Reliable and minimally invasive biomarkers are needed for early detection, prognosis, and monitoring of colon cancer (CC). The aim of our study was to evaluate the role of systemic nitric oxide (NO) in inflammation and tumor progression and its diagnostic and prognostic value in CC. This prospective monocentric case-control study included 130 patients with non-metastatic CC and 100 healthy subjects. Clinical and pathological data were collected, and blood cell count-derived ratios were calculated. Systemic nitrite and cytokines levels were assessed using Griess method and ELISA respectively. Tumor-infiltrating immune cells were evaluated by immunohistochemistry in 44 patients. ROC curves, Kaplan-Meier, and log-rank tests were performed to highlight the diagnostic and prognostic value of NO production in patients followed for two years. Systemic plasma nitrite levels were significantly higher in patients than in controls (p < 0.0001), and correlated significantly and positively with most inflammatory and tumor markers and CD68+ cells and CD4+ T cells, but negatively with IL-6, albumin and CD8+ T cells. Interestingly, high nitrite levels were associated with tumor progression (cancer stage, tumor size, lymph node ratio). ROC analysis confirmed a high diagnostic performance (AUC = 0.88 for patients vs. controls; AUC = 0.71 for early vs. advanced stages). Prognostically, elevated nitrite levels predicted postoperative complications (AUC = 0.67; p log-rank<0.0001), reduced recurrence-free survival (AUC = 0.70; p log-rank = 0.03), and reduced overall survival (AUC = 0.75; p log-rank = 0.04). Our findings indicate that systemic nitrite levels are closely linked to inflammation and tumor progression in CC and demonstrate strong predictive accuracy, emerging as a promising biomarker for patient management.
Nitric oxide (NO) produced by endothelial cells plays a central role in regulating vascular tone, blood flow, and inflammatory responses. Although NO freely diffuses across cell membranes, intracellular and extracellular NO-related signals are often measured interchangeably, complicating interpretation of NO production, signaling, and bioavailability. Moreover, how cryopreservation and experimental context influence these two measurement compartments remains poorly defined. Here, we systematically compared intracellular and extracellular NO-related fluorescence in mouse cardiac endothelial cells (MCECs) under defined stimulatory, inhibitory, and culture conditions. Using DAF-FM DA (4-amino-5-methylamino-2',7'-difluorofluorescein diacetate) and DAF-FM-based assays, we examined (i) the impact of cryopreservation on intra- and extracellular NO-related signals following calcium ionophore A23187 stimulation, and (ii) the effects of physiological stimulation (bradykinin), enzymatic inhibition (Nᴳ-Nitro-L-arginine methyl ester (L-NAME)), and NO scavenging (carboxy-PTIO potassium salt (cPTIO)) in non-cryopreserved cells. Calcium ionophore A23187 increased intracellular NO-related fluorescence across non-cryopreserved and post-thaw groups, whereas extracellular responses were smaller and more variable, with increases observed primarily in glycerol-cryopreserved cells. The removal of phenol red from the medium enhanced extracellular NO-related fluorescence (reflecting improved detection sensitivity) but reduced intracellular signals, indicating a strong influence of medium composition on NO-related measurements. Bradykinin produced dose-dependent increases in extracellular signals accompanied by reductions in intracellular signals, consistent with rapid diffusion and context-dependent intracellular detection. L-NAME reduced intracellular fluorescence and suppressed extracellular signals only under simplified buffer conditions, while cPTIO produced modest reductions in extracellular fluorescence with substantial variability. Together, these findings indicate that intracellular and extracellular NO-related fluorescence are differentially regulated by stimulation, membrane properties, oxidative environment, and assay conditions. The results underscore the importance of compartment-specific, method-aware interpretation when using fluorescence-based approaches to assess NO signaling in endothelial cell models, particularly in the context of cryopreservation and experimental reproducibility.

