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(Circulation. 2001;104:1236.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Point Mutation in the Stalk of Angiotensin-Converting Enzyme Causes a Dramatic Increase in Serum Angiotensin-Converting Enzyme But No Cardiovascular Disease

Cornelis Kramers, MD, PhD; Sergei M. Danilov, MD, PhD; Jaap Deinum, MD, PhD; Irina V. Balyasnikova, PhD; Nicole Scharenborg, BS; Maaike Looman, BS; Frans Boomsma, MD, PhD; Marinus H. de Keijzer, MD, PhD; Cornelia van Duijn, PhD; Sabrina Martin, BS; Florent Soubrier, MD, PhD; Gosse J. Adema, PhD

From the Department of Pharmacology/Toxicology and Department of Internal Medicine (C.K.), Laboratory of Tumor Immunology (N.S., M.L., G.J.A.), the Department of Clinical Chemistry (M.H.d.K.), University Medical Center, Nijmegen, the Netherlands; the Department of Anesthesiology, University of Illinois (S.M.D., I.V.B.), Chicago; the Department of Internal Medicine (J.D., F.B.) and the Department of Epidemiology and Biostatistics (C.v.D.), Erasmus University Medical Center, Rotterdam, the Netherlands; and INSERM U 525 (S.M., F.S.), Hôpital Saint-Louis; Paris, France.

Correspondence to Dr G.J. Adema, Laboratory of Tumor Immunology, UMC Nijmegen, Philips van Leydenlaan 25, PO Box 9101, 6500 HB Nijmegen, The Netherlands. E mail g.adema{at}dent.kun.nl

Background— Angiotensin-converting enzyme (ACE) metabolizes many small peptides and plays a key role in blood pressure regulation. Elevated serum ACE is claimed to be associated with an increased risk for cardiovascular disease. Previously, two families with dramatically increased serum ACE were described, but no systematic survey of affected individuals was performed, and the molecular background of this trait is unknown.

Methods and Results— Eight families were identified with autosomal dominant inheritance of a dramatic (5-fold) increase of serum ACE activity. Strikingly, no clinical abnormalities were apparent in the affected subjects. Isolated blood cells were used for genetic and biochemical analysis. The level of ACE expression on the blood leukocytes and dendritic cells and total cell-associated ACE of the affected individuals was similar to that in nonaffected relatives; however membrane-bound mutant ACE was much more efficiently clipped from the cell surface compared with its wild-type counterpart. A point mutation causing Pro1199Leu in the stalk region of the ACE molecule cosegregates with the increase in serum ACE (LOD score, 6.63).

Conclusions— A point mutation in the stalk region of the ACE protein causes increased shedding, leading to increased serum ACE, whereas cell-bound ACE is unaltered, and affected individuals exhibit no clinical abnormalities. These findings qualify the importance of serum ACE and establish a new determinant of ACE solubilization.

Key Words: genetics • angiotensin • proteins • blood pressure

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