A B S T R A C T Endothelial cells in tissue culturedegrade bradykinin and convert angiotensin I to angiotensin II. These are both functions of a single dipeptidyl hydrolase, angiotensin converting enzyme. Monolayer cultures were prepared from human, rabbit, pig, and calf vessels. Angiotensin converting enzyme activity was assessed by adding either bradykinin or angiotensin I to the cells in culture flasks, and measuring residual peptide over time by radioimmunoassay. Peptide degradation was inhibited by the specific converting enzyme inhibitor, SQ 20881. The flasks were equilibrated with varying hypoxic gas mixtures: hypoxia rapidly (<2 min) decreased enzyme activity and room air restored it as rapidly. The extent to which activity was reduced was a direct function of Po2 (r = 0.93, P < 0.001), and there was no enzyme activity below a Po2 of 30 mm Hg. Four preparations were studied with respect to decrease in enzyme activity by hypoxia: (a) intact cells in monolayer, (b) sonicated cells, (c) sonicated cells from which converting enzyme was partially dissolved by a detergent, and (d) purified converting enzyme. Hypoxia had progressively less of an inhibiting effect on the enzyme activity of the preparations as the degree of cell integrity decreased. Hypoxia inhibits angiotensin converting enzyme activity in cultured endothelial cells, but the effect of hypoxia is not on the enzyme per se, but appears to be a unique characteristic of the endothelial cell.
We studied the effect of a change in oxygen tension on converting enzyme activity in anesthetized, paralyzed, catheterized dogs ventilated with room air, 100% O2, and hypoxic gas mixtures. Bradykinin was continuously infused into the femoral vein and simultaneous samples drawn from the pulmonary artery and left atrium; bradykinin was extracted into ethanol and measured by radioimmunoassay. Clearance of bradykinin by lung converting enzyme decreased from 96% at PaO2 levels above 95 Torr to 0% below 26 Torr. Inhibition of enzyme activity was rapid in onset (less than 2 min), closely correlated with PaO2 (r = 0.92, P less than 0.001), and reversible within 2 min after return to room air breathing. Converting enzyme activity of the systemic vascular bed was also inhibited by hypoxia; kininase I activity was unaffected by oxygen tension. Although arterial bradykinin concentrations in the range of 0.5 ng/ml produced hypotension in normoxic animals, elevations to 30 ng/ml had no hypotensive effect in hypoxic dogs. During acute hypoxia, venous bradykinin will pass through the lung unmetabolized, and local levels of angiotensin II and bradykinin will vary in vascular beds with different oxygen tensions, providing a finely-graded mechanism for blood flow regulation.
A B S T R A C T To investigate mechanisms of pulmonary edema in respiratory failure, we studied unanesthetized sheep with vascular catheters, pleural balloons, and chronic lung lymph fistulas. Animals breathed either a hypercapnic-enriched oxygen (n = 5) or a hypercapnic-hypoxic (n = 5) gas mixture for 2 h. Every 15 min blood gases, pressures, cardiac output, lymph flow (Qlym), plasma and lymph albumin (mol wt, 70,000), IgG (mol wt, 150,000), IgM (mol wt, 900,000), and blood bradykinin concentrations were determined. In both groups, cardiac output and pulmonary arterial pressures increased, whereas left atrial pressures were unchanged. Acidosis alone (arterial pH = 7.16, Paco2 = 81 mm Hg, Pao2 = 250 mm Hg) resulted in a doubling of lymph flow, a small increase in protein flux, and a decrease in lymph to plasma protein concentration (L/P) ratio for all three proteins. Acidotic-hypoxic animals (arterial pH = 7.16, Paco2 = 84 mm Hg, Pao2 = 48 mm Hg) tripled Qlym. In these animals the increase in lymphatic flux of albumin, IgG, and IgM was significantly (P < 0.05) greater than that seen in either the acidosis alone group or in animals where left atrial pressures were elevated (n = 5; P < 0.05). Also, their percent increase in flux of the large protein (IgM) was greater than for the small protein (albumin) (P < 0.05). With acidosis alone, only pulmonary arterial bradykinin concentration increased (1.27+0.25 ng/ml SE), whereas acidosis plus hypoxia elevated both pulmonary arterial bradykinin
