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Zhuang Y, Niu F, Liu D, Sun J, Zhang X, Zhang J, Guo S. Association between AGTR1 A1166C polymorphism and the susceptibility to diabetic nephropathy: Evidence from a meta-analysis. Medicine (Baltimore) 2018; 97:e07689. [PMID: 30313019 PMCID: PMC6203571 DOI: 10.1097/md.0000000000007689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diabetic nephropathy (DN) is a common complication in patients with diabetic mellitus (DM). Growing evidences have demonstrated that the polymorphisms of angiotensin II receptor type 1 (AGTR1) showed significant association with DN onset, but no consensus has been achieved yet. Therefore, we performed this meta-analysis to combine the findings of previous researches for a more comprehensive conclusion. METHODS Eligible publications were identified through electronic databases. The intensity of the correlation between AGTR1 A1166C polymorphism and DN susceptibility was evaluated through calculating pooled odds ratios (ORs) with their 95% confidence intervals (95% CIs). Heterogeneity among included studies was examined with Q test. When P-value less than .05, significant heterogeneity presented, random-effects model was used to calculate the pooled ORs, otherwise, the fixed-effects model was used. Stratification analyses were also performed based on ethnicity and the type of DM. RESULTS Seventeen eligible articles were finally included in the present meta-analysis. The analysis results showed that AGTR1 A1166C polymorphism was significantly related to increased risk of DN under CC versus AA (OR = 1.723, 95% CI = 1.123-2.644), CC + AC versus AA (OR = 1.179, 95% CI = 1.004-1.383), CC versus AA + AC (OR = 1.662, 95% CI = 1.112-2.486), and C versus A (OR = 1.208, 95% CI = 1.044-1.397) genetic models. Additionally, a similar result was also found in Asian and T2DM (type 2 diabetic mellitus) groups after subgroup analyses of ethnicity and DM type. CONCLUSION AGTR1 A1166C polymorphism may increase the susceptibility to DN, especially in Asians and T2DM population.
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Affiliation(s)
| | | | | | | | | | - Jian Zhang
- Department of Infectious Diseases, Linyi Central Hospital, Linyi, Shandong, China
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Chang HF, Hsiao PJ, Hsu YJ, Lin FH, Lin C, Su W, Chen HC, Su SL. Association between angiotensin II receptor type 1 A1166C polymorphism and chronic kidney disease. Oncotarget 2018; 9:14444-14455. [PMID: 29581855 PMCID: PMC5865681 DOI: 10.18632/oncotarget.24469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022] Open
Abstract
Studies of the association between angiotensin II receptor type 1 A1166C (AGTR1 A1166C) polymorphism and chronic kidney disease (CKD) risk have yielded conflicting results. We conducted a combined case-control study and meta-analysis to better define this association. The case-control study included 634 end-stage renal disease (ESRD) patients and 739 healthy controls. AGTR1 A1166C genotype was determined using polymerase chain reaction and iPLEX Gold SNP genotyping methods. The meta-analysis included 24 studies found in the PubMed and Cochrane Library databases. Together, the case-control study and meta-analysis included 36 populations (7,918 cases and 6,905 controls). We found no association between the C allele and ESRD (case-control study: OR: 1.02, 95% CI: 0.77–1.37; meta-analysis: OR: 1.07; 95% CI: 0.97–1.18). Co-dominant, dominant, and recessive model results were also not significant. No known environmental factors moderated the effect of AGTR1 A1166C on CKD in our gene-environment interaction analysis. Sensitivity analysis showed an AGTR1 A1166C-CKD association in Indian populations (OR: 1.46, 95% CI: 1.26–1.69), but not in East Asian or Caucasian populations. Additional South Asian studies will be required to confirm the potential role of this polymorphism in CKD.
