The role of nitric oxide in the pathogenesis of multiple sclerosis.

Nitric oxide is a free radical gas, NO, of paramount relevance in biology. The enzymes responsible for the synthesis of NO from L-arginine in mammalian tissues are known as nitric oxide synthases (NOS). The inducible NOS (iNOS) is associated with the development of a number of autoimmune diseases. iNOS is induced on monocytes, cells playing a key role in the initiation and progression of the immune response. Induction of the enzyme is effected by proinflammatory cytokines, immunomodulating peptides, and even beta-endorphin through a mechanism involving an increase in cAMP. An excessive production of NO has been implicated in the severe lesions observed in multiple sclerosis (MS). Nitrosation of proteins caused by NO in monocytes may contribute to the formation of new epitopes involved in the autoimmune response. Monocytes/macrophages enhance also their cytotoxic capacity through an increase in NO. iNOS seems to establish a link between neuroendocrine and immune system through beta-endorphin explaining stress-related relapses in MS. One of the causes of demyelination is the lysis of oligodendrocytes by cytotoxic T lymphocytes (CTLs); and T cell response is also known to be modulated by NO.