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Gupta P, Mohapatra E, Patel S, Patnayak LL, Nanda R, Shah S, Abraham J, Behera A, Jindal A. Effect of the Angiotensin-Converting Enzyme (ACE) (I/D) Polymorphism in COVID-19 Patients and Their Healthy Contacts. Cureus 2023; 15:e38610. [PMID: 37284379 PMCID: PMC10239705 DOI: 10.7759/cureus.38610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction The quest to understand the pathophysiology behind the deleterious effects of the coronavirus disease 2019 (COVID-19) outbreak took a turn when involvement of the angiotensin converting enzyme (ACE) receptors in different organs, especially the lungs, could explain all the clinical manifestations and adverse events in patients. The I/D polymorphism in the ACE gene, having been attributed in various studies, was also seen to have an effect in this pandemic. Present study aimed to analyze the effect of this I/D mutation in COVID-19 patients and in their healthy contacts. Methods Patients with past history of COVID-19 infection and their healthy contacts were enrolled in the study after obtaining ethical clearance and informed consent. The polymorphism was studied by real-time polymerase chain reaction (PCR). Data was analyzed in SPSS version 20 (IBM Corp., Armonk, NY, USA). p value less than 0.05 was taken as significant. Results The allelic distribution followed the Hardy-Weinberg equilibrium, with the wild 'D' allele being dominant in the population. Between the case and controls, the mutant 'I' allele was observed more in the controls, and the association was statistically significant. Conclusion From the results of the present study, it could be concluded that while the wild 'D' allele led to higher chances of being affected with COVID-19, the polymorphism to 'I' allele was relatively protective in nature.
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Affiliation(s)
- Prishni Gupta
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Eli Mohapatra
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Suprava Patel
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Lisie L Patnayak
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Rachita Nanda
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Seema Shah
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Jessy Abraham
- Biochemistry, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Ajoy Behera
- Pulmonary Medicine, All India Institute of Medical Sciences Raipur, Raipur, IND
| | - Atul Jindal
- Paediatrics, All India Institute of Medical Sciences Raipur, Raipur, IND
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Kałka D, Gebala J, Biernikiewicz M, Mrozek-Szetela A, Rożek-Piechura K, Sobieszczańska M, Szuster E, Majchrowska M, Miętka A, Rusiecka A. Erectile Dysfunction in Men Burdened with the Familial Occurrence of Coronary Artery Disease. J Clin Med 2021; 10:jcm10184046. [PMID: 34575155 PMCID: PMC8470252 DOI: 10.3390/jcm10184046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 12/12/2022] Open
Abstract
Erectile dysfunction (ED) and coronary artery disease (CAD) share common risk factors, some of which have genetic backgrounds, while others may be stimulated by family lifestyle. We investigated the impact of the familial occurrence of CAD on the presence of ED and the presence of classic risk factors for ED in men with CAD. This cross-sectional observational study involved 751 men with CAD who were subjected to cardiac rehabilitation. Overall, 75.63% of the men had ED. CAD was diagnosed in 39.28% of the studied men’s relatives. ED was less frequent in the men with familial CAD than in those without (71.53% vs. 78.29%). Similar relations were observed for the presence of CAD in parents (70.43% vs. 78.34%) and the father (69.95% vs. 77.46%). The International Index of Erectile Function 5 score was significantly higher in patients with familial CAD (median (interquartile range); 17 (12–22) vs. 16 (10–21); p = 0.0118), in parents (18 (12–22) vs. 16 (10–20); p = 0.021), and in the father (18 (12–22) vs. 16 (10–21); p = 0.0499). Age and education minimized the effect of familial CAD. Familial CAD increased the incidence of hypertension, dyslipidemia, and smoking but not sedentary lifestyle. Despite the higher prevalence of selected risk factors for ED in men with familial CAD, a higher incidence of ED was not observed.
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Affiliation(s)
- Dariusz Kałka
- Cardiosexology Unit, Department of Physiology & Pathophysiology, Wrocław Medical University, 50-368 Wrocław, Poland; (M.M.); (A.M.); (A.R.)
- Centre for Men’s Health, 53-151 Wrocław, Poland
- Correspondence:
| | - Jana Gebala
- Cardiosexology Students’ Scientific Club, Wrocław Medical University, 50-368 Wrocław, Poland; (J.G.); (E.S.)
| | | | - Aneta Mrozek-Szetela
- Doctoral School at Wrocław of Environmental and Life Sciences, 50-375 Wrocław, Poland;
| | - Krystyna Rożek-Piechura
- Faculty of Physiotherapy, Wrocław University of Health and Sport Sciences, 51-612 Wrocław, Poland;
| | | | - Ewa Szuster
- Cardiosexology Students’ Scientific Club, Wrocław Medical University, 50-368 Wrocław, Poland; (J.G.); (E.S.)
| | - Marzena Majchrowska
- Cardiosexology Unit, Department of Physiology & Pathophysiology, Wrocław Medical University, 50-368 Wrocław, Poland; (M.M.); (A.M.); (A.R.)
| | - Anna Miętka
- Cardiosexology Unit, Department of Physiology & Pathophysiology, Wrocław Medical University, 50-368 Wrocław, Poland; (M.M.); (A.M.); (A.R.)
| | - Agnieszka Rusiecka
- Cardiosexology Unit, Department of Physiology & Pathophysiology, Wrocław Medical University, 50-368 Wrocław, Poland; (M.M.); (A.M.); (A.R.)
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Krittanawong C, Sun T, Herzog E. Big Data and Genome Editing Technology: A New Paradigm of Cardiovascular Genomics. Curr Cardiol Rev 2017; 13:301-304. [PMID: 28782493 PMCID: PMC5730963 DOI: 10.2174/1573403x13666170804152432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/25/2017] [Accepted: 07/28/2017] [Indexed: 12/02/2022] Open
Abstract
Opinion Statements: Cardiovascular diseases (CVDs) encompass a range of conditions extending from congenital heart disease to acute coronary syndrome most of which are heterogenous in nature and some of them are multiple genetic loci. However, the pathogenesis of most CVDs remains incompletely understood. The advance in genome-editing technologies, an engineering process of DNA sequences at precise genomic locations, has enabled a new paradigm that human genome can be precisely modified to achieve a therapeutic effect. Genome-editing includes the correction of genetic variants that cause disease, the addition of therapeutic genes to specific sites in the genomic locations, and the removal of deleterious genes or genome sequences. Site-specific genome engineering can be used as nucleases (known as molecular scissors) including zinc finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and the clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated 9 (Cas9) systems to provide remarkable opportunities for developing novel therapies in cardiovascular clinical care. Here we discuss genetic polymorphisms and mechanistic insights in CVDs with an emphasis on the impact of genome-editing technologies. The current challenges and future prospects for genome-editing technologies in cardiovascular medicine are also discussed.
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Affiliation(s)
- Chayakrit Krittanawong
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, 1000 10th Ave, New York, NY 10019. United States
| | - Tao Sun
- Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, MN. United States
| | - Eyal Herzog
- Department of Cardiovascular Disease, Icahn School of Medicine at Mount Sinai St' Luke, Mount Sinai Heart, New York, NY. United States
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Saba N, Yusuf O, Rehman S, Munir S, Ahmad S, Mansoor A, Raja GK. An angiotensin I-converting enzyme insertion/deletion polymorphism is associated with Pakistani asthmatic cases and controls. J Biosci 2017; 41:439-44. [PMID: 27581935 DOI: 10.1007/s12038-016-9617-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Asthma is a chronic disease due to inflammation of the airways of lungs that is clinically characterized by variable symptoms including wheezing, coughing and shortness of breath. Angiotensin I-converting enzyme (ACE) plays a major role in fibrous tissue formation and is highly expressed in lungs. The main aim of this research work was to study the role of ACE insertion/deletion (I/D) polymorphism, rs4646994, in asthma in Pakistani patients. A total of 854 subjects, including 333 asthma patients and 521 ethnically matched controls, were studied. The ACE (I/D) polymorphism was genotyped using polymerase chain reaction (PCR). Chi-square, Fisher's exact and Hardy-Weinberg equilibrium tests were used to compare groups. Homozygous insertion genotype II (p less than 0.0001, OR=3.38) and insertion allele (I) was significantly more frequent in Pakistani asthmatics than in healthy controls (p=0.0007, OR=1.40). The ID genotype (p less than 0.0001, OR=0.43) and the deletion allele (D) were associated with protection of disease in Pakistani patients (p=0.0007, OR=0.71). These data suggest the involvement of ACE I/D polymorphism in asthma risk in the Pakistani population. This marker may be an important indication in the molecular mechanism of asthma and can become a useful tool in risk assessment and help in designing strategy to combat disease.
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Affiliation(s)
- Nusrat Saba
- Institute of Biomedical and Genetic Engineering, Islamabad, Pakistan,
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Imbalzano E, Vatrano M, Quartuccio S, Di Stefano R, Aragona CO, Mamone F, D’Ascola A, Scuruchi M, Felice F, Trapani G, Alibrandi A, Ciconte VA, Ceravolo R, Saitta A, Mandraffino G. Clinical impact of angiotensin I converting enzyme polymorphisms in subjects with resistant hypertension. Mol Cell Biochem 2017; 430:91-98. [DOI: 10.1007/s11010-017-2957-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/28/2017] [Indexed: 01/08/2023]
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Milionis HJ, Kostapanos MS, Vakalis K, Theodorou I, Bouba I, Kalaitzidis R, Georgiou I, Elisaf MS, Siamopoulos KC. Impact of renin-angiotensin-aldosterone system genes on the treatment response of patients with hypertension and metabolic syndrome. J Renin Angiotensin Aldosterone Syst 2016; 8:181-9. [PMID: 18205097 DOI: 10.3317/jraas.2007.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. To evaluate the influence of clinical, biochemical and genetic markers on the response to antihypertensive treatment in patients with essential hypertension and the metabolic syndrome (MetS). Methods. Measurements of anthropometric indices, blood pressure (BP), and metabolic parameters were obtained from the medical records of 132 (77 women) newly diagnosed, untreated hypertensive patients. Renin-angiotensin-aldosterone system (RAAS) genes polymorphisms (including ACE I/D, angiotensinogen M235T, angiotensin II type 1 receptor [AT1-receptor] A1166C) were determined. Response to treatment was defined as BP less than 140/90 mmHg. Results. Patients with MetS (n=60) had higher systolic BP and pulse pressure and a more atherogenic lipid profile than patients without MetS.The frequencies of the ACE and the AT1-receptor gene polymorphisms were similar between patients with and without MetS. Response to treatment was positively associated with pulse pressure, and the presence of the C allele as well as the AC genotype of the AT1-receptor gene and inversely with age after adjustment for confounding factors. Conclusions. RAAS genes distribution does not differ between hypertensive patients with and without the MetS. Higher baseline pulse pressure levels, the presence of the C allele and/or the AC genotype may be in favour of a better response to structured antihypertensive treatment in patients with MetS. However, these findings need to be evaluated in future studies.
