Ethanol (ETOH) selectively suppressed Escherichia coli endotoxin lipopolysaccharide (LPS)-stimulated, but not dibutyryl cAMP (db-cAMP)-stimulated upregulation of inducible nitric oxide synthase (iNOS) in rat alveolar macrophages (AMs) in vivo (Zhao et al., Alcohol. Clin. Exp. Res. 21:1062–1074, 1997). LPS-induced stimulation of iNOS is inhibited in vitro by db-cAMP and purine-2-Y (P2Y) receptor-mediated agonists. We examined the effect of ETOH on this interaction in rat lung AMs in vivo. Two hours after co-administration of LPS [0.6 mg/kg, intratracheal (i.t.)] with db-cAMP (0.1 mg/kg, i.t.) or 2-methylthio-adenosine-triphosphate (2-mes-ATP) to Sprague-Dawley rats (225 to 250 g) (n = 10 to 24/gp) iNOS messenger ribonucleic acid (mRNA), iNOS protein, and nitrate and nitrite anions [reactive nitrogen intermediates (RNIs)] in bronchoalveolar lavage fluid (BALf), and the ex vivo incubates of AMs were increased more than when these compounds were given individually to the rats. Co-administration of LPS with the autacoids did not affect LPS-stimulated increases of tumor necrosis factor-alpha (TNFalpha) mRNA, but inhibited LPS-stimulated BALf TNFalpha protein and attenuated LPS-mediated decreases of cell-associated TNFalpha. Pretreatment of rats with ETOH (4.5 g/kg, ip) or diethyldithiocarbamate (DETC; 5 mg/kg, i.t.), an inhibitor of the nuclear transcription factor NF kappa B (NF-kappaB), 30 min before co-administration of LPS with the autacoids restored iNOS mRNA levels to that obtained with the autacoid alone. Pretreatment of rats with ETOH decreased iNOS protein and RNI below that produced by either compound given individually to the rats. Although pretreatment of rats with DETC also decreased iNOS protein and RNI levels produced by LPS, the levels of both substances were elevated above that of the autacoid alone, LPS-induced upregulation of iNOS mRNA was associated with elevated levels of p65/p50 NF-kappaB in the nucleus of AMs. Neither db-cAMP or 2-mes-ATP affected LPS-stimulated NF-kappaB-DNA binding. Moreover, ETOH and DETC inhibited LPS-stimulated NF-kappaB-DNA binding. We conclude that in rat AMs in vivo: (1) both db-cAMP and P2Y-receptor stimulation summate with, rather than inhibit, LPS-induced upregulation of the iNOS mRNA, protein, and RNI; (2) ETOH and DETC inhibit LPS-induced upregulation of iNOS mRNA only when stimulated through the NF-kappaB pathway; and (3) ETOH inhibits both autacoid and LPS-stimulated formation of iNOS protein by a mechanism independent of its ability to suppress iNOS transcription.