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Zhou B, Wen M, Mi L, Hu CJ, Zhang Y, Wang JT, Tang L. Associations between angiotensinogen M235T polymorphisms and the risk of diabetic nephropathy: A meta-analysis. Diabetes Res Clin Pract 2018; 142:26-36. [PMID: 29775675 DOI: 10.1016/j.diabres.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/22/2018] [Accepted: 05/08/2018] [Indexed: 11/20/2022]
Abstract
AIMS The aim of the present study was to clarify the potential relationship of angiotensinogen (AGT) M235T polymorphism and diabetic nephropathy (DN) risk. METHODS Comprehensive electronic search in Pubmed, Web of Science, EBSCO, Embase, the Cochrane Library and China National Knowledge Infrastructure (CNKI) to find original articles about the association between AGT M235T polymorphism and DN risk published before 27 September 2017. Literature quality assessment was performed with the Newcastle-Ottawa Scale. Heterogeneity across studies was assessed using I2 statistics. Random-effects model or Fixed-effects model was used to estimate the odds ratios (ORs) with 95% confidence intervals (CIs). Sensitivity analyses to assess the influence of individual studies on the pooled estimate. Publication bias was investigated using funnel plots and Egger's regression test. Analyses were performed by using Stata 15.0. RESULTS Overall, 20 eligible studies involving a total of 3822 cases and 3911 controls were included in our meta-analysis. The results showed that AGT M235T polymorphism significantly increased DN risk in recessive model (T/T versus M/T + M/M: OR = 1.35, 95%CI (1.07-1.69), I2 = 63.8%, Z = 2.56, P = 0.010), homozygote model (T/T versus M/M: OR = 1.46, 95%CI (1.11-1.92), I2 = 62.4%, Z = 2.69, P = 0.007) and allele model (T versus M: OR = 1.17, 95%CI (1.01-1.35), I2 = 72.5%, Z = 2.14, P = 0.032); Subgroup analysis by ethnicity showed that AGT M235T polymorphism significantly increased DN risk in recessive model (T/T versus M/T + M/M: OR = 1.39, 95%CI (1.06-1.81), I2 = 66.6%, Z = 2.42, P = 0.016), homozygote model (T/T versus M/M: OR = 1.47, 95%CI (1.08-2.01), I2 = 67.7%, Z = 2.47, P = 0.013) and allele model (T versus M: OR = 1.18, 95%CI (1.02-1.37), I2 = 69.4%, Z = 2.26, P = 0.024) in Caucasian DM population; Subgroup analysis by clinical subtype of DM also showed that AGT M235T polymorphism significantly increased DN risk in recessive model (T/T versus M/T + M/M: OR = 1.28, 95%CI (1.05-1.57), I2 = 21.3%, Z = 2.40, P = 0.016), homozygote model (T/T versus M/M: OR = 1.41, 95%CI (1.04-1.92), I2 = 30.2%, Z = 2.23, P = 0.026) and allele model (T versus M: OR = 1.14, 95%CI (1.03-1.28), I2 = 35.5%, Z = 2.44, P = 0.015) in type 1 diabetes patients. CONCLUSION Our study showed that AGT M235T homozygous mutation significantly increase DN risk in Caucasian DM population and type 1 diabetes patients.
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Affiliation(s)
- Bo Zhou
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Basic Medical, Guizhou Medical University, Guizhou 550004, China.
| | - Min Wen
- College of Basic Medical, Guizhou Medical University, Guizhou 550004, China
| | - Ling Mi
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Pharmacy, Guizhou Medical University, Guizhou 550004, China
| | - Cu-Jiao Hu
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Pharmacy, Guizhou Medical University, Guizhou 550004, China
| | - Yi Zhang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Pharmacy, Guizhou Medical University, Guizhou 550004, China
| | - Jian-Tar Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Pharmacy, Guizhou Medical University, Guizhou 550004, China
| | - Lei Tang
- State Key Laboratory of Functions and Applications of Medicinal Plants, Guizhou Medical University, Guizhou 550004, China; Engineering Technology Research Center for Chemical Drug R&D, Guizhou 550004, China; College of Pharmacy, Guizhou Medical University, Guizhou 550004, China.