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Affiliation(s)
- Haralampos J Milionis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Michael S Kostapanos
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos Vakalis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioanna Theodorou
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioanna Bouba
- Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Rigas Kalaitzidis
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis Georgiou
- Laboratory of Human Reproductive Genetics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Moses S Elisaf
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Kostas C Siamopoulos
- Department of Internal Medicine, Outpatient Hypertension Clinic, School of Medicine, University of Ioannina, Ioannina, Greece
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The Angiotensin Converting Enzyme Insertion/Deletion Polymorphism Modifies Exercise-Induced Muscle Metabolism. PLoS One 2016; 11:e0149046. [PMID: 26982073 PMCID: PMC4794249 DOI: 10.1371/journal.pone.0149046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 01/25/2016] [Indexed: 01/03/2023] Open
Abstract
Objective A silencer region (I-allele) within intron 16 of the gene for the regulator of vascular perfusion, angiotensin-converting enzyme (ACE), is implicated in phenotypic variation of aerobic fitness and the development of type II diabetes. We hypothesised that the reportedly lower aerobic performance in non-carriers compared to carriers of the ACE I-allele, i.e. ACE-DD vs. ACE-ID/ACE-II genotype, is associated with alterations in activity-induced glucose metabolism and capillarisation in exercise muscle. Methods Fifty-three, not-specifically trained Caucasian men carried out a one-legged bout of cycling exercise to exhaustion and/or participated in a marathon, the aim being to identify and validate genotype effects on exercise metabolism. Respiratory exchange ratio (RER), serum glucose and lipid concentration, glycogen, and metabolite content in vastus lateralis muscle based on ultra-performance lipid chromatography-mass spectrometry (UPLC-MS), were assessed before and after the cycling exercise in thirty-three participants. Serum metabolites were measured in forty subjects that completed the marathon. Genotype effects were assessed post-hoc. Results Cycling exercise reduced muscle glycogen concentration and this tended to be affected by the ACE I-allele (p = 0.09). The ACE-DD genotype showed a lower maximal RER and a selective increase in serum glucose concentration after exercise compared to ACE-ID and ACE-II genotypes (+24% vs. +2% and –3%, respectively). Major metabolites of mitochondrial metabolism (i.e. phosphoenol pyruvate, nicotinamide adenine dinucleotide phosphate, L-Aspartic acid, glutathione) were selectively affected in vastus lateralis muscle by exercise in the ACE-DD genotype. Capillary-to-fibre ratio was 24%-lower in the ACE-DD genotype. Individuals with the ACE-DD genotype demonstrated an abnormal increase in serum glucose to 7.7 mM after the marathon. Conclusion The observations imply a genetically modulated role for ACE in control of glucose import and oxidation in working skeletal muscle. ACE-DD genotypes thereby transit into a pre-diabetic state with exhaustive exercise, which relates to a lowered muscle capillarisation, and deregulation of mitochondria-associated metabolism.
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Al-Serri A, Ismael FG, Al-Bustan SA, Al-Rashdan I. Association of the insertion allele of the common ACE gene polymorphism with type 2 diabetes mellitus among Kuwaiti cardiovascular disease patients. J Renin Angiotensin Aldosterone Syst 2015; 16:910-6. [PMID: 26458572 DOI: 10.1177/1470320315610255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Accepted: 09/08/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The D allele of the common angiotensin-converting enzyme (ACE) I/D gene polymorphism (rs4646994) predisposes to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). However, results on which allele predisposes to disease susceptibility remain controversial in Asian populations. This study was performed to evaluate the association of the common ACE I/D gene polymorphism with both T2DM and CVD susceptibility in an Arab population. METHODS We genotyped the ACE I/D polymorphisms by direct allele-specific PCR in 183 healthy controls and 400 CVD patients with diabetes (n=204) and without (n=196). Statistical analysis comparing between the different groups were conducted using R statistic package "SNPassoc". RESULTS Two genetic models were used: the additive and co-dominant models. The I allele was found to be associated with T2DM (OR=1.84, p=0.00009) after adjusting for age, sex and body mass index. However, there was no association with CVD susceptibility (p>0.05). CONCLUSION The ACE I allele is found to be associated with T2DM; however, no association was observed with CVD. The inconsistency between studies is suggested to be attributed to genetic diversity due to the existence of sub-populations found in Asian populations.
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Affiliation(s)
- Ahmad Al-Serri
- Human Genetics Unit, Department of Pathology, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Fatma G Ismael
- Department of Biological Sciences, Faculty of Science, Kuwait University, Safat, Kuwait
| | - Suzanne A Al-Bustan
- Department of Biological Sciences, Faculty of Science, Kuwait University, Safat, Kuwait
| | - Ibrahim Al-Rashdan
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
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Foo M, Coppack SW, Denver AE, Bulmer K, Yudkin JS. Lack of impact of angiotensin-converting enzyme gene polymorphism and salt intake on insulin resistance and limb blood flow. Clin Endocrinol (Oxf) 2015; 82:76-83. [PMID: 25154650 DOI: 10.1111/cen.12595] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 06/05/2014] [Accepted: 08/18/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES We postulated the mechanism for the association between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and insulin sensitivity might relate to changes in blood flow regulation. We studied the association of this polymorphism with insulin action, and insulin-mediated changes in limb blood flow (LBF), under conditions of high and low salt intake. We also studied effects of genotype and salt loading on renin-angiotensin-aldosterone system (RAAS) activity. MATERIALS/METHODS Twenty people with (10 I/I; 10 D/D) and 23 without (10 I/I; 13 D/D), type 2 diabetes were studied during 6 days of 40 mmol/day and 220 mmol/day sodium diet in a randomized, double-blind cross-over fashion. On the sixth day of each condition, we measured 24-h blood pressure, plasma volume, LBF and insulin sensitivity during hyperinsulinaemic clamp at low (40 mU/m(2) /min) and high (600 mU/m(2) /min) dose insulin infusion. RESULTS Salt intake variation produced greater effects on the renin-angiotensin-aldosterone system than ACE genotype. Diabetes status and insulin infusion were associated with differences in the metabolic clearance rate of glucose, (P < 0·001 for each) and insulin infusion increased LBF (P < 0·001). However, ACE genotype and salt intake had no consistent impacts on either variable in nondiabetic and diabetic subgroups, or in the combined group. CONCLUSIONS Reported differences in insulin sensitivity between ACE genotypes were not found in this study under strict regulation of sodium intake. Insulin sensitivity was also unaffected in either group by sodium loading. ACE genotype and salt status do not impact on insulin sensitivity through changes in limb blood flow during hyperinsulinaemia.
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Affiliation(s)
- Marjorie Foo
- Department of Medicine, Centre for Diabetes and Cardiovascular Risk, University College London, London, UK
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Al-Hazzani A, Daoud MS, Ataya FS, Fouad D, Al-Jafari AA. Renin-angiotensin system gene polymorphisms among Saudi patients with coronary artery disease. ACTA ACUST UNITED AC 2014; 21:8. [PMID: 25984491 PMCID: PMC4389886 DOI: 10.1186/2241-5793-21-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/29/2014] [Indexed: 01/13/2023]
Abstract
BACKGROUND The polymorphisms in the components of the renin-angiotensin system (RAS) are important in the development and progression of coronary artery disease (CAD) in some individuals. Our objectives in the present investigation were to determine whether three RAS polymorphisms, angiotensin-converting enzyme insertion/deletion (ACE I/D), angiotensin receptor II (Ang II AT2 - C3123A) and angiotensinogen (AGT-M235T), are associated with CAD in the Saudi population. We recruited 225 subjects with angiographically confirmed CAD who had identical ethnic backgrounds and 110 control subjects. The polymerase chain reaction-restriction fragment length polymorphisms (RFLP) technique was used to detect polymorphisms in the RAS gene. RESULTS Within the CAD group, for the ACE I/D genotype, DD was found in 64.4%, 26.3% carried the ID genotype, and 9.3% carried the II genotype. Within the control group, the DD genotype was found in 56.4%, 23.6% carried the ID genotype, and 20% carried the II genotype. The odds ratio (OR) of the ACE DD vs II genotype with a 95% confidence interval (CI) was 2.45 (1.26-4.78), with p = 0.008. For the Ang II AT2 receptor C3123A genotype, within the CAD group, CC was found in 39.6%, 17.8% carried the CA genotype, and 42.6% carried the AA genotype. Within the control group, CC was found in 39.1%, 60.9% carried the CA genotype, and there was an absence of the AA genotype. The OR of the Ang II AT2 receptor C3123A CC vs AA genotypes (95% CI) was 0.01, with p = 0.0001. A significant association with CAD was shown. For the AGT-M235T genotype, within the CAD group, MM was found in 24.0%, 43.6% carried the MT genotype and 32.4% carried the TT genotype. Within the control group, MM was found in 26.4%, 45.5% carried the TT genotype and 28.2% carried the MT genotype. The OR of MM vs TT (95% CI) was 0.79 (0.43 to 1.46), which was insignificant. CONCLUSIONS There is an association between the ACE I/D and Ang II AT2 receptor C3123A polymorphisms and CAD, however, no association was detected between the AGT M235T polymorphism and CAD in the Saudi population.
