Aminopeptidase P in individuals with a history of angio-oedema on ACE inhibitors

• Published in: The Lancet (British edition) Vol. 359; no. 9323; pp. 2088 - 2089
• Main Authors: Adam, Albert, Cugno, Massimo, Molinaro, Giuseppe, Perez, Melissa, Lepage, Yves, Agostoni, Angelo
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 15.06.2002; Lancet; Elsevier Limited
• Subjects: ACE inhibitors; Adult; Aged; Aminopeptidase; Aminopeptidases - blood; Analysis of Variance; Angioedema - blood; Angioedema - chemically induced; Angioedema - enzymology; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - adverse effects; Biological and medical sciences; Bradykinin; Case-Control Studies; Drug therapy; Drug toxicity and drugs side effects treatment; Edema; Enzymes; Humans; Hypertension; Hypertension - drug therapy; Inhibitors; Lysine carboxypeptidase; Lysine Carboxypeptidase - blood; Medical research; Medical sciences; Middle Aged; Miscellaneous (drug allergy, mutagens, teratogens...); Patients; Peptidyl-dipeptidase A; Pharmacology; Pharmacology. Drug treatments; Plasma; Risk factors; Side effects; Anaheim California; Canada; United States > US; Human; Immunopathology; Allergy; Concentration factor; Enzyme; Toxicity; Aminopeptidases; Blood plasma; Peptidases; Chemotherapy; Angioneurotic edema; Treatment; Low; Risk factor; Hydrolases; X-Pro aminopeptidase; ACE inhibitor
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(02)08914-6

Angio-oedema is a rare but potentially life threatening side-effect of angiotensin-converting-enzyme (ACE) inhibitor treatment. Identification of individuals at risk of this adverse effect is not possible. Angio-oedema is associated with raised concentrations of bradykinin, which is mainly inactivated by ACE. We assessed the plasma activity of two other enzymes that catabolise bradykinin (aminopeptidase P and carboxypeptidase N) in 39 hypertensive patients with a history of angio-oedema during ACE inhibitor treatment and in 39 hypertensive patients who had never had ACE inhibitor associated side-effects. Patients with previous angio-oedema had a lower plasma activity of aminopeptidase P than did those who never presented with angio-oedema (p=0·003). Our data suggest that low plasma concentrations of aminopeptidase P could be a predisposing factor for development of angio-oedema in patients treated with ACE inhibitors.