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Su SL, Chen WT, Hsiao PJ, Lu KC, Lin YF, Lin C, Su W, Yeh SJ, Chang H, Lin FH. Angiotensin II receptor type 1 A1166C modifies the association between angiotensinogen M235T and chronic kidney disease. Oncotarget 2017; 8:107833-107843. [PMID: 29296205 PMCID: PMC5746107 DOI: 10.18632/oncotarget.22121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022] Open
Abstract
Single nucleotide polymorphisms (SNPs) in renin-angiotensin system (RAS) genes are associated with RAS imbalance and chronic kidney disease (CKD). We performed a case-control study and meta-analysis to investigate the association between angiotensinogen (AGT) M235T polymorphism and CKD. A total of 634 patients with end-stage renal disease and 739 healthy controls were studied. We also searched PubMed and the Cochrane Library to identify prospective observational studies published before December 2015. We found that the TT and MT genotypes were associated with a higher risk of CKD than the MM genotype (odds ratio [OR]: 3.56; 95% confidence interval [CI]: 1.14-11.16 and OR: 2.93; 95% CI: 0.91-9.46, respectively). Thirty-eight study populations were included in the meta-analysis. The T allele was associated with a higher risk of CKD than the M allele in all populations (OR: 1.19; 95% CI: 1.08-1.32). The OR was 1.33 in Asians (95% CI: 1.06-1.67) and 1.10 in Caucasians (95% CI: 1.02-1.18). Evaluation of gene-gene and gene-environment interactions using epistasis analysis revealed an interaction between AGT M235T and angiotensin II receptor type 1 A1166C in CKD (OR: 0.767; 95% CI: 0.609-0.965). Genetic testing for CKD in high-risk individuals may be an effective strategy for CKD prevention.
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Affiliation(s)
- Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Teing Chen
- Division of Thoracic Medicine, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Po-Jen Hsiao
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chin Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Wen Su
- Department of Nursing, Tri-Service General Hospital, Taipei, Taiwan
| | - Shih-Jen Yeh
- Office of The President, Da-Yeh University, Changhua, Taiwan
| | - Hung Chang
- Department of Physiology and Biophysics, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
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The Role of Renin Angiotensin Aldosterone System Genes in Diabetic Nephropathy. Can J Diabetes 2016; 40:178-83. [DOI: 10.1016/j.jcjd.2015.08.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/20/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
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Ahluwalia TS, Ahuja M, Rai TS, Kohli HS, Bhansali A, Sud K, Khullar M. ACE Variants Interact with the RAS Pathway to Confer Risk and Protection against Type 2 Diabetic Nephropathy. DNA Cell Biol 2009; 28:141-50. [DOI: 10.1089/dna.2008.0810] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tarunveer Singh Ahluwalia
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Monica Ahuja
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Taranjit Singh Rai
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harbir Singh Kohli
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Bhansali
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Sud
- Department of Nephrology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhu Khullar
- Department of Experimental Medicine and Biotechnology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Eroglu Z, Cetinkalp S, Erdogan M, Kosova B, Karadeniz M, Kutukculer A, Gunduz C, Tetik A, Topcuoglu N, Ozgen AG, Tuzun M. Association of the angiotensinogen M235T and angiotensin-converting enzyme insertion/deletion gene polymorphisms in Turkish type 2 diabetic patients with and without nephropathy. J Diabetes Complications 2008; 22:186-90. [PMID: 18413162 DOI: 10.1016/j.jdiacomp.2006.12.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 11/29/2006] [Accepted: 12/27/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Recent studies have suggested an association between a deletion variant of the angiotensin-converting enzyme (ACE) gene and diabetic nephropathy. However, this finding has not been confirmed by all investigators. Furthermore, an M235T variant of the angiotensinogen (AGT) gene has been associated with hypertension, an important risk factor for the development and progression of diabetic nephropathy. RESEARCH DESIGN AND METHODS We investigated the relationship of the ACE insertion/deletion (I/D) and AGT M235T gene polymorphisms in Turkish patients with type 2 diabetes mellitus (DM) with and without diabetic nephropathy. A total of 102 individuals were screened for the presence of the ACE I/D and AGT M235T polymorphism: 46 individuals who had type 2 DM with diabetic nephropathy and, as controls, 56 individuals who had type 2 DM without diabetic nephropathy. Gene polymorphisms were determined by the specific melting temperature (T(m)) values of the resulting amplicons after real-time online polymerase chain reaction and melting curve analysis. RESULTS The frequencies of the ACE DD, ID, and II genotypes were 34.8%, 37.0%, and 28.3%, respectively, among type 2 diabetic patients with nephropathy, and 33.9%, 42.9%, 23.2%, respectively (P=.788), in the control subjects without diabetic nephropathy. On the other hand, the frequencies of the AGT MM, MT, and TT genotypes among the same groups were 26.1%, 52.2%, 21.7% and 26.8%, 57.1%, 16.1%, respectively (P=.758). CONCLUSIONS There were no differences in the frequencies of the AGT M235T and ACE I/D genotypes between Turkish patients with type 2 DM with and without nephropathy.