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Affiliation(s)
- Amal Al-Hazzani
- Department of Botany and Microbiology, College of Science, King Saud University, P.O. Box 22452, Riyadh, 11459 Saudi Arabia
| | - Mohamed S Daoud
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451 Saudi Arabia ; King Fahd Unit Laboratory, Department of Clinical and Chemical Pathology, Kasr Al-Ainy University Hospital, Cairo University, El-Manial, Cairo, 11562 Egypt
| | - Farid S Ataya
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451 Saudi Arabia ; Department of Molecular Biology, Genetic Engineering Division, National Research Center, Dokki, Cairo, 12311 Egypt
| | - Dalia Fouad
- Department of Zoology, College of Science, King Saud University, Riyadh, Saudi Arabia ; Department of Zoology and Entomology, Faculty of Science, Helwan University, Ein Helwan, Cairo, Egypt
| | - Abdulaziz A Al-Jafari
- Department of Biochemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451 Saudi Arabia
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The importance of association between angiotensin-converting enzyme (ACE) Gene I/D polymorphism and diabetic peripheral neuropathy. Gene 2013; 530:253-6. [DOI: 10.1016/j.gene.2013.07.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 07/05/2013] [Accepted: 07/10/2013] [Indexed: 01/04/2023]
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Underwood PC, Adler GK. The renin angiotensin aldosterone system and insulin resistance in humans. Curr Hypertens Rep 2013; 15:59-70. [PMID: 23242734 DOI: 10.1007/s11906-012-0323-2] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Alterations in the renin angiotensin aldosterone system (RAAS) contribute to the underlying pathophysiology of insulin resistance in humans; however, individual differences in the treatment response of insulin resistance to RAAS blockade persist. Thus, understanding inter-individual differences in the relationship between the RAAS and insulin resistance may provide insights into improved personalized treatments and improved outcomes. The effects of the systemic RAAS on blood pressure regulation and glucose metabolism have been studied extensively; however, recent discoveries on the influence of local tissue RAAS in the skeletal muscle, heart, vasculature, adipocytes, and pancreas have led to an improved understanding of how activated tissue RAAS influences the development of insulin resistance and diabetes in humans. Angiotensin II (ANGII) is the predominant RAAS component contributing to insulin resistance; however, other players such as aldosterone, renin, and ACE2 are also involved. This review examines the role of local ANGII activity on insulin resistance development in skeletal muscle, adipocytes, and pancreas, followed by a discussion of the other RAAS components implicated in insulin resistance, including ACE2, Ang1-7, renin, and aldosterone.
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Affiliation(s)
- Patricia C Underwood
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Lee SR, Moon JY, Lee SH, Ihm CG, Lee TW, Kim SK, Chung JH, Kang SW, Kim TH, Park SJ, Kim YH, Jeong KH. Angiotensinogen polymorphisms and post-transplantation diabetes mellitus in Korean renal transplant subjects. Kidney Blood Press Res 2013; 37:95-102. [PMID: 23594830 DOI: 10.1159/000343404] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Post-transplant diabetes mellitus (PTDM) is a common and serious metabolic complication. Genetic polymorphisms of angiotensin-converting enzyme (ACE) and angiotensinogen (AGT) genes have been reported to be related to diabetes mellitus and insulin sensitivity; however, the role of these genes in the development of PTDM is not known. For this purpose, we investigated the association of ACE and AGT genetic polymorphisms with PTDM. METHODS A total of 302 subjects without previously diagnosed diabetes who had received kidney transplants were included. One ACE single nucleotide polymorphism (SNP) (rs4291) and two AGT SNPs (rs 699 and rs 4762) were genotyped from genomic DNA with direct sequencing. RESULTS PTDM developed in 49 (16.2%) of 302 subjects. Subjects in the PTDM were older than those in the non-PTDM. There was a significant difference between the two groups in tacrolimus use (p=0.03). Of the three SNPs, the rs4762 of the AGT gene was significantly associated with the development of PTDM in the dominant models (p = 0.03) after adjusting for age and tacrolimus usage. CONCLUSIONS AGT gene rs4762 polymorphisms may serve as genetic markers for the development of PTDM. The exact molecular mechanisms still need to be clarified.
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Affiliation(s)
- Sul ra Lee
- Division of Nephrology, School of Medicine, Kyung Hee University, Seoul 130-702, Republic of Korea
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Hsiao CF, Sheu WWH, Hung YJ, Lin MW, Curb D, Ranadex K, Quertermous T, Chen YM, Chen IYD, Wu KD. The effects of the renin-angiotensin-aldosterone system gene polymorphisms on insulin resistance in hypertensive families. J Renin Angiotensin Aldosterone Syst 2012; 13:446-54. [PMID: 22419662 DOI: 10.1177/1470320312438790] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The hereditability of insulin resistance has been demonstrated in both familial and twin studies. The effects of renin-angiotensin-aldosterone system gene polymorphisms on insulin resistance remain inconclusive. METHODS This is a sibling-based association study. Polymorphisms of renin-angiotensin-aldosterone system genes were examined in 1113 hypertension and 676 normotension siblings from Chinese and Japanese hypertensive families. The generalized estimation equations method was used to compare the differences in metabolic variables between hypertension and normotensive siblings. RESULTS For the G-6A polymorphism of AGT, GG siblings had lower 2-h insulin than siblings carrying the A allele (p=0.006). Siblings with different variants of the angiotensin II type 1 receptor A1166C had no difference in metabolic variables. Siblings carrying the D allele of the angiotensin converting enzyme gene had higher levels of fasting glucose, fasting insulin, area under the curve of insulin levels and the homeostasis model assessment of insulin resistance than II siblings (all p<0.05). Lower levels of fasting glucose and 2-h glucose were observed in siblings with the T allele than their CC homozygotes for the C-344T polymorphism of CYP11B2 (p<0.05). Siblings carrying three high-risk genotypes of the angiotensin converting enzyme, angiotensinogen and CYP11B2 had higher fasting glucose level than siblings carrying no high-risk genotypes (p=0.011). CONCLUSION Our comprehensive analysis of renin-angiotensin-aldosterone system gene polymorphisms demonstrates that the angiotensin converting enzyme and CYP11B2 gene polymorphisms are associated with insulin resistance in hypertensive families.
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Affiliation(s)
- Chin-Fu Hsiao
- Division of Biostatistics and Bioinformatics, National Health Research Institutes, Taipei, Taiwan
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15
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Nakamura E, Okamoto T, Nagaya K, Hayashi T. Maternal deletion allele of Angiotensin-converting enzyme gene is associated with fetal growth restriction. Pediatr Dev Pathol 2012; 15:114-7. [PMID: 22150532 DOI: 10.2350/11-09-1092-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
To investigate the correlation between maternal and fetal angiotensin-converting enzyme gene insertion or deletion polymorphism and birth size, angiotensin-converting enzyme gene insertion or deletion polymorphisms of 470 Japanese pairs of mothers and infants were genotyped. The relationships between maternal and fetal angiotensin-converting enzyme gene insertion or deletion polymorphisms and birth sizes (weight, length, head circumference, and the incidence of small-for-gestational age status) were analyzed. No relationship between fetal angiotensin-converting enzyme genotype and birth size was observed. In contrast, the incidence of small-for-gestational age status in babies whose mothers had 1 or 2 deletion alleles was greater than that in babies whose mothers had 2 insertion alleles (7% vs 3%, P = 0.045). Maternal deletion allele of angiotensin-converting enzyme is associated with fetal growth restriction in the Japanese normal population.
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Affiliation(s)
- Eiki Nakamura
- Department of Pediatrics, Asahikawa Medical College, 2-1-1-1 Midorigaoka Higashi, Asahikawa, Hokkaido 078-8510, Japan.
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16
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Özdemir BH, Özdemir FN, Ataç FB, Özdemir AA, Haberal M. Angiotensinogen t235 and angiotensin-converting enzyme insertion/deletion polymorphisms associated with the development of posttransplantation diabetes mellitus in renal allograft recipients. Transplant Proc 2011; 43:572-4. [PMID: 21440764 DOI: 10.1016/j.transproceed.2011.01.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Genetic polymorphisms of the renin-angiotensin system (RAS) have been reported to play an important role in the pathogenesis of diabetes mellitus and hypertension. In addition, a close association has been reported between RAS and the progression of both diabetes and hypertension. But the role of RAS on the development of posttransplantation diabetes mellitus (PTDM) is not known. For this purpose we investigated the association of polymorphisms in the genes for angiotensin-converting enzyme (ACE) and angiotensinogen (AGT) with the development of PTDM. METHODS Genotyping for ACE insertion/deletion (I/D) and AGT M235T polymorphisms was performed in 50 patients who underwent renal transplantation during a 5-year period. Group 1 consisted of 23 recipients who developed PTDM and group 2 consisted of 27 recipients that did not have PTDM. RESULTS Of 50 patients, 13 (26%) showed the ACE DD, 21 (42%) the ACE ID, and 16 the ACE II genotype. The frequencies of AGT MM, AGT MT, and AGT TT were 0, 54%, and 46%, respectively. Compared with group 2, there were high frequencies of the AGT TT genotype in group 1 recipients (P<.001). In addition the ACE DD genotype was found significantly higher in group 1 patients compared with group 2 patients (P=.001). CONCLUSION The high frequencies of the AGT TT genotype and ACE DD genotype in recipients may contribute to the high prevalence of PTDM. Our data suggest a synergistic effect between the ACE and AGT polymorphism in the risk of PTDM, but to support this theory a larger patient group must be studied.
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Affiliation(s)
- B H Özdemir
- Department of Pathology, Başkent University, Ankara, Turkey.
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Karabulut A, Turgut S, Turgut G. Angiotensin converting enzyme gene insertion/deletion polymorphism in patients with polycystic ovary syndrome. Gynecol Endocrinol 2010; 26:393-8. [PMID: 20170341 DOI: 10.3109/09513591003632167] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate the relevance of polymorphism in angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism to the pathophysiology of polycystic ovary syndrome (PCOS). SUBJECTS AND METHODS Thirty patients with PCOS by Rotterdam consensus criteria and 33 control subjects were prospectively investigated. ACE gene amplification of DNA was performed by polymerase chain reaction. Homeostatic model assessment (HOMA-IR) was applied. RESULTS Compared to controls, ACE gene DD genotype and D allele were observed more frequently in PCOS (63% vs. 46% for DD genotype and 75% vs. 67% for D allele) (p > 0.05). Body mass index, fasting glucose and insulin levels, HOMA-IR index and total testosterone levels were higher in PCOS group (p < 0.05). The frequencies of D and I alleles were 45 (75%) and 15 (25%) for PCOS group and 44 (67%) and 22 (33%) for control group (p > 0.05). No significant differences were observed in the genotype and allele distributions between cases and control groups. HOMA-IR index was significantly higher in patients with PCOS with DD genotype than those with II genotype (p < 0.05). CONCLUSION The ACE gene polymorphism was not associated with PCOS. However, the presence of D allele was associated with higher rate of insulin resistance in patients with PCOS.
