The Nobel Prize in Medicine this past week was awarded to Yoshinori Oshumi for work on autophagy or “self-eating” of cells. Notable was that this field of study initiated in the 1960s and it took 50 years to gain this recognition. Clinical translation of this research into potentially extending lifespans is unrealized at this time. Science can move slowly.
Closer to my area of clinical interest was the Nobel Prize in Medicine awarded in 1998 to 3 researchers for describing the central role of nitric oxide (NO) as a signaling molecule in the cardiovascular system. A tremendous amount has been learned about NO in the last few decades. This body of research led in part to the development of drugs to treat erectile dysfunction drugs like Viagra. In routine care of heart patients however, NO is rarely mentioned in conferences or coronary care units. This is due in part to the 30 second half-life of NO making it difficult to measure.
There is room for hope that the last 18 years since the Nobel Prize was awarded for NO research is about to yield safe and effective clinical therapies. One breakthrough is the ability to assess NO production clinically. Although it is still not routine to measure NO directly, an assay for ADMA, a naturally occurring chemical that competes for the enzyme that produces NO, is available and is used routinely in my clinic. High levels of ADMA indicate low production of NO and it is possible to assess the impact of lifestyle and other therapies on NO production via ADMA measurements.
Another area of hope is a focus on the role of NO in preventing atherosclerosis. There are multiple pathways by which abundant NO production may keep arteries from clogging up. These have recently been reviewed and are complex science but boil down to hopeful prospects. There has been little human data directly confirming that strategies to boost NO production may alter the rate of atherosclerosis but one recent preliminary study has suggested that result. Ten patients with atherosclerosis were studied with a carotid ultrasound called an intimal-medial thickness (CIMT) before and after 6 months of a natural supplement that is formulated to raise NO production. The thickness of the carotid arteries decreased by 11% in 6 months, an unexpected and hopeful finding that atherosclerosis and inflammation in the arteries were reversed.
Lifestyle measures that are known to be healthy such as avoiding smoking, regular exercise, eating a whole food diet rich in fruits and vegetables, and control of blood pressure, are known to promote NO production. In addition, the research leading to the award of the 1998 Nobel Prize and subsequent studies have suggested that supplementation, such as used in the CIMT study, can further boost NO production. Arginine is an amino acid that is the precursor to NO and supplementation has been studied extensively for cardiac and renal benefits. Foods rich in polyphenols, including apples and grapes, can activate the enzyme that produces NO and boost its activity. A pathway for NO production by eating dietary nitrates, identified since the 1998 Nobel Prize, has been used to alleviate blood pressure elevation and enhance athletic performance.
The research behind the 2016 Nobel Prize in Medicine holds exciting prospects for extending life and reversing degenerative diseases. The 1998 prize also hold such promise for the prevention and reversal of the number one killer in the world, cardiovascular disease. Enhancing the production of NO, by lifestyle and perhaps more effective supplementation, may be the YES we have been waiting for to stop the tragic losses that atherosclerotic heart disease creates.
Originally posted on HuffingtonPost.com