The level of serum
angiotensin-converting enzyme (ACE) was elevated in 15 of 17 patients with active
sarcoidosis. Serum ACE was studied to determine the effect of chronic
lung disease upon the blood level of an
enzyme believed to originate from the lungs. The assay was performed in approximately 200 control subjects and 200 patients with chronic
lung disease using
hippuryl-L-histidyl-L-leucine as substrate.
Enzyme activity greater in male control subjects than in female subjects of comparable age and greater in children than in adults. Serum ACE was significantly reduced in patients with
chronic obstructive lung disease,
lung cancer,
tuberculosis and
cystic fibrosis, as compared to control subjects, and was even lower in those receiving
corticosteroids. Of greatest interest, however, was that levels in patients with active
sarcoidosis not receiving
steroids were greater than 2 standard deviations above the mean for the adult control subjects (greater than 11.6 units) whereas levels in patients with
sarcoidosis receiving
steroids and in those with resolved disease were normal. A survey of subjects with other granulomatous diseases failed to reveal any other condition that was significantly associated with a similar elevation of serum ACE levels. Elevation of ACE levels in
sarcoidosis appears to be associated with the active disease process and does not appear to be a familial inherited
enzyme abnormality. An assay of serum ACE is a useful tool for regulating
therapy in
sarcoidosis and for confirming the diagnosis, since it readily distinguishes these patients from others with
tuberculosis,
lung cancer or
lymphoma.