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Affiliation(s)
- Zuhal Eroglu
- Department of Medical Biology, Medical School, University Ege, Izmir, Turkey
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Prasad P, Tiwari AK, Kumar KMP, Ammini AC, Gupta A, Gupta R, Sharma AK, Rao AR, Nagendra R, Chandra TS, Tiwari SC, Rastogi P, Gupta BL, Thelma BK. Chronic renal insufficiency among Asian Indians with type 2 diabetes: I. Role of RAAS gene polymorphisms. BMC MEDICAL GENETICS 2006; 7:42. [PMID: 16672053 PMCID: PMC1479320 DOI: 10.1186/1471-2350-7-42] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Accepted: 05/03/2006] [Indexed: 03/03/2023]
Abstract
Background Renal failure in diabetes is mediated by multiple pathways. Experimental and clinical evidences suggest that renin-angiotensin-aldosterone system (RAAS) has a crucial role in diabetic kidney disease. A relationship between the RAAS genotypes and chronic renal insufficiency (CRI) among type 2 diabetes subjects has therefore been speculated. We investigated the contribution of selected RAAS gene polymorphisms to CRI among type 2 diabetic Asian Indian subjects. Methods Twelve single nucleotide polymorphisms (SNPs) from six genes namely-renin (REN), angiotensinogen (ATG), angiotensin converting enzyme I (ACE), angiotensin II type 1 receptor (AT1) and aldosterone synthase (CYP11B2) gene from the RAAS pathway and one from chymase pathway were genotyped using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and tested for their association with diabetic CRI using a case-control approach. Successive cases presenting to study centres with type 2 diabetes of ≥2 years duration and moderate CRI diagnosed by serum creatinine ≥3 mg/dl after exclusion of non-diabetic causes of CRI (n = 196) were compared with diabetes subjects with no evidence of renal disease (n = 225). Logistic regression analysis was carried out to correlate various clinical parameters with genotypes, and to study pair wise interactions between SNPs of different genes. Results Of the 12 SNPs genotyped, Glu53Stop in AGT and A>T (-777) in AT1 genes, were monomorphic and not included for further analysis. We observed a highly significant association of Met235Thr SNP in angiotensinogen gene with CRI (O.R. 2.68, 95%CI: 2.01–3.57 for Thr allele, O.R. 2.94, 95%CI: 1.88–4.59 for Thr/Thr genotype and O.R. 2.68, 95%CI: 1.97–3.64 for ACC haplotype). A significant allelic and genotypic association of T>C (-344) SNP in aldosterone synthase gene (O.R. 1.57, 95%CI: 1.16–2.14 and O.R. 1.81, 95%CI: 1.21–2.71 respectively), and genotypic association of GA genotype of G>A (-1903) in chymase gene (O.R. 2.06, 95%CI: 1.34–3.17) were also observed. Conclusion SNPs Met235Thr in angiotensinogen, T>C (-344) in aldosterone synthase, and G>A (-1903) in chymase genes are significantly associated with diabetic chronic renal insufficiency in Indian patients and warrant replication in larger sample sets. Use of such markers for prediction of susceptibility to diabetes specific renal disease in the ethnically Indian population appears promising.
