Effect of bradykinin metabolism inhibitors on evoked hypotension in rats: rank efficacy of enzymes associated with bradykinin-mediated angioedema
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Background and purpose: Inhibition of bradykinin metabolizing enzymes (BMEs) can cause acute angioedema, as demonstrated in a recent clinical trial in patients administered the antihypertensive, omapatrilat. However, the relative contribution of specific BMEs to this effect is unclear and confounded by the lack of a predictive pre‐clinical model of angioedema. Experimental approach: Rats were instrumented to record blood pressure and heart rate; inhibitors were infused for 35 min and bradykinin was infused during the last 5 min to elicit hypotension, as a functional marker of circulating bradykinin and relative angioedema risk. Key results: In the presence of omapatrilat bradykinin produced dose‐dependent hypotension, an effect abolished by B 2 blockade. In the presence of lisinopril (ACE inhibitor), but not candoxatril (NEP inhibitor) or apstatin (APP inhibitor), bradykinin also elicited hypotension. Lisinopril‐mediated hypotension was unchanged with concomitant blockade of NEP or NEP/DPPIV (candoxatril+A‐899301). However, hypotension was enhanced upon concomitant blockade of APP and further intensified in the presence of NEP inhibition to values not different from omapatrilat alone. Conclusions and implications: We demonstrated that bradykinin is degraded in vivo with an enzyme rank‐efficacy of ACE>APP≫NEP or DPPIV. These results suggest the effects of omapatrilat are mediated by inhibition of three BMEs, ACE/APP/NEP. However, dual inhibition of ACE/NEP or ACE/NEP/DPPIV elicits no increased risk of angioedema compared to ACE inhibition alone. Thus, novel BME inhibitors must display no activity against APP to avoid angioedema risk due to high prevalence of ACE inhibitor therapy in patients with diabetes and cardiovascular disease. British Journal of Pharmacology (2008) 153 , 947–955; doi: 10.1038/sj.bjp.0707641 ; published online 17 December 2007
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APP inactivates both bradykinin and des-Arg9-bradykinin, a role of major importance when ACE is inhibited.
“Thus, APP inactivates bradykinin and des-Arg 9 -bradykinin [Turner and Cottrell, 2004], a role that is of major importance in the presence of ACEi [Cyr et al., 2001;Fryer et al., 2008;Kim et al., 2000].”
From A functional XPNPEP2 promoter haplotype leads to reduced plasma aminopeptidase P and increased risk of ACE inhibitor‐induced angioedema (2011) · cites this paper as Fryer et al., 2008
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- Authors
- Fryer, R. M., Segreti, J., Banfor, P. N., Widomski, D. L., Backes, B. J., Lin, C. W., Ballaron, S. J., Cox, B. F., Trevillyan, J. M., Reinhart, G. A., & von Geldern, T. W.
- Affiliations
- Abbott (United States) (US)
- Corresponding author
- Fryer, R M
- Venue
- British Journal of Pharmacology
- Publisher
- Wiley
- Published
- 2008-03
- Volume
- 153
- Issue
- 5
- Pages
- 947-955
- ISSN
- 0007-1188 (ISSN-L)
- 1476-5381
- PMC
- PMC2267285
- OpenAlex
- W1560143001
- Cited by
- 130
- References
- 59
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 3 · 2022: 4 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 12 · 2017: 7 · 2016: 18 · 2015: 14 · 2014: 6 · 2013: 14 · 2012: 8
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- British Journal of Pharmacology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Genetics › Coagulation, Bradykinin, Polyphosphates, and Angioedema
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Renin-Angiotensin System Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Keywords
- angioedema, omapatrilat, lisinopril, ACE inhibitors, aprotinin, neprilysin, dipeptidyl peptidase IV, bradykinin degradation, drug safety
- MeSH terms
- Aminopeptidases, Angioedema, Angiotensin-Converting Enzyme Inhibitors, Animals, Bradykinin, Dose-Response Relationship, Drug, Drug Evaluation, Preclinical, Enzyme Inhibitors, Hypotension, Indans, Male, Peptides, Propionates, Pyridines, Thiazepines, Neprilysin, Rats, Sprague-Dawley, Lisinopril, Rats
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