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Affiliation(s)
- Aysun Karabulut
- Department of Obstetrics and Gynecology, Denizli State Hospital, Denizli, Turkey.
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18
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Akin F, Turgut S, Bastemir M, Turgut G, Kursunluoglu R, Karasu U, Guclu A. Angiotensin-Converting Enzyme Gene Polymorphism in Overweight and Obese Turkish Patients with Insulin Resistance. DNA Cell Biol 2010; 29:207-12. [PMID: 20070157 DOI: 10.1089/dna.2009.0934] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Fulya Akin
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Sebahat Turgut
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Mehmet Bastemir
- Department of Endocrinology and Metabolism, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gunfer Turgut
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Raziye Kursunluoglu
- Department of Physiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ugur Karasu
- Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Aydin Guclu
- Department of Internal Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Association of angiotensin-converting enzyme insertion/deletion polymorphism with obesity, cardiovascular risk factors and exercise-mediated changes in Korean women. Eur J Appl Physiol 2009; 105:879-87. [DOI: 10.1007/s00421-008-0973-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2008] [Indexed: 12/24/2022]
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Conen D, Glynn RJ, Buring JE, Ridker PM, Zee RY. Renin-angiotensin and endothelial nitric oxide synthase gene polymorphisms are not associated with the risk of incident type 2 diabetes mellitus: a prospective cohort study. J Intern Med 2008; 263:376-85. [PMID: 18069999 DOI: 10.1111/j.1365-2796.2007.01894.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The renin-angiotensin system and endothelial function have both been implicated in the pathogenesis of type 2 diabetes. The aim of this study was to assess the relationship between a set of well-characterized genetic variants of the renin-angiotensin system and the endothelial nitric oxide synthase (NOS3) gene and the incidence of type 2 diabetes. DESIGN Prospective cohort study. SETTING Women's Health Study, United States. SUBJECTS A total of 24,309 Caucasian women free of diabetes at baseline. MAIN OUTCOME MEASURES Six previously characterized single nucleotide polymorphisms (NOS3 rs1800779, NOS3 rs3918226, NOS3 rs1799983, ACE rs1799752, AGT rs699 and AGTR rs5186) were genotyped. Cox proportional-hazards models were constructed to compare the incidence of type 2 diabetes according to the different genotypes. RESULTS During a median follow-up of 10.2 years (interquartile range 9.6-10.6 years), 999 women developed type 2 diabetes. The age-adjusted incidence rates across the six genotypes were very similar, and ranged from 3.7 to 4.8 cases/1000 person-years of follow-up. The multivariable adjusted hazard ratios (95% confidence intervals) for rs1800779, rs3918226, rs1799983, rs1799752, rs699, and rs5186 were 1.01 (0.92-1.10), 1.09 (0.93-1.27), 0.95 (0.86-1.05), 1.04 (0.95-1.14), 1.08 (0.98-1.18), 1.01 (0.91-1.11), confirming the lack of association between the genotypes and incident type 2 diabetes. Stratification by body mass index revealed essentially unchanged results. Finally, there was no association between NOS3-haplotypes and incident type 2 diabetes. CONCLUSION We did not find an association between six well-characterized genetic polymorphisms of the renin-angiotensin system or the NOS3 gene and the occurrence of type 2 diabetes.
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Affiliation(s)
- D Conen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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21
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ACE gene polymorphism and cardiac structure in patients with insulin resistance. Mol Biol Rep 2008; 36:623-9. [DOI: 10.1007/s11033-008-9222-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2007] [Accepted: 03/04/2008] [Indexed: 12/19/2022]
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Muthumala A, Gable DR, Palmen J, Cooper JA, Stephens JW, Miller GJ, Humphries SE. Is the influence of variation in the ACE gene on the prospective risk of Type 2 diabetes in middle-aged men modified by obesity? Clin Sci (Lond) 2007; 113:467-72. [PMID: 17624939 DOI: 10.1042/cs20070158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is strong evidence for the presence of a functional renin-angiotensin system in diabetogenic tissues, and ACE (angiotensin-converting enzyme) inhibitors may improve glucose metabolism in those individuals at high risk of developing T2DM (Type 2 diabetes). In the present study, we tested the hypothesis that subjects with genetically lower plasma and tissue ACE activity, because of their ACE [I/D (insertion/deletion)] genotype, would have a lower risk of T2DM in 2642 healthy middle-aged Caucasian men (mean age, 56 years) followed-up for 15 years. Obesity was the strongest predictor of T2DM, with an HR (95% CI) [hazard ratio (95% confidence interval)] of 3.74 (2.66-5.26) (P<0.0001). Overall there was no association between ACE genotype (II homozygotes, n=623; and D allele carriers, n=2019) and risk of T2DM, and although in lean men there was no genotype difference in risk in D allele carriers compared with II homozygotes [adjusted HR=0.75 (95% CI, 0.46-1.22)], in obese (body mass index >30 kg/m(2)) men the risk of T2DM was higher [adjusted HR=4.26 (95% CI, 1.30-13.93)] with a genotype-obesity interaction of P=0.01. A similar pattern of risk was seen by re-analysis of a previously published case-control study, where D allele carriers had a non-significant 1.30 (0.97-1.74)-fold higher risk of developing T2DM than II homozygotes when non-obese, but a 1.79 (1.17-2.72) (P=0.007)-fold higher risk when obese. Further prospective studies are needed to confirm these findings. The ACE D allele may worsen glucose metabolism, which could raise the prospective T2DM risk in obese men, but not in lean men. In obesity, adipose tissue undergoes inflammatory infiltration and the subsequent higher levels of pro-inflammatory angiotensin II may explain this association.
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Affiliation(s)
- Amal Muthumala
- Centre For Cardiovascular Genetics, Royal Free and UCL Medical School, The Rayne Institute, 5 University Street, London WC1E 6JF, UK.
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Galletti F, Strazzullo P. Involvement of the renin-angiotensin system in obesity: older and newer pathways. Nutr Metab Cardiovasc Dis 2007; 17:699-704. [PMID: 17698332 DOI: 10.1016/j.numecd.2007.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
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Han T, Wang X, Cui Y, Ye H, Tong X, Piao M. Relationship between angiotensin-converting enzyme gene insertion or deletion polymorphism and insulin sensitivity in healthy newborns. Pediatrics 2007; 119:1089-94. [PMID: 17545375 DOI: 10.1542/peds.2006-3297] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT It was proposed that the association between low birth weight and adult insulin resistance is principally genetically mediated. The insertion/deletion polymorphism of the angiotensin-converting enzyme gene was associated with insulin sensitivity in adults. OBJECTIVE Our goal was to investigate the relationship between angiotensin-converting enzyme gene insertion/deletion polymorphism and the insulin sensitivity in healthy newborns. PATIENTS AND METHODS One hundred eighty healthy newborns, all of whom had a 1-minute Apgar score of > 7 and gestational age > 33 weeks, were enrolled in the study. Fasting glucose and insulin levels were measured on day 2 or 3 after birth, and angiotensin-converting enzyme genotype was determined. RESULTS The observed frequency distribution of angiotensin-converting enzyme genotypes did not deviate from that predicted by Hardy-Weinberg equilibrium in this group. There were no statistically significant differences in birth size and shape in different angiotensin-converting enzyme genotypes. Those carriers of the genotype homozygous for the deletion allele had the highest logarithmically transformed homeostasis model assessment compared with those who were heterozygous or homozygous for the insertion polymorphism. When compared with those with > or = 1 insertion allele, those of the genotype homozygous for the deletion allele had significantly higher logarithmically transformed fasting insulin and logarithmically transformed homeostasis model assessment results. Regarding birth weight, birth length, ponderal index, and fasting glucose concentration, there were no significant differences between the genotype homozygous for the deletion allele and the genotypes heterozygous or homozygous for the insertion allele. CONCLUSIONS In this study, the deletion allele was associated with relatively impaired insulin sensitivity in healthy neonates. It may be a clue to explain the association between the deletion allele and insulin resistance in the long-term.
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Affiliation(s)
- Tongyan Han
- Department of Pediatrics, Third Hospital, Peking University, Beijing 100083, PR China.
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25
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Costacou T, Chang Y, Ferrell RE, Orchard TJ. Identifying genetic susceptibilities to diabetes-related complications among individuals at low risk of complications: An application of tree-structured survival analysis. Am J Epidemiol 2006; 164:862-72. [PMID: 16928730 DOI: 10.1093/aje/kwj287] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The authors hypothesized that genetic predisposition to diabetes complications would be more evident among low-risk individuals and aimed to identify genes related to developing complications (confirmed distal symmetric polyneuropathy, overt nephropathy, or coronary artery disease) in low-risk groups. Participants in the Pittsburgh, Pennsylvania, Epidemiology of Diabetes Complications Study of childhood-onset type 1 diabetes, first seen in 1986-1988 (mean age, 28 years; diabetes duration, 19 years), were reexamined biennially for 10 years. For each complication, subgroups with the lowest disease risk were identified by using tree-structured survival analysis, and 15 candidate genes were compared between subjects with and without complications. In the group with the lowest incidence of confirmed distal symmetric polyneuropathy (n = 123), confirmed distal symmetric polyneuropathy risk increased fivefold for those with the eNOS GG genotype (p < 0.05). In the group with the lowest risk of overt nephropathy (n = 340), the ACE D polymorphism increased overt nephropathy risk twofold (p = 0.05), whereas a protective effect was observed for the LIPC CC genotype (p < 0.05). In the group with the lowest incidence of coronary artery disease (n = 331), the MTHFR CC genotype increased coronary artery disease risk threefold (p < 0.05). Tree-structured survival analysis may help identify genetic predispositions among individuals who, despite low risk, develop diabetes-related complications.
