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Nitric Oxide and the Regulation of the Peripheral Circulation.
  1. K Stuart-Smith

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    Kadowitz PJ, McNamara DB, eds. (£86.00.) Birkhauser, 2000. ISBN 3 7643 4046 0.

    In the first chapter of this book, Louis Ignarro gives an overview of the discovery of endothelial control of vascular smooth muscle relaxation (endothelium dependent relaxation; EDRF), and the simultaneous elucidation of the mechanism of action of nitrovasodilators (release of nitric oxide (NO) from glyceryl trinitrate). Ignarro and Salvador Moncada showed by different techniques that EDRF and NO were the same substance. In 2001, NO is recognised as a ubiquitous molecule with multiple functions, but it continues to tease us with therapeutic possibilities rather than actualities. We are still at the edge of understanding with this molecule, and the contents of this book bear this out. Each chapter describes the actions of NO at a particular channel, or on a particular ion, or in a particular vascular bed. All chapters are written by experts in the field and give highly readable overviews of the known effects of NO in that particular organ. I found the chapters on vascular beds, outside my normal range of interest, particularly informative. For me highlights were the chapters on the liver and kidney. The effects of NO on the cerebral circulation, a particularly difficult area to describe to the non-specialist, are also well explained. Nevertheless, there are some reservations, both practical and philosophical, about this volume.

    The first practical issue is the age of the references. Mostly, these date to 1997 at the latest—a long time ago in pharmacological terms. Many references are a staggering 20 years old, which begs the question: is this a review book or a book of current thinking? This leads to the second problem, which is that the structure of the chapters is inconsistent. Some give a general overview of their subject, whereas others seem to contain experimental data, which do not appear to have been peer reviewed at the time of publication, because the graphs are often unattributed and, with one exception, not referenced to a meeting where they might have been presented. If I am mistaken in this, I apologise. Perhaps the editors could enlighten me.

    The philosophical issue is one that has been troubling me for some time; namely, that our understanding of NO is still mainly descriptive. We know what happens if NO metabolism is manipulated pharmacologically, and all the chapters in this book describe such data. Some authors do attempt to put NO into a physiological context, but do not answer the basic questions. Why did NO come to be such an important molecule in evolutionary terms? Why is it ubiquitous? And how is it really interacting in these vascular beds? In short, what is NO really for? Having been a young postdoctoral fellow at the time of the original excitement in the 1980s, I cannot help feeling that NO research has blundered into a maze with no clear way to the truth at the centre. My colleagues tell me this is just a midlife crisis. I hope so. In the meantime, this excellent little book will fill a space in the university library, until the truth comes along.

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