Hypertension and single nucleotide polymorphisms

Combinatorial analysis of ACE and ACE2 polymorphisms reveals protection against COVID-19 worsening: A genetic association study in Brazilian patients

Since angiotensin-converting enzyme 2, ACE2, was identified as the receptor for SARS-CoV-2 and considering the intense physiological interplay between the two angitensinases isoforms, ACE and ACE2, as counter-regulatory axis of the renin-angiotensin system, we proposed the evaluation of polymorphisms in these two key regulators in relation to COVID-19 severity. A genetic association study involving 621 COVID-19 hospitalized patients from Brazil was performed. All subjects had a confirmed diagnosis of COVID-19 via RT-PCR. Patients were categorized into two groups: the "mild" group (N = 296), composed of individuals hospitalized in ward beds who progressed to cure, and the "severe" group (N = 325), composed of individuals who required hospitalization in an intensive care unit (ICU), or who died. Blood samples were genotyped for ACE I/D polymorphism and ACE2 G8790A polymorphism by real-time PCR via TaqMan assay. The analysis of combined polymorphisms revealed a protective role for genotypic profile II/A_ (ORA = 0,26; p = 0,037) against the worsening of COVID-19 in women. The results indicate a protection profile to COVID-19 progression, in which the II/A_ carriers have almost four times less chance of a severe outcome. It is proposed that a decreased activity of ACE (deleterious effects) in conjunction with an increased ACE2 activity (protective effects), should be the underlying mechanism. The findings are unprecedented once other studies have not explored the genotypic combination analysis for ACE and ACE2 polymorphisms and bring perspectives and expectations for dealing with the COVID-19 pandemic based on definitions of genetically-based risk groups within the context of personalized medicine.

Association of genetic variants in Leptin, leptin receptor and adiponectin with hypertension risk and circulating Leptin/Adiponectin changes

BACKGROUNDS

Hypertension is inheritable, and some candidate genes such as leptin and adiponectin have drawn special concerns.

OBJECTIVES

We performed a meta-analysis on the association of 7 genetic variants in genes encoding leptin, leptin receptor and adiponectin with hypertension risk and circulating leptin/adiponectin changes.

METHODS

Literature search, report selection and data extraction were performed by two authors independently. Effect sizes are expressed as odds ratio (OR) or standard mean difference (SMD) with 95% confidence interval (CI).

RESULTS

Total 32 reports (7432 cases with hypertension and 9218 controls) were meta-analyzed. Overall analyses indicated that rs7799039 (dominant model: OR = 1.67; 95 % CI: 1.03 to 2.71; P = 0.038) and (TTTC)_n (allelic model: OR = 1.53; 95 % CI: 1.05 to 2.23; P = 0.028) were significantly associated with hypertension risk. Subgroup analyses indicated that hypertension type, race, diabetes, genotyping method and quality score might be potential causes for between-study heterogeneity. Besides rs2241766, no evidence of publication bias existed for the other variants. Carriers of rs7799039-AG genotype had significantly higher leptin concentrations than carriers of rs7799039-GG genotype (SMD = 1.98; 95 % CI: 0.07 to 3.89; P = 0.042). In Mendelian randomization analyses, an increment of leptin concentrations by 1 ng/mL was causally associated with a 25 % significantly increased risk of hypertension (95 % CI: 1.02 to 10+; P < 0.05).

CONCLUSIONS

Our findings indicated that leptin gene rs7799039 and (TTTC)_n were potential hypertension-candidacy loci, and importantly high circulating leptin concentrations causally precipitated the development of hypertension.