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Affiliation(s)
- Tina Costacou
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
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26
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Affiliation(s)
- Trevor J Orchard
- MBBCh, MMedSci, Diabetes and Lipid Research Bldg., 3512 Fifth Ave., Pittsburgh, PA 15213, USA.
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Freathy RM, Lonnen KF, Steele AM, Minton JAL, Frayling TM, Hattersley AT, Macleod KM. The impact of the angiotensin-converting enzyme insertion/deletion polymorphism on severe hypoglycemia in Type 2 diabetes. Rev Diabet Stud 2006; 3:76-81. [PMID: 17487330 PMCID: PMC1783578 DOI: 10.1900/rds.2006.3.76] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme gene (ACE) is associated with altered serum ACE activity. Raised ACE levels and the ACE DD genotype are associated with a 3.2 to 6.8-fold increased risk of severe hypoglycemia in type 1 diabetes. This relationship has not been assessed in type 2 diabetes. We aimed to test for association of the ACE I/D polymorphism with severe hypoglycemia in type 2 diabetes. Patients with type 2 diabetes (n = 308), treated with insulin (n = 124) or sulphonylureas (n = 184), were classified according to whether or not they had previously experienced severe hypoglycemia. Samples of DNA were genotyped for the ACE I/D polymorphism using two alternative polymerase chain reactions to prevent mistyping due to preferential amplification of the D allele. Overall, 12% of patients had previously experienced one or more episodes of severe hypoglycemia. This proportion did not differ between genotype groups (odds ratio (95% confidence limits) for carriers of D allele relative to II homozygotes: 0.79 (0.35-1.78)). This study found no evidence for association of the ACE I/D polymorphism with severe hypoglycemia frequency in patients with type 2 diabetes. However, we cannot rule out a smaller effect (odds ratio </= 1.78). Our results suggest that any effect of ACE genotype on severe hypoglycemia risk in type 2 patients is likely to be smaller than that seen in type 1 diabetes. We recommend future larger-scale studies.
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Affiliation(s)
- Rachel M Freathy
- Institute of Biomedical and Clinical Science, Peninsula Medical School, Exeter, United Kingdom
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28
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Angiotensin-I-converting enzyme (ACE) insertion/deletion polymorphism in Mexican patients with coronary artery disease. Association with the disease but not with lipid levels. Exp Mol Pathol 2006; 81:131-5. [PMID: 16764852 DOI: 10.1016/j.yexmp.2006.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 03/16/2006] [Accepted: 04/11/2006] [Indexed: 12/01/2022]
Abstract
Angiotensin-I-converting enzyme (ACE) insertion/deletion (ID) polymorphism has been associated with the genetic susceptibility to coronary artery disease (CAD) and also with the lipid profile in several populations. In the present work, we analyzed the distribution of ID polymorphism in 147 Mexican patients with CAD and 100 unrelated healthy controls. The correlation of this polymorphism with the lipid profile (cholesterol, low density lipoprotein-cholesterol, very low density lipoprotein-cholesterol, high density lipoprotein-cholesterol and triglycerides) in the patients group was determined. Increased frequency of D allele as well as DD genotype and decreased frequency of I allele and II genotype were found in CAD patients group (pC = 0.00058, OR = 1.96, pC = 0.021, OR = 2.5 and pC = 0.00058, OR = 0.51, pC = 0.0028, OR = 0.38). Correlation between ID genotypes and lipid profile in patients was carried out in total population and separately for females and males. After they had been adjusted for age, sex and BMI, there was no association among the three genotypes (II, ID and DD) and lipids and lipoproteins in none of the studied groups. Our data suggest that genetic variation at the ACE is a genetic factor related with the susceptibility to coronary artery disease in the Mexican Mestizo population.
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Degirmenci I, Kebapci N, Basaran A, Efe B, Gunes HV, Akalin A, Kurt H, Urhan M, Demirustu C. Frequency of angiotensin-converting enzyme gene polymorphism in Turkish type 2 diabetic patients. Int J Clin Pract 2005; 59:1137-42. [PMID: 16178979 DOI: 10.1111/j.1368-5031.2005.00586.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We aimed to investigate the angiotensin-converting enzyme (ACE) gene polymorphism, ACE activity and their associations with diabetic complications in Turkish patients with type 2 diabetes mellitus. A total of 143 patients and 133 controls were screened for ACE gene I/D polymorphism by using polymerase chain reaction. Serum ACE activities were determined spectrophotometrically. There was no significant difference in the distribution of ACE I/D genotypes between patients and controls. The patients with DD genotype had a higher ACE activity than those with ID and II. Hypertensive diabetic patients with DD genotype had higher ACE activities than those with ID and II. There was no significant difference in the distribution of ACE I/D genotypes between patients with and without nephropathy, retinopathy and hypertension except for patients with and without neuropathy. In patients with DD genotype, creatinine clearance correlated with duration of diabetes. The grade of retinopathy was correlated with duration of diabetes in DD and ID genotypes. The highest ACE activity was measured in hypertensive diabetics with DD genotype. ID genotype was suggested to be a risk factor and II was suggested to be protective for diabetic neuropathy. The DD and ID genotypes might be a predictor for the development of retinopathy in relation to duration of diabetes.
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Affiliation(s)
- I Degirmenci
- Department of Medical Biology, Medical Faculty, Osmangazi University, Eskisehir, Turkey.
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30
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Abstract
Type 2 diabetes mellitus is becoming a major health problem associated with excess morbidity and mortality. As the prevalence of type 2 diabetes is rapidly increasing, prevention of the disease should be considered as a key objective in the near future. Besides lifestyle changes, various pharmacological treatments have proven their efficacy in placebo-controlled clinical trials, including antidiabetic drugs such as metformin, acarbose and troglitazone, or antiobesity agents such as orlistat. Arterial hypertension, a clinical entity in which insulin resistance is common, is strongly associated with type 2 diabetes and may precede the disease by several years. While antihypertensive agents such as diuretics or beta-adrenoceptor antagonists may worsen insulin resistance and impair glucose tolerance, newer antihypertensive agents exert neutral or even slightly positive metabolic effects. Numerous clinical trials have investigated the effects of ACE inhibitors or angiotensin II receptor antagonists (ARAs) on insulin sensitivity in hypertensive patients, with or without diabetes, with no consistent results. Almost half of the studies with ACE inhibitors in hypertensive nondiabetic individuals demonstrated a slight but significant increase in insulin sensitivity as assessed by insulin-stimulated glucose disposal during a euglycaemic hyperinsulinaemic clamp, while the other half failed to reveal any significant change. The effects of ARAs on insulin sensitivity are neutral in most studies. Mechanisms of improvement of glucose tolerance and insulin sensitivity through the inhibition of the renin-angiotensin system (RAS) are complex. They may include improvement of blood flow and microcirculation in skeletal muscles and, thereby, enhancement of insulin and glucose delivery to the insulin-sensitive tissues, facilitating insulin signalling at the cellular level and improvement of insulin secretion by the beta cells. Six recent large-scale clinical studies reported a remarkably consistent reduction in the incidence of type 2 diabetes in hypertensive patients treated with either ACE inhibitors or ARAs for 3-6 years, compared with a thiazide diuretic, beta-adrenoceptor antagonist, the calcium channel antagonist amlodipine or even placebo. The relative risk reduction averaged 14% (p = 0.034) in the CAPPP (Captopril Prevention Project) with captopril compared with a thiazide or beta1-adrenoceptor antagonist, 34% (p < 0.001) in the HOPE (Heart Outcomes Prevention Evaluation) study with ramipril compared with placebo, 30% (p < 0.001) in the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) with lisinopril compared with chlortalidone, 25% (p < 0.001) in the LIFE (Losartan Intervention For Endpoint reduction in hypertension study) with losartan compared with atenolol, and 25% (p = 0.09) in the SCOPE (Study on Cognition and Prognosis in the Elderly) with candesartan cilexetil compared with placebo, and 23% (p < 0.0001) in the VALUE (Valsartan Antihypertensive Long-term Use Evaluation) trial with valsartan compared with amlodipine. All these studies considered the development of diabetes as a secondary endpoint, except the HOPE trial where it was a post hoc analysis. These encouraging observations led to the initiation of two large, prospective, placebo-controlled randomised clinical trials whose primary outcome is the prevention of type 2 diabetes: the DREAM (Diabetes REduction Approaches with ramipril and rosiglitazone Medications) trial with the ACE inhibitor ramipril and the NAVIGATOR (Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research) trial with the ARA valsartan. Finally, ONTARGET (ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial) will also investigate as a secondary endpoint whether it is possible to prevent the development of type 2 diabetes by blocking the RAS with either an ACE inhibitor or an ARA or a combination of both. Thus, the recent consistent observations of a 14-34% reduction of the development of diabetes in hypertensive patients receiving ACE inhibitors or ARAs are exciting. From a theoretical point of view, they emphasise that there are many aspects of the pathogenesis, prevention and treatment of type 2 diabetes that still need to be uncovered. From a practical point of view, they may offer a new strategy to reduce the ongoing epidemic and burden of type 2 diabetes.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Department of Medicine, Nutrition and Metabolic Disorders, CHU Sart Tilman, Liège, Belgium.
