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Pediatric Critical Care Medicine:
doi: 10.1097/PCC.0b013e3182a55735
Online Brief Report

Imbalance Between Pulmonary Angiotensin-Converting Enzyme and Angiotensin-Converting Enzyme 2 Activity in Acute Respiratory Distress Syndrome

Wösten-van Asperen, Roelie M. MD1; Bos, Albert P. MD1; Bem, Reinout A. MD1; Dierdorp, Barbara S. BSc2; Dekker, Tamara BSc2; van Goor, Harry PhD3; Kamilic, Jelena PhD3; van der Loos, Chris M. PhD4; van den Berg, Elske MD1; Bruijn, Martijn MD1; van Woensel, Job B. MD1; Lutter, René PhD2

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Abstract

Objective: Angiotensin-converting enzyme and its effector peptide angiotensin II have been implicated in the pathogenesis of acute respiratory distress syndrome. Recently, angiotensin-converting enzyme 2 was identified as the counter-regulatory enzyme of angiotensin-converting enzyme that converts angiotensin II into angiotensin-(1-7). The aim of this study was to determine pulmonary angiotensin-converting enzyme and angiotensin-converting enzyme 2 activity in patients with acute respiratory distress syndrome.

Design: Prospective observational pilot study.

Setting: A PICU of a university hospital.

Patients: Fourteen patients admitted, requiring mechanical ventilation for respiratory syncytial virus lower respiratory tract infection.

Interventions: None.

Measurements and Main Results: Two groups of patients were distinguished at admission: a group fulfilling the criteria for acute respiratory distress syndrome and a non–acute respiratory distress syndrome group. Angiotensin-converting enzyme and angiotensin-converting enzyme 2 activity were measured in bronchoalveolar lavage fluid. Patients with acute respiratory distress syndrome had increased angiotensin-converting enzyme activity and decreased angiotensin-converting enzyme 2 activity (p < 0.001) compared with the control group.

Conclusion: It is shown for the first time that in acute respiratory distress syndrome, enhanced angiotensin-converting enzyme activity is paralleled by a reduced angiotensin-converting enzyme 2 activity, similar to that found in an experimental rat model of acute respiratory distress syndrome. The reduced angiotensin-converting enzyme 2 activity may be counteracted by restoring angiotensin-(1-7) level, thereby offering a novel treatment modality for this syndrome.

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies

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