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Affiliation(s)
- Pushplata Prasad
- Department of Genetics, University of Delhi South Campus, New Delhi, India
| | - Arun K Tiwari
- Department of Genetics, University of Delhi South Campus, New Delhi, India
| | - KM Prasanna Kumar
- Department of Endocrinology and Metabolism, M.S. Ramiah Medical College, Bangalore, India
| | - AC Ammini
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Gupta
- Jaipur Diabetes and Research Centre, Jaipur, India
| | - Rajeev Gupta
- Monilek Hospital and Research Centre, Jaipur, India
| | - AK Sharma
- Monilek Hospital and Research Centre, Jaipur, India
| | - AR Rao
- Biometrics Division, Indian Agricultural Statistics Research Institute, New Delhi, India
| | - R Nagendra
- Department of Endocrinology and Metabolism, M.S. Ramiah Medical College, Bangalore, India
| | - T Satish Chandra
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - SC Tiwari
- Department of Nephrology, All India Institute of Medical Sciences, New Delhi, India
| | | | - B Lal Gupta
- Jaipur Diabetes and Research Centre, Jaipur, India
| | - BK Thelma
- Department of Genetics, University of Delhi South Campus, New Delhi, India
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Abstract
Diabetic nephropathy is a serious complication of diabetes and the leading cause of end-stage renal disease. Studies indicate both environmental and genetic factors contribute to the development and progression of diabetic nephropathy. In particular, epidemiological evidence shows a familial clustering of nephropathy in siblings with diabetes, supporting an important role of genetic susceptibility in the pathogenesis of diabetic nephropathy. A common approach in genetic research is assessment of candidate gene polymorphisms using case-control analysis; a number of studies have evaluated predictable candidate genes for diabetic nephropathy. In contrast, only a few studies have used a whole genome approach, such as scanning of micro-satellite markers, in the assessment of genetic susceptibility to diabetic nephropathy. A whole genome linkage analysis using families of Pima Indians showed susceptibility loci for diabetic nephropathy on chromosome 3, 7, and 20. Another linkage analysis using discordant sib-pairs of Caucasian families with type 1 diabetes identified a critical area on chromosome 3q. However, these results have been inconclusive and further investigation is required. Recently, a genome-wide, case-control analysis identifying susceptibility genes for diabetic nephropathy was performed. As a result, a single nucleotide polymorphism in exon 23 of the solute carrier family 12 (sodium-chloride cotransporter) member 3 gene was found to be strongly associated with diabetic nephropathy. Although further assessment of this polymorphism is needed, this strategy offers great promise in the identification of genetic factors predisposing patients to diabetic nephropathy. Identification of genetic susceptibility markers may offer new hope in the diagnosis and treatment of diabetic nephropathy.
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Affiliation(s)
- Nobue Tanaka
- The Diabetes Center, Tokyo Women's Medical University, Tokyo, Japan.
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Affiliation(s)
- Sharon Adler
- Harbor-UCLA Medical Center, Division of Nephrology and Hypertension, Torrance, California, USA
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Lindner TH, Mönks D, Wanner C, Berger M. Genetic aspects of diabetic nephropathy. KIDNEY INTERNATIONAL. SUPPLEMENT 2003:S186-91. [PMID: 12694341 DOI: 10.1046/j.1523-1755.63.s84.24.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Diabetic nephropathy from type 2 diabetes mellitus is the most common cause of end-stage renal disease (ESRD) in the United States and in Western Europe. Although patients with overt nephropathy generally experience greater cumulative glycemic exposure, the difference in glycemic control between patients developing nephropathy compared to those who did not, could not be demonstrated. This observation is consistent with the notion that perhaps other factors, in addition to glycemic control, have a bearing on the development of nephropathy. Genetic factors, which specifically increase the susceptibility to nephropathy in patients with diabetes, have been proposed. METHODS A range of linkage and association studies has been performed for revealing the genetic background of diabetic nephropathy. RESULTS Until now, no mutation has been identified which could explain the development of diabetic nephropathy in the majority of diabetic patients. CONCLUSIONS Because of relatively small case numbers of all studies being performed so far, conclusions from those studies are limited. With the development of better technologies for an affordable genome-wide association study using thousands of markers, it might become possible to unravel the genetic causes of diabetic nephropathy.
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Affiliation(s)
- Tom H Lindner
- Department of Medicine, Division of Nephrology, University Clinic, Würzburg, Germany.