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Ribichini F, Ferrero V, Matullo G, Feola M, Vado A, Camilla T, Guarrera S, Carturan S, Vassanelli C, Uslenghi E, Piazza A. Association study of the I/D polymorphism and plasma angiotensin-converting enzyme (ACE) as risk factors for stent restenosis. Clin Sci (Lond) 2004; 107:381-9. [PMID: 15101817 DOI: 10.1042/cs20030380] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2003] [Revised: 02/23/2004] [Accepted: 04/21/2004] [Indexed: 12/13/2022]
Abstract
The ID (insertion/deletion) polymorphism of the ACE (angiotensin-converting enzyme) gene controls plasma ACE levels. Both have been correlated with ISR (in-stent restenosis) in preliminary analyses, but not confirmed in larger studies. In the present study, baseline and 6-month quantitative coronary analysis were performed in 897 patients who had stent implantation and the ID polymorphism genotyped. Plasma ACE levels were measured in 848 patients (95%). Restenosis rates among genotypes were 31.2% DD, 25.5% ID and 28.8% II (not significant). Plasma ACE levels were significantly higher in restenotic patients compared with patients without restenosis (30.7+/-18.6 units/l compared with 22.8+/-12.8 units/l; P=0.0001) and a strong independent predictor of ISR [OR (odds ratio)=3.70; 95% CI (confidence interval), 2.40-5.71; P<0.0001], except in diabetics. In the subgroup of diabetics and patients with AMI (acute myocardial infarction), the DD genotypes actually had a lower risk of ISR than the II genotypes (diabetics, OR=0.16; 95% CI, 0.04-0.69; P=0.014; and patients with AMI, OR=0.21; 95% CI, 0.061-0.749; P=0.016). After exclusion of diabetics and patients with AMI, ISR rates for genotypes in 632 patients were 31.7% DD, 24.3% ID and 17.6% II (P=0.02; DD compared with non-DD OR=1.57; 95% CI, 1.09-2.25). The association between the D allele and ISR observed in selected populations does not hold with a larger sample size. Other than sample size, clinical variables can modulate the association between ID polymorphism and ISR. Plasma ACE level is a risk factor for ISR, independently of the ID genotype.
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Affiliation(s)
- Flavio Ribichini
- Division of Cardiology, Universita' del Piemonte Orientale, Ospedale Maggiore della Carita', Novara, Italy
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32
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Heimann AS, Favarato MH, Gozzo FC, Rioli V, Carreño FR, Eberlin MN, Ferro ES, Krege JH, Krieger JE. ACE gene titration in mice uncovers a new mechanism for ACE on the control of body weight. Physiol Genomics 2004; 20:173-82. [PMID: 15522949 DOI: 10.1152/physiolgenomics.00145.2004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Mice harboring 1, 2, or 3 copies of the angiotensin-converting enzyme (ACE) gene were used to evaluate the quantitative role of the ACE locus on obesity. Three-copy mice fed with a high-fat diet had lower body weight and peri-epididymal adipose tissue than did 1- and 2-copy mice (P < 0.05). On regular diet, 3-copy mice had to eat more to maintain the same body weight; on a high-fat diet, they ate the same but weighed less than 1- and 2-copy mice (P < 0.05), indicating a higher metabolic rate in 3-copy mice that was not affected by ANG II AT(1) blocker treatment. A catalytically inactive form of thimet oligopeptidase (EC 3.4.24.15; EP24.15) was used to isolate ACE substrates from adipose tissue. Liquid chromatography electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) identified 162 peptide peaks; 16 peptides were present in both groups (1- and 3-copy mice fed with a high-fat diet), whereas 58 of the 72 unique peptides were found only in the 3-copy mice. Peptide size distribution was shifted to lower molecular weight in 3-copy mice. Two of the identified peptides, LVVYPWTQRY and VVYPWTQRY, which are ACE substrates, inhibited in vitro protein kinase C phosphorylation in a concentration-dependent manner. In addition, neurolysin (EC 3.4.24.16; EP24.16) activity was lower in fat tissue from 3- vs. 1-copy mice (P < 0.05). Taken together, these results provide evidence that ACE is associated with body weight and peri-epididymal fat accumulation. This response may involve the generation of oligopeptides that inhibit the activity of EP24.16 and other oligopeptidases within the adipose tissue.
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Affiliation(s)
- A S Heimann
- Heart Institute (InCor) and Department of Medicine-LIM13, University of São Paulo Medical School, São Paulo, Brazil
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33
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Liu KP, Lin CY, Chen HJ, Wei CF, Lee-Chen GJ. Renin-angiotensin system polymorphisms in Taiwanese primary vesicoureteral reflux. Pediatr Nephrol 2004; 19:594-601. [PMID: 15045574 DOI: 10.1007/s00467-003-1379-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2003] [Revised: 10/28/2003] [Accepted: 11/03/2003] [Indexed: 03/01/2023]
Abstract
We studied the angiotensin-converting enzyme (ACE), angiotensinogen (AGT), and angiotensin II type 1 receptor (AT1R) gene polymorphisms for association with susceptibility to primary vesicoureteral reflux (VUR) and disease progression in 74 Taiwanese children, including 16 with end-stage renal disease (ESRD), and 117 normal controls. Polymerase chain reaction-amplified products containing the ACE gene T-5491C, A-5466C, T-3892C, A-3692C, A-240T, Alu I/D, the AGT gene C-532T, G-217A, G-152A, A-20C, A-6G, T174M, T235M, and the AT1R gene A-1138T, T-810A, T-713G, C-521T, AG-214CC, A-153G, A1166C polymorphisms were analyzed by restriction enzyme digestion, gel electrophoresis, or single-strand conformation polymorphism analysis. All the polymorphisms examined were in Hardy-Weinberg equilibrium. The strong non-random association within the ACE, AGT, and AT1R genes suggests low levels of intragenic recombination. None of these polymorphisms showed association with VUR susceptibility. However, the allele frequency distribution of the six ACE polymorphisms among primary VUR patients with or without ESRD was statistically different. The linked ACE T-A-T-A-A-I allele was observed significantly more frequently in VUR children with ESRD (P<0.001). A significant increase of left ventricular mass index was also found in the linked ACE T-A-T-A-A-I allele group compared with the non-ACE T-A-T-A-A-I allele group of patients aged 18 years with renal progression. The AGT A-6G genotype frequencies were significantly different when the analysis was stratified by genotype of the ACE polymorphisms. The data showed that ACE gene polymorphisms were associated with progressive renal deterioration in Taiwanese children with VUR and might act synergistically with the -6 G allele of the AGT gene.
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Affiliation(s)
- Kuo-Pao Liu
- Department of Life Science, National Taiwan Normal University, Taipei, Taiwan
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Strazzullo P, Galletti F. Impact of the renin-angiotensin system on lipid and carbohydrate metabolism. Curr Opin Nephrol Hypertens 2004; 13:325-32. [PMID: 15073492 DOI: 10.1097/00041552-200405000-00010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE OF REVIEW This review is intended to provide an update of the impact of the renin-angiotensin system on lipid and carbohydrate metabolism and of its relationship with adipose-tissue and skeletal muscle activities. RECENT FINDINGS The components of the renin-angiotensin system are fully represented in the adipose tissue and appear to be upregulated in obesity--a condition associated with enhanced circulating angiotensinogen levels. The local renin-angiotensin system plays a role in adipocyte differentiation and possibly in body-fat accumulation. In humans, angiotensin II produced by mature adipocytes appears to inhibit the differentiation of adipocyte precursors, thus decreasing the percentage of small insulin-sensitive adipocytes. In turn, the lipid-storage capacity of adipose tissue could become reduced and triglycerides might accumulate in liver and skeletal muscle, contributing to insulin resistance. Randomized controlled trials indicating that pharmacological renin-angiotensin system blockade improves insulin sensitivity and reduces the risk of type 2 diabetes are in keeping with this possibility. The local renin-angiotensin system in skeletal muscle may affect exercise performance and the individual response to different types of muscular performance. The concept that the local renin-angiotensin system plays a role in body-fat storage and in lipid and carbohydrate metabolism is further supported by genetic studies showing that susceptibility to weight gain and possibly insulin resistance is greater in individuals carrying certain renin-angiotensin system allelic variants associated with alterations in systemic and local angiotensinogen levels and angiotensin-converting enzyme activity. SUMMARY In summary, the aforementioned data imply that the renin-angiotensin system plays a substantial role in obesity, insulin resistance and the associated increase in blood pressure.
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Affiliation(s)
- Pasquale Strazzullo
- Department of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy.
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Chou HT, Tsai CH, Tsai FJ. Association Between Angiotensin I-Converting Enzyme Gene Insertion/Deletion Polymorphism and Risk of Rheumatic Heart Disease. ACTA ACUST UNITED AC 2004; 45:949-57. [PMID: 15655270 DOI: 10.1536/jhj.45.949] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Scarring and collagen deposition in the valves and destruction of myocytes may result from the combined effects of a smoldering rheumatic process and a constant trauma to the mitral valve or aortic valve by the turbulent flow in rheumatic heart disease (RHD). It has been suggested that angiotensin I-converting enzyme (ACE) may be responsible for the increased valvular fibrosis and calcification in the pathogenesis of RHD. However, the role of ACE genetic variant in RHD has not been studied among the Chinese population in Taiwan. Hence, a case-controlled study was carried out to investigate the possible relationship between the ACE gene insertion/deletion (I/D) and G2350A polymorphisms and RHD. A group of 115 patients with RHD documented by echocardiography and 100 age- and sex-matched normal control subjects were studied. ACE gene I/D and G2350A polymorphisms were identified by polymerase chain reaction-based restriction analysis. There was a significant difference in the distribution of ACE I/D genotypes (P = 0.02) and allelic frequencies (P = 0.04) between RHD cases and normal controls. An odds ratio for the risk of RHD associated with the ACE I/D II genotype was 2.12 (95% CI, 1.21-3.71). An odds ratio for the risk of RHD associated with the ACE I allele was 1.50 (95% CI, 1.02-2.21). The ACE G2350A polymorphism showed no association with RHD (P = 0.90). Further categorization of RHD patients into mitral valve disease and combined valve disease subgroups revealed no statistical difference in these gene polymorphisms when compared between the two subgroups. This study shows that patients with RHD have a higher frequency of ACE II genotype and I allele, which supports a role for ACE I/D gene polymorphisms in determining the risk of RHD in Taiwan Chinese.
