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(Circulation. 2000;102:2011.)
© 2000 American Heart Association, Inc.

Basic Science Reports

Pulmonary Capillary Endothelium-Bound Angiotensin-Converting Enzyme Activity in Acute Lung Injury

Stylianos E. Orfanos, MD, PhD; Apostolos Armaganidis, MD; Constantinos Glynos, MD; Ekaterini Psevdi, MD; Panagiotis Kaltsas, MD; Paulina Sarafidou, MD; John D. Catravas, PhD; Urania G. Dafni, ScD; David Langleben, MD; Charis Roussos, MD, PhD

From the Critical Care Department, Evangelismos Hospital, University of Athens Medical School (S.E.O., A.A., C.G., E.P., P.K., P.S., C.R.), and Department of Nursing, University of Athens (U.G.D.), Greece; the Vascular Biology Center, Medical College of Georgia, Augusta (J.D.C.); and the Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada (D.L.).

Correspondence to Dr Stylianos Orfanos, Critical Care Department, Evangelismos Hospital, 45-47, Ipsilandou St, 10675, Athens, Greece. E-mail stelmar{at}ath.forthnet.gr

Background—Pulmonary capillary endothelium-bound (PCEB) angiotensin-converting ectoenzyme (ACE) activity alteration is an early, sensitive, and quantifiable lung injury index in animal models. We hypothesized that (1) PCEB-ACE alterations can be found in patients with acute lung injury (ALI) and (2) PCEB-ACE activity correlates with the severity of lung injury and may be used as a quantifiable marker of the underlying pulmonary capillary endothelial dysfunction.

Methods and Results—Applying indicator-dilution techniques, we measured single-pass transpulmonary hydrolysis of the synthetic ACE substrate ³H-benzoyl-Phe-Ala-Pro (BPAP) in 33 mechanically ventilated, critically ill patients with a lung injury score (LIS) ranging from 0 (no lung injury) to 3.7 (severe lung injury) and calculated the kinetic parameter A_max/K_m. Both parameters decreased early during the ALI continuum and were inversely related to APACHE II score and LIS. Hydrolysis decreased with increasing cardiac output (CO), whereas 2 different patterns were observed between CO and A_max/K_m.

Conclusions—PCEB-ACE activity decreases early during ALI, correlates with the clinical severity of both the lung injury and the underlying disease, and may be used as a quantifiable marker of underlying pulmonary capillary endothelial dysfunction.

Key Words: lung • endothelium • angiotensin • enzymes • acute lung injury

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