Nitric oxide in septic shock: directions for future therapy?

Septic shock is a major cause of death among patients in intensive care units. It has a mortality rate of 20% to 80%. The clinical syndrome of septic shock is characterised by hypotension, hyporesponsiveness to vasoconstrictors and volume depletion which will then lead to multiorgan dysfunction and death. Except for surgical and supportive care, no specific therapy is known. Recently interest has been focused on the role of nitric oxide (NO) in septic shock. Large amounts of NO released by the endothelium and vascular smooth muscle cells lead to profound vasodilation and hyporesponsiveness to vasoconstrictors. The cytotoxic effect of NO could also cause tissue injury and organ failure. Inhibition of NO synthase, the enzyme responsible for NO production, has been proposed as a new therapy for septic shock. However, experimental reports have provided conflicting results, demonstrating both beneficial and detrimental effects. A brief review of the role of NO in septic shock and the possible use of NO synthase inhibitors as potential therapeutic agents is presented here.