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Affiliation(s)
- Hsiang-Tai Chou
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung 404, Taiwan, ROC
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36
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Higgins KS. Hypoglycaemia: ACE high or low? Diabet Med 2003; 20 Suppl 4:4-6. [PMID: 12940858 DOI: 10.1046/j.1464-5491.2003.00013.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- K S Higgins
- Leicester Royal Infirmary, University Hospitals of Leicester NHS Trust, Leicester, UK
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Bloomgarden ZT. American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome: 25-26 August 2002, Washington, DC. Diabetes Care 2003; 26:933-9. [PMID: 12610060 DOI: 10.2337/diacare.26.3.933] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Orchard TJ, Chang YF, Ferrell RE, Petro N, Ellis DE. Nephropathy in type 1 diabetes: a manifestation of insulin resistance and multiple genetic susceptibilities? Further evidence from the Pittsburgh Epidemiology of Diabetes Complication Study. Kidney Int 2002; 62:963-70. [PMID: 12164879 DOI: 10.1046/j.1523-1755.2002.00507.x] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The pathogenesis of diabetic nephropathy remains unclear, although previous reports implicate a wide range of putative genetic and metabolic factors. METHODS Incident and prevalent cases of overt nephropathy (ON), defined as an albumin excretion rate>200 microg/min in at least two of the three timed urines, from the Pittsburgh Epidemiology of Diabetes Complication Study (a prospective epidemiologic study of an incident cohort of childhood onset type 1 diabetic subjects) were studied. RESULTS Incidence analyses reveal differences in univariate baseline risk factors that predict ON within 5 years of measurement [low-density lipoprotein (LDL) cholesterol, triglycerides, white blood cell count, and hypertension] and those that predict in the long-term, that is, 6 to 10 years after baseline, hemoglobin A1 (Hb A1). Estimated glucose disposal rate (calculated using a formula derived from euglycemic-hyperinsulinemic clamp studies), however, strongly (P < 0.001) predicted ON throughout follow-up. Comparing individuals who were most susceptible to ON (those with an onset before 20 years duration of type 1 diabetes and before the development of other advanced complications) with the least susceptible (late or no occurrence of ON despite the development of other advanced complications) revealed otherwise undetected genetic associations [that is, apolipoprotein E (Apo E), angtiotensin-converting enzyme insertion/deletion (ACE I/D), and lipoprotein lipase (LPL) HindIII polymorphism) with odds ratios ranging from 2.9 to 7.1. CONCLUSIONS In type 1 diabetes insulin resistance is an underlying risk state for ON, which may be accelerated by other disturbances (for example, hypertension and dyslipidemia). A novel approach to classifying (that is, phenotyping) subjects, which compares those at the extremes of susceptibility, reveals strong genetic associations and important interactions with other risk factors not otherwise apparent.
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Affiliation(s)
- Trevor J Orchard
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, DLR Building, 35123 Fifth Avenue, Pittsburgh, PA 15213, USA.
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39
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Feng Y, Niu T, Xu X, Chen C, Li Q, Qian R, Wang G, Xu X. Insertion/deletion polymorphism of the ACE gene is associated with type 2 diabetes. Diabetes 2002; 51:1986-8. [PMID: 12031990 DOI: 10.2337/diabetes.51.6.1986] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In an attempt to examine the role of an ACE gene insertion/deletion (I/D) polymorphism in type 2 diabetes, we conducted a case-control association study among 132 couple-pairs from northern China. The genotype frequencies for II, ID, and DD were 39.8, 39.8, and 20.3%, respectively, in the case group and 44.8, 44.8, and 10.4% in the control group. The DD frequency was significantly higher in the case group than in the control group (chi(2)(1) = 4.77, P = 0.03), suggesting that the DD genotype is associated with an increased susceptibility to type 2 diabetes in our study population.
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Affiliation(s)
- Yan Feng
- Division of Endocrinology, the Third Affiliated Hospital of Beijing University, Beijing, China
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40
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Hurlbut DE, Lott ME, Ryan AS, Ferrell RE, Roth SM, Ivey FM, Martel GF, Lemmer JT, Fleg JL, Hurley BF. Does age, sex, or ACE genotype affect glucose and insulin responses to strength training? J Appl Physiol (1985) 2002; 92:643-50. [PMID: 11796676 DOI: 10.1152/japplphysiol.00499.2001] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The purpose of the present study was to determine whether age, sex, or angiotensin I-converting enzyme (ACE) genotype influences the effects of strength training (ST) on glucose homeostasis. Nineteen sedentary young (age = 20-30 yr) men (n = 10) and women (n = 9) were studied and compared with 21 sedentary older (age = 65-75 yr) men (n = 12) and women (n = 9) before and after a 6-mo total body ST program. Fasting insulin concentrations were reduced in young men and in older men with ST (P < 0.05 in both). In addition, total insulin area under the curve decreased by 21% in young men (P < 0.05), and there was a trend for a decrease (11%) in older men (P = 0.06). No improvements in insulin responses were observed in young or older women. The ACE deletion/deletion genotype group had the lowest fasting insulin and insulin areas under the oral glucose tolerance test (OGTT) curve before training (all P < 0.05), but those with at least one insertion allele had a trend for a greater reduction in total insulin area than deletion homozygotes (P = 0.07). These results indicate that ST has a more favorable effect on insulin response to an OGTT in men than in women and offer some support for the hypothesis that ACE genotype may influence insulin responses to ST.
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Affiliation(s)
- D E Hurlbut
- Department of Kinesiology, College of Health and Human Performance, University of Maryland, College Park, Maryland 20742, USA
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41
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Abstract
Clustering of diseases has been appreciated by health insurers and epidemiologists for some time. Co-morbidity suggests shared pathways of disease. It is by now well agreed that common diseases have a strong genetic component. Here we present evidence that the angiotensin I-converting enzyme (ACE) deletion/deletion (D/D) genotype is associated with a large number of common adult diseases, including cardiovascular disease, cancer, and psychiatric disease. Since the ACE D/D genotype has been shown to be associated with increased levels of tissue ACE expression at the protein level, these data suggest that overactivity of ACE may be involved in the pathogenesis of common diseases, as well as the utility of effective ACE inhibition in their treatment and, perhaps, prevention.
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42
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Thamer C, Koch M, Haap M, Machicao F, Häring HU, Stumvoll M. Association of the ACE gene I/D polymorphism with insulin sensitivity depends on the presence of additional macroangiopathic risk factors. Atherosclerosis 2002; 160:257-8. [PMID: 11755945 DOI: 10.1016/s0021-9150(01)00739-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ryan AS, Nicklas BJ, Berman DM, Ferrell RE. The insertion/deletion polymorphism of the ACE gene is related to insulin sensitivity in overweight women. Diabetes Care 2001; 24:1646-52. [PMID: 11522714 DOI: 10.2337/diacare.24.9.1646] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The ACE insertion/deletion (I/D) polymorphism has been identified as a genetic risk factor for coronary heart disease (CHD). The deletion (D) allele of the ACE gene may be associated with higher insulin sensitivity. Individuals who are homozygous for the DD allele have higher ACE levels and possibly more angiotensin II, which, when infused exogenously, causes an increase in insulin sensitivity. The purpose of this study was to investigate the association of the I/D polymorphism of the ACE gene with insulin sensitivity and CHD risk factors. RESEARCH DESIGN AND METHODS The study included 66 women (ages 57 +/- 1 years) who were overweight or obese (means +/- SEM, BMI = 33 +/- 1 kg/m(2)) and sedentary (VO(2max) = 19.6 +/- 0.4 ml. kg(-1). min(1)). Total body fat mass and percent fat were determined by dual-energy X-ray absorptiometry, and abdominal fat was by computed tomography. Insulin sensitivity was measured during the last 30 min of 3-h hyperinsulinemic-euglycemic clamps (40 mU. m(-2). min(-1)). Comparisons were made among women with the II (n = 9), ID (n = 36), and DD (n = 21) genotypes. RESULTS Age, percent body fat, waist-to-hip ratio, visceral and subcutaneous abdominal fat areas, plasma lipid levels, and systolic and diastolic blood pressures did not differ by ACE genotype. Fasting glucose and 2-h glucose levels were similar among genotypes, but fasting plasma insulin levels were lower in DD women than in ID women (P < 0.05). Glucose utilization was higher in women with the DD genotype than in women with the II genotype (53.1 +/- 3.9 vs. 36.0 +/- 3.8 micromol. kg(-1) FFM. min(-1), P = 0.01) and was higher in ID women than in II women (48.5 +/- 2.5 micromol. kg(-1) FFM. min(-1), P = 0.04). CONCLUSIONS These data suggest that the I/D polymorphism is not associated with risk factors for CHD in overweight sedentary women; however, women who are homozygous for the D allele of the ACE gene are more insulin sensitive, whereas women who are homozygous for the I allele of the ACE gene have greater insulin resistance and potential risk for type 2 diabetes.
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Affiliation(s)
- A S Ryan
- Department of Medicine, Division of Gerontology at the University of Maryland School of Medicine, Baltimore, MD, USA.
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Viitanen L, Pihlajamäki J, Halonen P, Lehtonen M, Kareinen A, Lehto S, Laakso M. Association of angiotensin converting enzyme and plasminogen activator inhibitor-1 promoter gene polymorphisms with features of the insulin resistance syndrome in patients with premature coronary heart disease. Atherosclerosis 2001; 157:57-64. [PMID: 11427204 DOI: 10.1016/s0021-9150(00)00705-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Polymorphisms of the angiotensin-converting enzyme (ACE) (insertion/deletion (I/D) in intron 16) and of the plasminogen activator inhibitor-1 (PAI-1) (promoter 4G/5G) genes have been linked with coronary heart disease (CHD) and/or myocardial infarction (MI). We studied the association of polymorphisms in these genes with CHD with linkage and association analyses in 118 families with premature and severe CHD and in 110 healthy controls. In linkage analysis there was no evidence for a linkage of the ACE or PAI-1 loci with CHD. However, in quantitative linkage analysis the ACE locus was linked with fasting glucose (P=0. 047) and fasting free fatty acid levels (P=0.029). In association analysis the ACE genotype frequencies of probands with CHD did not differ from those of healthy controls. Normoglycemic probands with MI and with the ACE polymorphism DD genotype had characteristics of the insulin resistance syndrome. They had higher levels of 1-h glucose (P=0.008) and 2-h free fatty acids (P=0.011) in an oral glucose tolerance test and higher levels of total (P=0.005) and very-low-density lipoprotein triglycerides (P=0.006) than probands with the ID or the II genotypes. The PAI-1 gene polymorphism was not associated with any of the variables of glucose or lipid metabolism. In conclusion, the ACE and PAI-1 gene polymorphisms are not linked with early-onset CHD. However, the ACE gene polymorphism is associated with features of the insulin resistance syndrome.
