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Vol. 295, Issue 2, 621-626, November 2000
Faculté de Pharmacie, Université de Montréal,
Montréal, Québec, Canada (C.B., D.F., G.M., A.A.); and
Division of Cardiology, University Health Network, Toronto General
Hospital, Toronto, Ontario, Canada (J.-L.R.)
Because part of the cardioprotective effects of angiotensin-converting
enzyme (ACE) inhibitors results from their protective effects on
cardiac bradykinin (BK) metabolism, the purpose of this study was to
define the metabolism of BK in normal and failing human hearts and to
compare the effect of omapatrilat, a vasopeptidase inhibitor (VPI),
which simultaneously inhibits both neutral endopeptidase (NEP) and ACE,
with that of an ACE inhibitor. Exogenous BK at a nanomolar
concentration was incubated alone, in the presence of an ACE inhibitor
(ramiprilat, 36 nM), or in the presence of a VPI (omapatrilat, 61 nM)
with left ventricular membranes prepared from normal donor hearts
(n = 7), and hearts from patients with an
ischemic (n = 11) or dilated
(n = 12) cardiomyopathy (DCM). The half-lives
calculated for BK alone (199 ± 60, 224 ± 108, and 283 ± 122 s; P = NS) exhibited similar values for
normal, ischemic, and DCM heart tissues, respectively. Ramiprilat
significantly increased the half-life of BK (P < .01), but the effect was similar for the three kinds of tissues
(297 ± 104, 267 ± 157, and 407 ± 146 s,
respectively; P = NS). The potentiating effect of
the VPI omapatrilat on the kinetic parameter of BK (478 ± 210, 544 ± 249, and 811 ± 349 s, respectively) was greater
than that of the ACE inhibitor (P < .01).
Moreover, omapatrilat had a more important potentiating effect with DCM
than normal heart membranes (P < .05). These
results show that not only ACE but also and mainly NEP play an
important role in the degradation of BK in human heart membranes.
Omapatrilat, a VPI, has a greater protective effect on BK metabolism
than that of a pure ACE inhibitor. Thus, inhibition of both ACE and NEP
with omapatrilat could be more cardioprotective than ACE inhibition alone.
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