Impaired angiotensin conversion and bradykinin clearance in experimental canine pulmonary emphysema

Angiotensin-converting enzyme activity in the isolated perfused guinea pig lung

We have developed a pressure-dependent isolated lung perfusion system that can be used for the determination of pulmonary enzyme activity and kinetics under physiologic conditions. This development was done using two different artificial radiolabeled substrates, glycine-1-hippuryl-L-histidyl-L-leucine and phenyl-4(n)-hippuryl-glycyl-glycine, for the pulmonary enzyme, angiotensin-converting enzyme. With this system, we assessed the effects of different perfusate types upon the stability of the perfusion as well as the independent effects of pressure, flow, and substrate concentration on the activity of this enzyme. We concluded that this system enables the operator to determine the kinetics and activities of pulmonary enzymes independently of the effects of pressure and flow in a perfusion system that is stable for at least 3 h under physiologic conditions.

What's new in lung physiology? Pulmonary vessel regulation/non-respiratory metabolic lung functions

Whereas in the last few decades respiratory functions of the lung occupied a central role in research activity, current interests are concentrating more and more on non-respiratory functions. The present small overview concerns itself with vasoregulation and metabolic operations of the lung. A series of important review articles on this topic convey extensive information.

Studies on the mechanism of decreased angiotensin I conversion in rat lungs injured with alpha-naphthylthiourea

Lung endothelial cell injury may be an important early event in the pathogenesis of increased permeability pulmonary edema. Since angiotensin converting enzyme (ACE) is located on the luminal surface of the endothelial cell membrane, we sought to determine whether the conversion of angiotensin I (AI) to angiotensin II is decreased after acute lung injury to rats, induced by alpha-naphthylthiourea (ANTU), and we investigated the mechanism of the decrease. We found that lungs isolated from rats treated 4 h earlier with ANTU at a dose of 15 mg/kg body weight (BW) had decreased AI conversion when perfused with Krebs-Henseleit at a constant flow rate of 30 ml/min/kg BW. When perfusate flow rate was increased from 30 to 50 ml/min/kg BW, lungs isolated from rats treated with 10 mg/kg BW ANTU also had decreased AI conversion when compared to controls treated with a vehicle, Tween 80. Investigating the mechanism of decreased AI conversion, there were no differences among experimental groups in pulmonary arterial pressures or effluent perfusate pH or pO2. There was no correlation between lung wet/dry weight ratios and the extent of AI conversion among control rat lungs. Lung homogenate and serum ACE activity did not differ among control rats and rats pretreated with the two doses of ANTU. Ultrastructural studies revealed an increased percentage of capillaries with blebbing of endothelial cells in lungs injured with ANTU, as compared to controls, but no evidence of increased endothelial cell denudation in injured lungs. We conclude that angiotensin I conversion is decreased after ANTU lung injury and that the extent of decrease is related to the dose of ANTU and to perfusate flow rate. Although we cannot exclude decreased vascular surface area perfused as a cause of decreased conversion, we speculate that subtle changes in the luminal endothelial cell membrane may have caused decreased AI conversion after ANTU lung injury.

Systemic hypertension in infants with bronchopulmonary dysplasia

Thirteen of 30 infants with bronchopulmonary dysplasia demonstrated systolic blood pressure readings above 113 mm Hg on at least three separate occasions. In contrast, only one of 22 infants without BPD developed hypertension. The onset of hypertension often followed discharge from the nursery, was transient, and responded well to antihypertensive medication. Its significance is exemplified by the presence of left ventricular hypertrophy in three infants and a cerebrovascular accident in one child. We conclude that systemic hypertension is a significant problem in infants with BPD, and recommend close monitoring of blood pressure during their follow-up care.

Systemic circulatory adjustments to acute hypoxia and reoxygenation in unanesthetized sheep. Role of renin, angiotensin II, and catecholamine interactions

The hemodynamic consequences of the hypoxic inhibition of angiotensin-converting enzyme activity were studied in chronically instrumented unanesthetized sheep (n = 8) breathing a hypoxic gas mixture for 60 min (PaO2 = 31 mm Hg) followed by reoxygenation with room air. Changes in cardiac output, vascular pressures, blood flow distribution, arterial pH, PaCO2, PaO2, and arterial levels of plasma renin activity, angiotensin II, bradykinin, and catecholamines were measured at selected time points. Seven additional sheep underwent the same protocol but received saralasin, an angiotensin II receptor blocker beginning at 55 min of hypoxia and extending into the reoxygenation period. During hypoxia, both groups developed identical hemodynamic patterns including a rise in cardiac output (25%), blood pressure (15%), and preferential blood flow distribution to the heart, brain, adrenals, diaphragm, and skeletal muscle, as well as a decrease in the fraction of cardiac output to the kidneys and most of the gut. This was associated with a decrease in angiotensin II concentrations (from 35 to 17 pg/ml) in spite of a doubling in plasma renin activity and catecholamines. Bradykinin levels did not change. Upon reoxygenation, bolus production of angiotensin II (from 17 to 1,819 pg/ml) occurred in spite of a constant level of plasma renin activity. Concurrently, different hemodynamic patterns between control and saralasin groups emerged upon reoxygenation, including an elevation from base line in blood pressure and systemic vascular resistance in the control group. Cardiac work (heart-rate systolic pressure product) in the control group remained elevated upon reoxygenation while coronary blood flow returned to base-line values. Saralasin reduced cardiac work upon reoxygenation and restored the match between coronary blood flow and work. We conclude that plasma renin activity and oxygen tension together govern angiotensin II levels for an optimal level of systemic vasomotor tone during hypoxia. However, upon reoxygenation, bolus production of angiotensin II may result in pathophysiologic circulatory patterns, such as impairment in oxygen delivery to the myocardium proportional to persistently elevated cardiac work in the immediate postresuscitation period.

The diseased lung and drugs

Among the numerous ways by which drug-lung relationships can be discussed we chose to examine three questions: Is the lung capable of directly modulating drug pharmacokinetics? Knowing that the pulmonary circulation can exert very selective and efficient clearance and catabolism of biogenic molecules such as serotonin (5-HT), norepinephrine (N.E.), prostaglandins PGE2 and PGF2 alpha, and bradykinin, as well as activation of angiotensin (A)I to AII, a similar behavior has been sought for drugs. Uptake of circulating drugs occurs clearance of biogenic amines, the significance of which remains to be fully evaluated, and iatrogenic phospholipidosis localization of which in the lung might result from the elevated drug concentration in the tissue. Lung cells contain enzymes, among them mixed function oxidases (MFO), which enables them to metabolize xenobiotics even in the intact organ. Although blood supply to the lung is higher than that to the liver, the comparatively low MFO content of the former organ predicts only a marginal pulmonary metabolic contribution in vivo. On the otherhand, enzymatic activity upon drugs can generate instable reactive metabolites which, even in minute amounts are toxic and can damage cells; furthermore, it is hypothesized that the relatively high bronchiolar Clara cell MFO content explains the striking susceptibility of the long to xenobiotics. Do lung diseases indirectly influence drug pharmacokinetics? Hindrance to blood flow is common in respiratory failure (R.F.), from both reduced area and hypoxic vasoconstriction, resulting in altered flow distribution to the liver and kidney.