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Affiliation(s)
- Hsien-Feng Chang
- School of Public Health, National Defense Medical Center, Taiwan, ROC
| | - Po-Jen Hsiao
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC.,Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taiwan, ROC.,Big Data Research Center, Fu-Jen Catholic University, Taiwan, ROC
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taiwan, ROC
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taiwan, ROC
| | - Wen Su
- Department of Nursing, Tri-Service General Hospital, Taiwan, ROC
| | - Hsiang-Cheng Chen
- Division of Rheumatology/Immunology/Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taiwan, ROC
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taiwan, ROC
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Assali A, Ghayour-Mobarhan M, Sahebkar A, Hassani M, Kasaian J, Tatari F, Moohebati M, Paydar R, Oladi M, Esmaeili HA, Tavallaie S, Tehrani SO, Ferns GAA, Behravan J. Association of angiotensin II type 1 receptor gene A1166C polymorphism with the presence of diabetes mellitus and metabolic syndrome in patients with documented coronary artery disease. Eur J Intern Med 2011; 22:254-61. [PMID: 21570644 DOI: 10.1016/j.ejim.2010.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 11/19/2010] [Accepted: 11/27/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND There are relatively limited data available on the genetic susceptibility to diabetes mellitus and metabolic syndrome in the Iranian population. We have therefore investigated the association between the angiotensin II type I receptor gene polymorphism (AT(1)R/A1166C) and the presence of diabetes mellitus and metabolic syndrome in a well defined group of patients. METHODS Patients with angiographically defined coronary artery disease (CAD) (n=309) were evaluated for the presence of AT(1)R/A1166C polymorphism. These patients were classified into subgroups with (n=164, M/F: 109/55) and without (n=145, M/F: 84/61) diabetes mellitus. The AT(1)R polymorphism was assessed using a polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) based method. RESULTS There was a higher frequency of polymorphic genotypes (AC+CC) in the diabetic compared with the non-diabetic group (p=0.01). When determined for each gender separately, this difference remained significant in the males (p=0.04) but not in females (p=0.09). With regard to the allele frequencies, the C allele was significantly higher and the A allele frequency was lower in the diabetic group (p=0.01). This remained significant after gender segregation for males (p=0.01) but not females. In the binary logistic regression analysis, only serum fasting glucose was found as the independent predictor for the presence of diabetes in the CAD patients (β=1.16, p<0.001 for total population and β=1.29, p<0.001 for male subjects). There was no significant difference in genotype or allele frequencies between subgroups with and without metabolic syndrome, this being unaffected by gender or the definition of metabolic syndrome used apart from a significantly lower frequency of C allele in male subjects with metabolic syndrome defined by the NCEP ATP III criteria (p=0.04). CONCLUSION The AT(1)R/A1166C polymorphism may be associated with the presence of diabetes mellitus in male subjects with documented CAD.
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Affiliation(s)
- Akram Assali
- Biotechnology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences (MUMS), Mashhad, Iran
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Möllsten A, Vionnet N, Forsblom C, Parkkonen M, Tarnow L, Hadjadj S, Marre M, Parving HH, Groop PH. A polymorphism in the angiotensin II type 1 receptor gene has different effects on the risk of diabetic nephropathy in men and women. Mol Genet Metab 2011; 103:66-70. [PMID: 21316998 DOI: 10.1016/j.ymgme.2011.01.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 01/12/2011] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The etiology of diabetic nephropathy depends partly on genetic factors. Elevated systemic and intraglomerular blood pressure and glomerular filtration rate, partly regulated by the renin-angiotensin system, increase the risk of diabetic nephropathy. METHODS The present case-control study investigated the association of the rs5186 polymorphism, in the angiotensin II type 1 receptor gene (AGTR1), with diabetic nephropathy. The study included 3561 patients with type 1 diabetes from Denmark, Finland, France and Sweden. Microalbuminuria was defined as albumin excretion rate (AER) ≥20 to <200 μg/min or albumin concentration ≥30 to <300 mg/l (n=707), macroalbuminuria was defined as AER≥200 μg/min or ≥300 mg/l (n=1546), and patients with renal replacement therapy were also included in this group. The controls had >15 years diabetes duration, AER <20 μg/min or <30 mg/l, and no antihypertensive treatment (n=1308). RESULTS AA genotype of the rs5186 polymorphism significantly increased the risk of diabetic nephropathy in male patients, OR=1.27 (95% CI=1.02-1.58), P=0.03, adjusted for age at diabetes onset, HbA1c, diabetes duration, smoking and country of origin. Among the women, there were no significant associations between rs5186 and diabetic nephropathy, OR=0.89 (0.71-1.11), P=0.30. CONCLUSION We conclude that the AGTR1 gene may be associated with increased risk of diabetic nephropathy in men with type 1 diabetes.
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Affiliation(s)
- Anna Möllsten
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden.
