Abstract
Thermolysin-like metalloendopeptidase (TME) is an oligopeptidase that, like serum angiotensin converting enzyme (ACE), is elevated in patients with active sarcoidosis. It has previously been shown that TME and ACE have similar validity as markers of disease activity, and that when used concurrently, they complement each other in the detection of active disease. In the present study, serum TME and ACE were measured in 122 consecutive patients with sarcoidosis, and the relationship of these enzymes to radiographic stage, disease chronicity, and corticosteroid treatment was examined. Highest values of TME and ACE were seen in patients with hilar adenopathy and parenchymal disease (roentgenographic stage II) (p < 0.05). The mean TME value for patients with chronic disease (at least two years' duration, with parenchymal infiltrates and/or persistent lymphadenopathy, splenomegaly, uveitis, or bone lesions) was twice that of all other patients (p < 0.001). In contrast, ACE was not significantly increased in chronic disease. Follow-up measurements of these enzymes in patients subsequently treated with corticosteroids revealed that TME values did not significantly change with treatment, whereas ACE decreased by 50 percent (p = 0.005). In summary, TME and ACE are markers of active sarcoidosis that are most elevated in patients with radiographic stage II disease. TME differs from ACE in that TME is elevated in patients with chronic sarcoidosis and it is not affected by administration of corticosteroids. The data indicate that TME and ACE may reflect different aspects of the disease process.
Published Version
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