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Affiliation(s)
- L Viitanen
- Department of Medicine, University of Kuopio, PO Box 1627, 70 211 Kuopio, Finland
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45
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Paolisso G, Tagliamonte MR, De Lucia D, Palmieri F, Manzella D, Rinaldi C, Bossone A, Colaizzo D, Margaglione M, Varricchio M. ACE gene polymorphism and insulin action in older subjects and healthy centenarians. J Am Geriatr Soc 2001; 49:610-4. [PMID: 11380755 DOI: 10.1046/j.1532-5415.2001.49122.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate the possible relationship between angiotensin-converting enzyme (ACE) insertion-deletion (ID) genotype and insulin resistance in a population of healthy older Italian subjects. DESIGN Prospective recruitment of a convenience sample. PARTICIPANTS One hundred twenty-five subjects age 62 to 105 in good health and not taking any drug known to interfere with glucose metabolism. RESULTS In the sample population, the relative frequencies of the ACE genotypes deletion-deletion (DD) (0.424), ID (0.400), and insertion-insertion (II) (0.176) were not significantly different from values predicted by Hardy-Weinberg equilibrium. The genotype distribution was similar in men and women. Subjects carrying the II genotype had a higher FPG (P <.001) and FPI (P <.001) than did subjects with DD or ID genotype. Subjects with II genotype also had a significantly higher HOMA index than did subjects with DD or ID genotype (P for trend <.002). In a multivariate stepwise regression analysis, the ACE ID polymorphism was significantly and independently associated with the HOMA index (P <.001). The same result was confirmed performing multivariate analysis in the younger group and centenarians separately. CONCLUSIONS In an older population, the presence of II ACE genotype is associated with a high degree of insulin resistance independent of other anthropometric variables known to interfere with insulin action; this association is significant in both the younger subjects and the centenarians.
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Affiliation(s)
- G Paolisso
- Department of Geriatric Medicine and Metabolic Diseases, Institute of General Pathology and Oncology, Second University of Naples, Italy
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46
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Thomas GN, Tomlinson B, Chan JC, Sanderson JE, Cockram CS, Critchley JA. Renin-angiotensin system gene polymorphisms, blood pressure, dyslipidemia, and diabetes in Hong Kong Chinese: a significant association of tne ACE insertion/deletion polymorphism with type 2 diabetes. Diabetes Care 2001; 24:356-61. [PMID: 11213892 DOI: 10.2337/diacare.24.2.356] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In Chinese populations, hypertension is common and is a major risk factor for cerebrovascular and coronary heart disease, particularly when associated with diabetes. The clustering of these disorders and dyslipidemia and obesity is termed the metabolic syndrome and is increasing in prevalence in the populations of modernizing Asian nations. The renin-angiotensin system (RAS) helps maintain blood pressure and salt homeostasis and may play a role in the pathogenesis of aspects of the metabolic syndrome. We investigated three RAS gene polymorphisms--the ACE insertion/deletion (I/D), angiotensinogen (AGT) M235T, and angiotensin II type 1 receptor (AT1R) A1166C polymorphisms--for a possible role in modulating these disorders in 853 Chinese subjects with varying components of the metabolic syndrome. RESEARCH DESIGN AND METHODS The three gene polymorphisms of this cross-sectional study were detected using polymerase chain reaction-based protocols. The genotype frequencies were compared between the controls (n = 119) and both overlapping and nonoverlapping groups of patients with type 2 diabetes, hypertension, and dyslipidemia using chi2 test. Differences in levels of the biochemical parameters between the genotypes were determined using analysis of variance. RESULTS No significant relationship was identified between these polymorphisms and blood pressure in this population. Although the AT1RA1166C polymorphism was not associated with any aspect of the metabolic syndrome examined, there was limited evidence to suggest that the AGT M235T polymorphism may be associated with cholesterol levels. The ACE I allele was significantly more frequent in each group comprising subjects with type 2 diabetes/glucose intolerance (GIT), and the I allele was associated with higher fasting plasma glucose levels. CONCLUSIONS These findings suggest that these polymorphisms are unlikely to be involved in the pathogenesis of hypertension. The ACE I/D polymorphism was associated with the metabolic syndrome, having a higher frequency of I allele-containing genotypes in those groups, but this appeared to result predominantly from the relationship with type 2 diabetes/GIT in this population of Chinese subjects.
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Affiliation(s)
- G N Thomas
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin.
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47
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Pankow JS, Arnett DK, Borecki IB, Hunt SC, Eckfeldt JH, Folsom AR, Djoussé L. Lack of association between the angiotensin-converting enzyme insertion/deletion polymorphism and plasminogen activator inhibitor-1 antigen levels in the National Heart, Lung, and Blood Institute Family Heart Study. Blood Coagul Fibrinolysis 2000; 11:551-8. [PMID: 10997795 DOI: 10.1097/00001721-200009000-00007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Experimental and clinical research supports a direct link between activation of the renin-angiotensin system and production of plasminogen activator inhibitor-1 (PAI-1), the primary physiologic inhibitor of tissue plasminogen activator. Several studies have reported higher PAI-1 levels in individuals carrying the deletion (D) allele of the angiotensin-converting enzyme (ACE) gene. We investigated the association between ACE genotypes and plasma PAI-1 levels in a family study of 577 women and 428 men from four US communities. Participants were between 25 and 84 years of age without evidence of coronary heart disease (CHD). Mean geometric plasma PAI-1 levels adjusted for ethnicity were 17.4, 17.9, and 18.1 ng/ml in participants with the DD, insertion-deletion (ID), and II genotypes, respectively (P = 0.89 for difference). We found no associations between ACE I/D genotypes and plasma PAI-1 antigen concentrations in a subset of participants without major CHD risk factors (hypertension, hypercholesterolemia, overweight, smoking, diabetes) or in a small sample of African-Americans. Our findings suggest that the ACE insertion/deletion polymorphism has relatively little, if any, influence on circulating PAI-1 levels in the population at large.
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Affiliation(s)
- J S Pankow
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, 27514, USA.
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Ohishi M, Rakugi H, Miki T, Katsuya T, Okamura A, Kamide K, Nakata Y, Takami S, Ikegami H, Yanagitani Y, Tabuchi Y, Kumahara Y, Higaki J, Ogihara T. Deletion polymorphism of angiotensin-converting enzyme gene is associated with postprandial hyperglycaemia in individuals undergoing general check-up. Clin Exp Pharmacol Physiol 2000; 27:483-7. [PMID: 10874503 DOI: 10.1046/j.1440-1681.2000.03278.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
1. Deletion polymorphism, DD, of the angiotensin-converting enzyme (ACE) gene is reported to be related to cardiovascular disease, which is frequently based on insulin resistance. 2. To clarify the relationship between the ACE genotype DD and plasma glucose increases after an oral glucose load, we performed 75 g oral glucose tolerance test (OGTT) in 301 nondiabetic men (age range 30-60 years) undergoing general check-up. 3. Insertion/deletion (I/D) polymorphism of the ACE gene was explored using a polymerase chain reaction. The frequency of the II, ID and DD genotypes was 0.43, 0.43 and 0.14, respectively. 4. There were no differences in baseline clinical characteristics between subjects with each ACE genotype. 5. The mean (+/- SEM) plasma glucose level at 60 min of the OGTT was significantly higher in subjects with the DD genotype (170.8 +/- 6.9 mg/dL) than in subjects with either the II or ID genotype (mean value for two groups 156.6 +/- 2.7 mg/dL; P < 0.05). Moreover, the mean percentage change of plasma glucose after 60 min of the OGTT, a marker of plasma glucose increase, was significantly higher in individuals with the DD genotype than in individuals with either the II or ID genotypes. 6. In contrast, the mean fasting plasma glucose level, the plasma glucose level at 120 min, the glucose response area and the fasting insulin level were not different between individuals with the DD genotype and individuals with other genotypes. 7. In conclusion, subjects with the DD genotype showed transiently higher levels of plasma glucose after an oral glucose load than subjects with other genotypes. Further studies are required to determine whether the association between ACE genotype and postprandial hyperglycaemia influences the incidence of cardiovascular disease and diabetes mellitus.
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Affiliation(s)
- M Ohishi
- Department of Geriatric Medicine, Osaka University Medical School, Suita, Japan
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Abstract
The renin-angiotensin-aldosterone system (RAS) plays a pivotal role in the cardiovascular system, and the therapeutic agents which interact with this pathway have a significant impact in both heart failure and following myocardial infarction (MI). Polymorphisms within the genes controlling this enzyme system may also contribute to the pathogenesis of cardiovascular disease. Over the last decade an association between a polymorphism of the angiotensin converting enzyme (ACE) gene (called the DD-ACE polymorphism) and phenotypic expression of cardiovascular disease, namely MI, has been reported. Since then, several small case-controlled studies have confirmed an association with manifestations of ischaemic heart disease or various other cardiac end points. However, in a large prospective study the ACE gene was found to confer no appreciable risk. This review article considers the evidence that links polymorphisms of the ACE gene with cardiovascular disease. The Medline database (1990 - 2000) was searched using the keywords myocardial infarction, ischaemic heart disease, angiotensin converting enzyme, polymorphisms (a search of the reference citations of relevant articles was also performed), and clinical studies on cardiovascular disease related to the ACE genotype were selected. Taken together, the available evidence supports the notion that the DD-ACE genotype adversely influences specific cardiovascular diseases, but appears to do so in specific geographical areas and in particular patient subgroups. It is not yet known whether it does this through an interaction with other genes or by as yet unexplained biochemical mechanisms. However, the impact of the DD-ACE genotype appears to be small and its clinical manifestations rather heterogeneous. This finding is not in contrast to the overall impact of the renin-angiotensin system in cardiovascular disease, given the fact that the ACE enzyme is only one component in the renin-angiotensin cascade and that one genetic variant cannot be expected to contribute more than a minor individual impact in genetically complex multifactorial cardiovascular disease.
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Affiliation(s)
- R Butler
- Dept of Cardiology, Glenfield Hospital, Leicester, UK.
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