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Alavi-Shahri J, Behravan J, Hassany M, Tatari F, Kasaian J, Ganjali R, Tavallaie S, Sabouri S, Sahebkar A, Oladi M, Mirhosseini N, Shakeri MT, Montaser-Kouhsari S, Omidvar Tehrani S, Ghayour-Mobarhan M, Visvikis-Siest S, Ferns G. Association between angiotensin II type 1 receptor gene polymorphism and metabolic syndrome in a young female Iranian population. Arch Med Res 2011; 41:343-9. [PMID: 20851291 DOI: 10.1016/j.arcmed.2010.06.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 06/23/2010] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND AIMS The overall prevalence of obesity and metabolic syndrome (MetS) is increasing among children and adolescents and can predispose to type II diabetes mellitus and cardiovascular disease. There are reported associations between an angiotensin II type I receptor gene polymorphism (AT(1)R/A1166C) with hypertension, myocardial infarction, insulin resistance and cardiovascular disease risk. In the present study, we aimed to investigate whether the AT(1)R/A1166C polymorphism was associated with MetS among adolescent Iranian girls. METHODS A total of 350 adolescent girls aged 15-17 years from high schools and different educational zones of Mashhad city participated in this population-based, genetic association study. Of these individuals, 101 patients had MetS (defined by the NCEP-ATP III criteria); the remaining 249 age-matched girls were considered as the control group. All subjects were genotyped for the AT(1)R/A1166C polymorphism using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. RESULTS Frequencies of the AA, AC and CC genotypes were 164 (65.9%), 80 (32.1%) and 5 (2.0%) in the control group and 79 (78.2%), 20 (19.8%) and 2 (2.0%) in patients, which were not consistent with the Hardy-Weinberg equilibrium (p <0.05 and p <0.001, respectively). Frequency of the AT(1)R C allele was found to be significantly lower in patients compared with controls (p <0.05). CONCLUSIONS Our findings suggested that the 1166C allele of AT(1)R gene may be associated with a decreased risk of MetS in adolescent Iranian females.
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Affiliation(s)
- Jamshid Alavi-Shahri
- Biotechnology Research Center, Avicenna Research Institute, Mashhad University of Medical Sciences, Iran
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O. Ejuogha OS, E. Chukwu O, E. Fidelis O. Incidence of Diabetic Nephropathy in Southern Nigeria. JOURNAL OF MEDICAL SCIENCES 2009. [DOI: 10.3923/jms.2009.264.269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Möllsten A, Kockum I, Svensson M, Rudberg S, Ugarph-Morawski A, Brismar K, Eriksson JW, Dahlquist G. The effect of polymorphisms in the renin-angiotensin-aldosterone system on diabetic nephropathy risk. J Diabetes Complications 2008; 22:377-83. [PMID: 18413189 DOI: 10.1016/j.jdiacomp.2007.06.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2007] [Revised: 04/17/2007] [Accepted: 06/01/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The risk of diabetic nephropathy (DN) can be increased by elevated intraglomerular pressure and glomerular filtration rate, leading to glomerular damage. This can be controlled by the renin-angiotensin-aldosterone (RAA) system, which has an important function regulating both systemic and intrarenal blood pressure. Smoking increases the risk of DN, but not all diabetic patients who smoke develop DN. There is a possibility that smoking has different effects depending on the different genotypes of the individual. We investigated the association of DN with seven polymorphisms in the RAA system and their possible interaction with smoking. SUBJECTS AND METHODS In the present case-control study, type 1 diabetic patients with diabetes duration > or =20 years, without albuminuria and without antihypertensive treatment (n=197), were included as controls. An albumin excretion rate (AER) of 20-200 microg/min (n=73) was considered as incipient DN, and an AER >200 microg/min was considered as overt DN (n=48). Smoking habits were obtained from questionnaires. RESULTS Homozygosity for the A allele, of the angiotensin II type 1 receptor (AGTR1) A1166C polymorphism, was associated with increased risk of overt DN (OR=3.04; 99% CI=1.02-9.06), independently of the other associated variables: age, duration of diabetes, ever smoking, HbA1c, and sex. The effect of the AA genotype was enhanced to a four times risk increase among ever-smoking patients. Two alleles of the microsatellite marker adjacent to the angiotensinogen gene were less common among nephropathy cases than among controls, but this was not significant when controlling for the same variables as above. CONCLUSIONS The risk of having overt DN was increased in patients homozygous for the A1166 allele, and smoking seemed to enhance the effect of the AGTR1 genotype.
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Affiliation(s)
- Anna Möllsten
- Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden.
