in young VVS patientswas reversed by blocking nitric oxide synthase(NOS). We hypothesised that nitric oxide may account for reduced orthostatic tolerance in young recurrent VVS patients.
Stewart, J. M., Sutton, R., Kothari, M. L., Goetz, A. M., Visintainer, P., & Medow, M. S. (2017). Nitric oxide synthase inhibition restores orthostatic tolerance in young vasovagal syncope patients. Heart, heartjnl-2017.
Guidelines recommend β-blockers and renin-angiotensin-aldosterone system blockers to improve long-term survival in hemodynamically stable myocardial infarction patients with a reduced left ventricular ejection fraction. The prevalence and outcomes associated with β and renin-angiotensin-aldosterone system blocker therapy in patients with ongoing cardiogenic shock is unknown.
van Diepen, S., Reynolds, H. R., Stebbins, A., Lopes, R. D., Džavík, V., Ruzyllo, W., ... & Dauerman, H. L. (2014). Incidence and outcomes associated with early heart failure pharmacotherapy in patients with ongoing cardiogenic shock. Critical care medicine, 42(2), 281-288.