Skip Navigation LinksHome > November 2013 - Volume 14 - Issue 9 > Imbalance Between Pulmonary Angiotensin-Converting Enzyme an...
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

Collapse Box


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


Article Level Metrics

Search for Similar Articles
You may search for similar articles that contain these same keywords or you may modify the keyword list to augment your search.