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Ewens KG, George RA, Sharma K, Ziyadeh FN, Spielman RS. Assessment of 115 candidate genes for diabetic nephropathy by transmission/disequilibrium test. Diabetes 2005; 54:3305-18. [PMID: 16249459 DOI: 10.2337/diabetes.54.11.3305] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Several lines of evidence, including familial aggregation, suggest that allelic variation contributes to risk of diabetic nephropathy. To assess the evidence for specific susceptibility genes, we used the transmission/disequilibrium test (TDT) to analyze 115 candidate genes for linkage and association with diabetic nephropathy. A comprehensive survey of this sort has not been undertaken before. Single nucleotide polymorphisms and simple tandem repeat polymorphisms located within 10 kb of the candidate genes were genotyped in a total of 72 type 1 diabetic families of European descent. All families had at least one offspring with diabetes and end-stage renal disease or proteinuria. As a consequence of the large number of statistical tests and modest P values, findings for some genes may be false-positives. Furthermore, the small sample size resulted in limited power, so the effects of some tested genes may not be detectable, even if they contribute to susceptibility. Nevertheless, nominally significant TDT results (P < 0.05) were obtained with polymorphisms in 20 genes, including 12 that have not been studied previously: aquaporin 1; B-cell leukemia/lymphoma 2 (bcl-2) proto-oncogene; catalase; glutathione peroxidase 1; IGF1; laminin alpha 4; laminin, gamma 1; SMAD, mothers against DPP homolog 3; transforming growth factor, beta receptor II; transforming growth factor, beta receptor III; tissue inhibitor of metalloproteinase 3; and upstream transcription factor 1. In addition, our results provide modest support for a number of candidate genes previously studied by others.
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Affiliation(s)
- Kathryn Gogolin Ewens
- Department of Genetics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6145, USA
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Abstract
Molecular variants of individual components of the renin-angiotensin system (RAS) have been thought to contribute to an inherited predisposition towards essential hypertension. The angiotensin II type 1 receptor (AT-1) mediates the major pressor and trophic actions of angiotensin II (Ang II) and at least 50 different polymorphisms have been described in the AT-1 gene (AT(1)R gene); in particular, the C allele of the +1166A/C polymorphism has been associated with the severe form of essential hypertension, but the role of this polymorphism is still ambiguous in pathologies related to high Ang II levels, such as deterioration of renal function, arterial stiffness and hypertrophic cardiomyopathy. A relationship was suggested between AT 1R A1166C polymorphism and the humoral and renal haemodynamic responses to losartan, an AT-1 blocker, as well as with enhanced Ang II vascular reactivity or sensitivity. Polymorphism has also been described in angiotensin II type 2 receptor (AT-2) gene, AT-2 being the mediator for vasodilatation, natriuresis and apoptosis of smooth muscle cells; associations were found between some of these polymorphisms and both hypertension and left ventricular structure. Further evaluation in adequately powered studies is necessary for full assessment of the allelic markers in genes for RAS components, as well as to allow determination of a predisposition to hypertension or related diseases and selection of an appropriate antihypertensive drug for an individual.
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Affiliation(s)
- Bruno Baudin
- Service de Biochimie A, Hôpital Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75571 Paris, Cedex 12, France.
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Affiliation(s)
- Sharon Adler
- Harbor-UCLA Medical Center, Division of Nephrology and Hypertension, Torrance, California, USA
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Abstract
Diabetic nephropathy can develop in up to one-third of patients with type 1 diabetes and approximately 25% of patients with type 2 diabetes. This complication is important as it not only leads to renal failure but is associated with a high risk of coronary artery disease and other vascular complications. Although hyperglycaemia is necessary for the development of diabetic nephropathy, it is not sufficient, genetic factors also being important. This is evidenced by studies showing that only a subgroup of patients are at risk of nephropathy and that nephropathy clusters in families. The genes involved in susceptibility to diabetic nephropathy have yet to be identified. Most studies to date have been case-control in design, and there have been conflicting results. Genes suggested as having a role include those encoding angiotensin-1 converting enzyme, apolipoprotein E, heparan sulphate and aldose reductase. In order to clarify the role of these and other candidate genes in nephropathy, association studies in families are necessary. Because of the large number required, this will require international collaboration. A genetic marker for nephropathy would enable the earlier detection of this complication, thus facilitating screening and targeted intervention. An understanding of the role of susceptibility genes will ultimately allow the development of novel therapeutic strategies.
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Affiliation(s)
- J D Rippin
- Division of Medical Sciences, University of Birmingham and Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, UK
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Duncan JA, Scholey JW, Miller JA. Angiotensin II type 1 receptor gene polymorphisms in humans: physiology and pathophysiology of the genotypes. Curr Opin Nephrol Hypertens 2001; 10:111-6. [PMID: 11195043 DOI: 10.1097/00041552-200101000-00017] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many studies have attempted to relate genetic variants of components of the renin-angiotensin system to complex diseases such as essential hypertension, cardiovascular disease and progressive renal failure. The angiotensin II type 1 receptor (AT1R) gene is an important example of this approach. Many polymorphisms of the AT1R gene have been identified, but the A1166-->C polymorphism has been the most extensively studied. The physiological significance of this polymorphism is uncertain because of its location in the 3'-untranslated region of the gene. The present review summarizes association studies of the AT1R gene, focusing on clinical end-points and physiological responses.
