Exogenous nitric oxide as an anti-infective agent

Both before and after the discovery that the high-output isoform of nitric oxide (NO) synthase (iNOS; NOS2) contributes to control of many infectious diseases, investigators have been treating infections with exogenous NO or NO-related moieties. Here, we review the anti-infective potential of topically applied NO-releasing materials, systemically administered anti-infective drugs that generate NO-related moieties, and inhalation of NO gas. Evidence for the safety and efficacy of inhaled NO (iNO) at higher doses than typically used in cardiopulmonary medicine encouraged us to discuss prospects for iNO to help treat pulmonary infections, with a focus on tuberculosis.