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Related Experiment Videos

Decrease of angiotensin-converting enzyme activity after plasma exchange.

F Fourrier1, L Leclerc, P Lestavel

  • 1Service de Réanimation Polyvalente, Hôpital B. Lille, France.

Critical Care Medicine
|February 1, 1988
PubMed
Summary
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Plasma exchange significantly depletes serum angiotensin-converting enzyme (ACE) activity, with recovery in 4-10 days. Polygelin plasma substitutes inhibit ACE, potentially impacting renin-aldosterone responses in ICU patients.

Area of Science:

  • Biochemistry
  • Critical Care Medicine
  • Pharmacology

Background:

  • Serum angiotensin-converting enzyme (ACE) plays a crucial role in cardiovascular regulation.
  • Plasma exchange (PE) is used in intensive care units (ICUs) but its effects on serum ACE are not fully understood.
  • Understanding ACE dynamics is vital for managing fluid balance and hormonal responses post-PE.

Purpose of the Study:

  • To investigate the impact of plasma exchange with plasma substitutes on serum ACE activity in ICU patients.
  • To compare ACE changes with other plasma proteins and explore the mechanism of ACE reduction.
  • To assess the consequent effects on the renin-angiotensin-aldosterone system.

Main Methods:

  • Sequential measurement of serum ACE activity in 12 ICU patients undergoing 51 plasma exchange procedures using albumin-Polygelin.

Related Experiment Videos

  • Comparison of ACE levels during hemodialysis, hemofiltration, and PE with fresh frozen plasma.
  • Analysis of ACE changes alongside IgG, antithrombin III, and fibronectin; in vitro and in vivo Polygelin infusion studies; renin-induced aldosterone response assessment.

    • Main Results:

    • A significant decrease in serum ACE activity was observed after each PE procedure, with near-total depletion after repeated sessions.
    • Serum ACE normalized within 4 to 10 days post-PE; no changes were noted with hemodialysis or hemofiltration.
    • Polygelin demonstrated ACE inhibitory effects in vitro and in vivo, contributing to 50-70% of the observed ACE decrease; relative hyperreninemic hypoaldosteronism was noted post-PE.

    Conclusions:

    • Plasma exchange with albumin-Polygelin markedly reduces serum ACE activity, likely due to Polygelin's inhibitory effect and plasma removal.
    • The observed ACE depletion and subsequent recovery pattern are important considerations for ICU patients.
    • Findings suggest potential clinical relevance for managing hypovolemia, dehydration, and hormonal imbalances following PE, especially in patients with compromised lung function.