Angiotensin-converting enzyme inhibitor-associated angioedema is characterized by a slower degradation of des-arginine(9)-bradykinin

Angioedema (AE) is a rare but potentially life-threatening side effect of therapy with inhibitors of angiotensin-converting enzyme (ACE), the main bradykinin (BK)- inactivating metallopeptidase in humans. The pathogenesis of ACE inhibitor (ACEi)- associated AE (AE+) is presently unknown, although th...

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Bibliographic Details
Published in:The Journal of pharmacology and experimental therapeutics 2002-10, Vol.303 (1), p.232
Main Authors: Molinaro, Giuseppe, Cugno, Massimo, Perez, Mélissa, Lepage, Yves, Gervais, Nicole, Agostoni, Angelo, Adam, Albert
Format: Article
Language:English
Subjects:
Angioedema - blood
Angioedema - chemically induced
Angioedema - physiopathology
Angiotensin-Converting Enzyme Inhibitors - adverse effects
Biotransformation
Bradykinin - analogs & derivatives
Bradykinin - blood
Bradykinin - pharmacokinetics
Female
Half-Life
Humans
Hypertension - drug therapy
Kinetics
Male
Mathematics
Models, Theoretical
Reference Values
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Summary:Angioedema (AE) is a rare but potentially life-threatening side effect of therapy with inhibitors of angiotensin-converting enzyme (ACE), the main bradykinin (BK)- inactivating metallopeptidase in humans. The pathogenesis of ACE inhibitor (ACEi)- associated AE (AE+) is presently unknown, although there is increasing evidence of a kinin role. We analyzed the metabolism of endogenous BK (B(2) receptor agonist) and its active metabolite, des-Arg(9)-BK (B(1) receptor agonist), in the presence of an ACEi during in vitro contact activation of plasma from hypertensive patients (n = 39) who presented AE+. Kinetic parameters were compared with those measured in a control group (AE-) of hypertensive patients (n = 39) who never manifested any acute or chronic side effects while treated with an ACEi. The different kinetic parameters were analyzed using a mathematical model (y = k t(alpha) e(-beta t)) previously applied to a normal, healthy population. The slope of BK degradation, but not its formation from high-molecular-weight kininogen, was lower in AE+ patients when compared with the AE- controls. des-Arg(9)-BK accumulation during the kinetic measurements was significantly higher in AE+ plasma. This accumulation of the B(1) agonist in AE+ patients paralleled its half-life of degradation. In conclusion, our results show, for the first time, that an abnormality of endogenous des-Arg(9)-BK degradation exists in the plasma of patients with ACEi-associated AE, suggesting that its pathogenetic mechanism lies in the catabolic site of kinin metabolism.
ISSN:0022-3565
DOI:10.1124/jpet.102.038067