Angiotensin converting enzymes in patients with acute respiratory distress syndrome

Angiotensin converting enzymes (ACEs) are important in the control of the cardiovascular function and their inhibition have a primary role in the treatment of hypertension and heart failure. However they have effects beyond the cardiovascular system. Angiotensin 2 production by ACE and stimulation of the angiotensin 1 (AT1) receptor subtype reduces nitric oxide bioavailability, promotes inflammation and fibrosis. The ACE type 2 (ACE2) increases angiotensin 1-7 production and counterbalances ACE effects. Some animal data have shown a beneficial role of the up-regulation of the ACE2 pathway and a detrimental role for the up-regulation of the ACE classic pathway in different ARDS, but there are no data in patients with ARDS.