TY - JOUR T1 - Increased blood angiotensin converting enzyme 2 activity in critically ill COVID-19 patients JF - ERJ Open Research JO - erjor DO - 10.1183/23120541.00848-2020 VL - 7 IS - 1 SP - 00848-2020 AU - Dirk van Lier AU - Matthijs Kox AU - Karine Santos AU - Hans van der Hoeven AU - Janesh Pillay AU - Peter Pickkers Y1 - 2021/01/01 UR - http://openres.ersjournals.com/content/7/1/00848-2020.abstract N2 - Pharmacological blockade of the renin–angiotensin–aldosterone system (RAAS) with angiotensin-converting enzyme (ACE)-inhibitors and angiotensin receptor blockers (ARBs) are cornerstone treatments in several cardiovascular disease entities [1]. The RAAS is a central regulator of blood pressure, consisting of two counterregulatory pathways, commonly described as classical and nonclassical, respectively [1]. The main effect of classical RAAS activation is the generation of angiotensin (Ang)-II by ACE [1]. In contrast, non-classical RAAS activation results in cleavage of Ang-II by angiotensin converting enzyme-2 (ACE2) to form angiotensin 1–7, which directly counteracts the effects of classical RAAS activation [1].Critically ill #COVID19 patients display markedly increased alternative angiotensin pathway activity compared to healthy controls, reflected by increased blood ACE2 levels as well as decreased angiotensin-II and enhanced angiotensin-1–7 formation https://bit.ly/2MU1z4z ER -