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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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Gumprecht J, Zychma MJ, Grzeszczak W, Zukowska-Szczechowska E. Angiotensin I-converting enzyme gene insertion/deletion and angiotensinogen M235T polymorphisms: risk of chronic renal failure. End-Stage Renal Disease Study Group. Kidney Int 2000; 58:513-9. [PMID: 10916074 DOI: 10.1046/j.1523-1755.2000.00197.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Chronic renal failure (CRF) is a complex phenotype that results from an underlying kidney disease and superimposing environmental and genetic factors. The aim of our study was to evaluate the role of polymorphisms in the genes encoding for components of the renin-angiotensin system (RAS) in the development and/or progression of CRF. METHODS Two hundred forty-seven family trios (patients with CRF and both parents; 120 with primary chronic glomerulonephritis, 80 with interstitial nephritis, and 47 with type 1 diabetes with nephropathy) were examined, and transmission/disequilibrium test (TDT) was used to evaluate allele transmission from heterozygous parents to affected offspring. RESULTS The D allele of the angiotensin I-converting enzyme (ACE) gene insertion/deletion polymorphism was transmitted significantly more frequently than expected for no association among all examined trios and in the subgroup of patients with interstitial nephritis. The angiotensinogen 235T allele was transmitted significantly more frequently to patients with CRF than expected for no association, but the effect was seen only in patients with interstitial nephritis. The presence of the DD or ID genotype was associated with a faster rate of decline of renal function, which was not observed for the angiotensinogen M235T polymorphism. For chymase gene and angiotensin II receptor type 1 gene, allele transmission did not deviate significantly from a random proportion of 50:50%. CONCLUSIONS The results of this study suggest that ACE gene insertion/deletion and angiotensinogen M235T polymorphisms contribute to the increased risk for the development of CRF, but the magnitude of the effect within subsets of patients with specific etiologies of CRF must be evaluated further.
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Affiliation(s)
- J Gumprecht
- Department and Clinic of Internal Medicine and Diabetology, Silesian School of Medicine, Zabrze, Poland
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Adler SG, Pahl M, Seldin MF. Deciphering diabetic nephropathy: progress using genetic strategies. Curr Opin Nephrol Hypertens 2000; 9:99-106. [PMID: 10757213 DOI: 10.1097/00041552-200003000-00002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Wong TY, Poon P, Szeto CC, Chan JC, Li PK. Association of plasminogen activator inhibitor-1 4G/4G genotype and type 2 diabetic nephropathy in Chinese patients. Kidney Int 2000; 57:632-8. [PMID: 10652041 DOI: 10.1046/j.1523-1755.2000.00884.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Plasminogen activator inhibitor-1 (PAI-1) is a key regulator of fibrinolytic pathway and extracellular matrix (ECM) turnover. Because diabetic nephropathy is characterized by the presence of basement membrane thickening and mesangial expansion, we examined the role of PAI-1 gene polymorphisms in the development of type 2 diabetic nephropathy. Evidence also suggested that the PA/plasmin system and the renin-angiotensin system (RAS) interact together to affect the risk of fibrosis and thrombosis. Hence, we also studied the synergistic effect between PAI-1 and angiotensin-converting enzyme (ACE) gene polymorphisms. METHODS The PAI-1 and ACE (D/I) gene polymorphisms were examined in a cohort of Chinese type 2 diabetic patients who had diabetes for an average of 14 years. These patients were sex and age matched. Group A (N = 46) consisted of patients without diabetic nephropathy (normoalbuminuric with creatinine <120 micromol/L), and group B (N = 95) was with diabetic nephropathy (with albuminuria or renal impairment, including patients on dialysis). RESULTS Patients with type 2 diabetic nephropathy had a higher frequency of PAI-1 (4G/4G) genotypes than those without nephropathy [4G/4G:4G/5G:5G/5G = 41:38:21 (%) vs. 15:65:20(%), P = 0.005]. Diabetic patients with coexistence of PAI-1 4G/4G genotype and ACE D alleles had a higher incidence of diabetic nephropathy (22 vs. 7%, P = 0.012) than those with other combinations of genotypes. Multivariate logistic regression analysis showed that PAI-1 4G/4G (P = 0.01) and the prevalence of hypertension (P < 0.0001) are independent risk factors of development of type 2 diabetic nephropathy. CONCLUSIONS These results suggest that the PAI-1 4G/4G genotype is associated with an increased risk for type 2 diabetic nephropathy in Chinese patients, which is an independent risk factor for the development of nephropathy. The PAI-1 4G/4G genotype also exhibits a synergistic effect with the ACE D allele on development of diabetic nephropathy.