The combination of ACE I/D and ACE2 G8790A polymorphisms revels susceptibility to hypertension: A genetic association study in Brazilian patients

BACKGROUND

Systemic arterial hypertension (SAH) is a multifactorial condition that already affects one third of the worldwide population. The identification of candidate genes for hypertension is a challenge for the next years. Nevertheless, the small contribution of each individual genetic factor to the disease brings the necessity of evaluate genes in an integrative manner and taking into consideration the physiological interaction of functions. Angiotensin I-converting enzymes, ACE and ACE2, are key regulators of blood pressure that have counterbalance roles by acting on vasoactive peptides from Renin-Angiotensin-Aldosterone System (RAAS). Insertion/deletion (I/D) polymorphism of ACE gene and single nucleotide polymorphism G8790A of ACE2 gene have been associated with susceptibility to SAH, but the literature is controversial. We proposed to evaluate these two polymorphisms jointly exploring the combined effects of ACE and ACE2 genotypes on SAH susceptibility, an approach that have not been done yet for ACE and ACE2 polymorphisms.

METHODS AND FINDINGS

This genetic association study included 117 hypertensive (mean age 59.7 years) patients and 123 normotensive and diabetes-free controls (mean age 57.5 years). ACE and ACE2 polymorphisms were genotyped by SYBR Green real-time PCR and RFLP-PCR, respectively. Crude and adjusted odds ratio (OR) values were calculated to estimate the susceptibility to SAH development. It was obtained homogeneity regarding distribution by sex, age range, smoking, alcohol consumption and body mass index (BMI) between case and control groups. No-association was verified for each gene individually, but the combination of ACE and ACE2 polymorphisms on female gender revealed a significative association for DD/G_ carriers who had a 3-fold increased risk to SAH development (p = 0.03), with a stronger susceptibility on DD/GG carriers (7-fold increased risk, p = 0.01). The D allele of ACE showed association with altered levels of lipid profile variables on case group (VLDL-cholesterol, p = 0.01) and DD genotype in all individuals analysis (triglycerides, p = 0.01 and VLDL-cholesterol, p = 0.01).

CONCLUSION

These findings indicate that the combination of ACE and ACE2 polymorphisms effects may play a role in SAH predisposition been the DD/G_ genotype the susceptibility profile. This result allowed us to raise the hypothesis that an increased activity of ACE (prohypertensive effects) in conjunction with reduced ACE2 activity (antihypertensive effects) could be the underlining mechanism. The association of ACE D allele with lipid alterations indicate that this can be a marker of poor prognostic on SAH evolution and contribute to CVD development. Although these preliminary findings must be confirmed by further researches with larger sample size, we could observe that the integrative analysis of ACE and ACE2 can be an informative tool in hypertension understanding that needs to be explored in new studies.

Effect of ACE polymorphisms on the association between noise and hypertension in a Pakistani population

Introduction: This study investigates the effect of angiotensin converting enzyme (ACE) polymorphisms on the association between noise and hypertension.

Subjects and methods: A cross sectional study was conducted involving 385 male volunteers. In the control group 156 participants were exposed to a sound level of ≤80 dB; in the exposed group 229 individuals were exposed to a sound level ≥80 dB. Both groups were subdivided into categories on the basis of blood pressure. A polymerase chain reaction (PCR)-based strategy was used to differentiate the various genotypes of ACE ID and ACE G2350A. Association of noise with genotypes as modifiers was estimated after adjustment of data for age and body mass index.

Results: These showed the following odds ratios (OR) with 95% confidence interval (CI) indicating that noise is associated with hypertension in a Pakistani population (OR: 3.196; CI: 1.803–5.666). ACE ID and ACE G2350A polymorphism affects this association. ID (OR: 2.844: CI: 1.32–6.110) and DD allele carriers (OR: 4.487; CI: 1.549–12.99) were at increased risk of hypertension. GG (OR: 3.970; CI: 1.628–9.681) and GA (OR: 3.705; CI: 1.407–9.758) carriers were also at increased risk of hypertension associated with noise. However II and AA allele carriers were not found to be at increased risk of hypertension.

Conclusion: ACE ID polymorphism and ACE G2350A polymorphism modulates the effects of noise on blood pressure.