To determine whether cold could activate the kallikrein-kinin system in vivo as it does in vitro, the circulating systemic concentrations of bradykinin were serially measured in 10 cyildren with congenital diseases of the heart undergoing corrective cardiac surgery. Bradykinin was measured by radioimmunoassay in blood samples obtained before, during and after profound hypothermia (to 18 degrees C) and cardiopulmonary bypass. The circulating concentrations of bradykinin increased significantly as body temperature decreased during surface cooling. The increase in circulating bradykinin was associated with a decrease in the circulating level of bradykininogen, the precursor of bradykinin. With the onset of cardiopulmonary bypass and hence, removal of the lung and pulmonary converting enzyme from the circulation, there was a further rise in the already elevated concentrations of bradykinin. This is the first in vivo demonstration that hypothermia leads to an increase in the circulating concentrations of bradykinin.
A B S T R A C T Chronic hypoxic lung diseases are associated with abnormal blood pressure regulation. Because the lung is the principal site of angiotensin conversion and because hypoxia decreases converting enzyme activity, we examined whether angiotensin converting enzyme activity was impaired in lung disease. 12 dogs received a 6 wk course of aerosolized and intratracheal papain that produced moderate panlobular emphysema. These dogs and 24 control dogs were anesthetized and sampling catheters were placed under fluoroscopic control. Angiotensin conversion was measured by a blood pressure response bioassay. Pulmonary converting enzyme activity was also assessed by infusing bradykinin (BK) and using radioimmunoassay to measure the instantaneous clearance of BK and the concentration of BK in the pulmonary artery which first produced spillover of BK into left atrial blood. Angiotensin conversion was reduced in the emphysematous dogs to 81.1% (13.2 SD) from 92% (6 SD) in the control dogs (P < 0.01). Instantaneous clearance of BK in the emphysematous dogs was only slightly reduced (93%), despite reduction in their Pao2 to 75 mm Hg, indicating that the greatest proportion of the perfused vascular bed was exposed to alveolar Po2 of >90 mm Hg. However, the barrier to BK passage provided by the lung, and measured by the spillover level, was reduced Y4 to ½2 that observed in control animals. That the defect was promptly corrected by supplemental oxygen indicates that regional pulmonary vascular converting enzyme activity had been impaired by regional alveolar hypoxia, which permitted some peptide to pass through the lungs (2). In men with lung disease sufficient to reduce arterial Po2 below 60 Torr, the same defects were observed and were reversed when supplemental oxygen was provided (3). Cohn and Luria (4) found that men with pulmonary emphysema failed to demonstrate increased systemic vascular resistance in response to shock, regardless of the precipitating event. Anderson et al. (5) found that the resting blood pressures of 30 men with mild to severe emphysema were significantly lower than controls. Other studies suggest that the defect is not exclusive for emphysema, but extends to other lung disease. In patients with cystic fibrosis, whether mild or severe, Lieberman and Rodbard (6) observed lower blood pressure; these patients also had a lower pressor response to exercise. The underlying mechanisms contributing to all ofthese conditions remain unknown, but they raise the possibility ofan interplay between disease ofthe lung parenchyma and control of systemic blood pressure in the whole organism.We have shown that acute hypoxia reduces the activity of angiotensin converting enzyme (7-9). pressor response to injected angiotensin I, as well as pulmonary bradykinin clearance, was reduced in hypoxic animals. We speculated that injury to the pulmonary vascular bed, occurring as a consequence ofthe development of pulmonary emphysema, could interfere with converting enzyme activity and blood pressure regulation in two ...
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