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Affiliation(s)
- J A Duncan
- Department of Medicine, University of Toronto, Canada
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Zhang X, Erdmann J, Regitz-Zagrosek V, Kürzinger S, Hense HW, Schunkert H. Evaluation of three polymorphisms in the promoter region of the angiotensin II type I receptor gene. J Hypertens 2000; 18:267-72. [PMID: 10726712 DOI: 10.1097/00004872-200018030-00005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Angiotensin II induces vasoconstriction and growth via stimulation of the AT1 receptor. A genetic variant (+1166A/C) in the 3' untranslated region of this gene had been found to be associated with arterial hypertension, aortic stiffness and coronary artery disease. OBJECTIVE In order to evaluate further the potential implications of the genetic variability of the AT1 gene we explored three newly characterized single nucleotide polymorphisms (SNPs) in its promoter in a Caucasian population-based sample (n = 623). One of these (-2228G/A) is in complete linkage disequilibrium with six additional SNPs in the region such that, indirectly, potential functional implications of these sites were assessed as well. For comparison, we genotyped the previously described +1166A/C variant RESULTS The allele frequencies of the -2228G/A, -1424C/ G and -521 C/T SNPs were 0.82/0.18, 0.963/0.037 and 0.64/0.36, respectively. Statistical analysis by one-factor ANOVA revealed no significant relationship of any allele, genotype or haplotype with age, sex, body mass index, heart rate, systolic or diastolic blood pressure, hypertension, the intake of antihypertensive medication or left ventricular mass. Likewise, renin, angiotensinogen, angiotensin-converting enzyme, aldosterone or atrial natriuretic peptide levels were not found to be associated with any of these SNPs. Surprisingly, the -2228 A allele was found to be overrepresented in subjects with diabetes mellitus (n = 25, P = 0.006). However, this result could not be confirmed when additional individuals with diabetes mellitus (n = 45) were analysed. A weak linkage disequilibrium was observed between the -2228 A allele and the +1166 C allele (chi2 1 3.1; P = 0.010). CONCLUSION From the present data it is unlikely that any one of the nine newly characterized SNPs in the promoter region of AT1 gene is associated with arterial hypertension.
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Affiliation(s)
- X Zhang
- Klinik und Poliklinik für Innere Medizin II, University of Regensburg, Germany
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Affiliation(s)
- S C Bain
- Department of Medicine, Birmingham Heartlands Hospital, UK.
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Wilmer WA, Hebert LA, Lewis EJ, Rohde RD, Whittier F, Cattran D, Levey AS, Lewis JB, Spitalewitz S, Blumenthal S, Bain RP. Remission of nephrotic syndrome in type 1 diabetes: long-term follow-up of patients in the Captopril Study. Am J Kidney Dis 1999; 34:308-14. [PMID: 10430979 DOI: 10.1016/s0272-6386(99)70360-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1994, we reported a 3.4 +/- 0.8 year follow-up of the eight patients who experienced remission of nephrotic syndrome during the Collaborative Study Group-sponsored, multicenter trial of captopril therapy in patients with type 1 diabetes with nephropathy (Captopril Study). Of the 409 patients randomized to treatment on the Captopril Study, 108 had nephrotic syndrome (24-hour proteinuria >/= 3.5 g of protein) at baseline. Of these 108 patients, 8 experienced remission of nephrotic syndrome (proteinuria </= 1.0 g/24 h of protein). Remission was significantly associated with captopril therapy and control of systolic blood pressure. The present study describes the status of these eight patients during a follow-up of 7.7 +/- 0.3 years. Since our previous report, one patient has been lost to follow-up and one patient progressed to end-stage renal disease (ESRD) 3.7 years after completion of the Captopril Study. The remaining six patients remain in remission of nephrotic syndrome (mean 24-hour proteinuria, 1.03 +/- 0.3 g of protein) and have stable serum creatinine levels (mean, 1.58 +/- 0.3 mg/dL) and body weights (mean, 69.8 +/- 5.3 kg). Of the six patients, one has discontinued angiotensin-converting enzyme inhibitor (ACEi) therapy because of hypotension. Excluding the patient who progressed to ESRD, the current mean systolic blood pressure is 135 +/- 6 mm Hg and mean diastolic blood pressure is 78 +/- 4 mm Hg. We conclude that long-term remission of nephrotic syndrome and preservation of renal function is achievable in some patients with type 1 diabetes. Control of blood pressure and ACEi therapy appear to be important in achieving long-term remission.
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Affiliation(s)
- W A Wilmer
- Northeast Ohio University College of Medicine, Columbus, OH, USA
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