Mitochondrial nitric oxide synthase, a voltage-dependent enzyme, is responsible for nitric oxide diffusion to cytosol.

The mitochondrial metabolic state regulates the rate of mitochondrial NO production and release to the cytosol. Nitric oxide release of rat heart mitochondria decreased markedly from 2.2 to 1.2 nmol NO/min. mg protein in the state 4 to state 3 transition. The activity of mtNOS, responsible for NO release, is driven by the membrane potential and not by intramitochondrial pH changes. The release of NO by rat liver mitochondria showed an exponential dependence on membrane potential. A similar behavior was reported for heart mitochondrial H2O2 production. The fraction of heart cytosolic NO provided by diffusion from mitochondria is 90%. The intramitochondrial concentrations of L-arginine and NADPH are higher than their KM values, and the changes in their concentrations in the state 4-state 3 transition are not enough to explain the changes in NO release. These data indicate that the redox state of the respiratory chain components regulates H2O2 production and mitochondrial membrane potential modulates NO release, and support the speculation that NO and H2O2 are a biological signal that reports a high mitochondrial energy charge to the cytosol. The marked regulation of mtNOS activity, as a voltage-dependent enzyme and at the physiological range of membrane potentials, makes mtNOS a highly sensitive enzyme that in turn regulates mitochondrial O2 uptake and H2O2 production.