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Affiliation(s)
- T Y Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong
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Klemm T, Paschke R. [Possible genetic causes for late complications of diabetes mellitus]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 2000; 95:31-9. [PMID: 10668342 DOI: 10.1007/bf03044978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Hyperglycemia occurs in every patient with diabetes mellitus. It is the most important factor in the development of diabetic complications. However, the onset, intensity and the progression of complications show large interindividual variations. Manifestation in families and the lack of complications in some diabetics with poor metabolic control indicate a genetic predisposition to develop diabetic complications like nephropathy, neuropathy and angiopathy. NEPHROPATHY Diabetic nephropathy occurs only in 25 to 40% of the diabetic patients. Therefore a genetic risk factor for this complication is very likely. Various variations in genes like ACE-gene and angiotensinogen-gene have been described, which could be associated with the development of diabetic nephropathy. NEUROPATHY Peripheral diabetic neuropathy occurs in up to 66% of all diabetics. Therefore and because of the possible pathological mechanisms genetic risk factors like variations in the Na/K-ATPase-gene and in the aldose reductase-gene are discussed. RETINOPATHY An association between diabetic retinopathy and polymorphisms in the ACE-gene and the aldose reductase-gene seems very unlikely, because up to 75% of the diabetic patients suffer from retinopathy after 15 years of diabetes. MACROANGIOPATHY A large number of studies show an association between diabetic macroangiopathy and genetic variations in the ACE-gene (I/D-variant) and the paraoxonase-gene (2 isoforms). CONCLUSION Based on the current evidence for associations of genetic markers with diabetic complications, the generation of an individual risk profile based on genetic markers seems to be possible. In addition to near euglycemia genetic markers could direct therapeutic strategies and lead to new therapeutic approaches.
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Affiliation(s)
- T Klemm
- Medizinische Klinik und Poliklinik III, Universität Leipzig
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Gardemann A, Stricker J, Humme J, Nguyen QD, Katz N, Philipp M, Tillmanns H, Hehrlein FW, Haberbosch W. Angiotensinogen T174M and M235T gene polymorphisms are associated with the extent of coronary atherosclerosis. Atherosclerosis 1999; 145:309-14. [PMID: 10488958 DOI: 10.1016/s0021-9150(99)00082-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND The relations of the angiotensinogen (AGT) T174M and M235T gene polymorphisms to the risk of coronary heart disease (CHD) have been investigated in only a few studies with conflicting results. RESULTS Therefore, we analysed the relationship of the AGT gene polymorphisms to the presence and extent of CHD in 2250 male Caucasians whose coronary anatomy was defined by means of coronary angiography. The relative frequencies of the T and M alleles of the T174M and of the M235T gene variation did not significantly differ between patients without or with single-, double- or triple-vessel disease and between subjects without or with myocardial infarction (MI). In contrast the mean CHD score--defined by Gensini--was higher within MM homozygotes of the T174M gene variation than within TT genotypes; TM subjects had intermediate values. In M235T genotypes, mean CHD scores were similar in the total sample and in older individuals (> or = 62 years), whereas in younger individuals (< 62 years) a higher CHD score was found within AGT 235 T allele carriers than within MM homozygotes. In younger individuals with high apoAI plasma levels, the mean CHD score was clearly higher within TT homozygotes of the M235T gene variation than within MM genotypes; MT subjects had intermediate values. An interaction between both angiotensinogen gene polymorphisms on the extent of CHD or on the risk of non-fatal MI were not observed when the M allele of AGT T174M was combined either with the T allele or the TT genotype of M235T. CONCLUSIONS The present study strengthens the hypothesis of an association of both angiotensinogen gene polymorphisms with the extent of coronary heart disease.
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Affiliation(s)
- A Gardemann
- Institut für Klinische Chemie und Pathobiochemie, Klinikum der Justus-Liebig-Universität Giessen, Germany
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Deinum J, Tarnow L, van Gool JM, de Bruin RA, Derkx FH, Schalekamp MA, Parving HH. Plasma renin and prorenin and renin gene variation in patients with insulin-dependent diabetes mellitus and nephropathy. Nephrol Dial Transplant 1999; 14:1904-11. [PMID: 10462269 DOI: 10.1093/ndt/14.8.1904] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The most striking abnormality in the renin angiotensin system in diabetic nephropathy (DN) is increased plasma prorenin. Renin is thought to be low or normal in DN. In spite of altered (pro)renin regulation the renin gene has not been studied for contribution to the development of DN. METHODS We studied plasma renin, prorenin, and four polymorphic markers of the renin gene in 199 patients with IDDM and DN, and in 192 normoalbuminuric IDDM controls matched for age, sex, and duration of diabetes. Plasma renin and total renin were measured by immunoradiometric assays. Genotyping was PCR-based. RESULTS Plasma renin was increased in patients with nephropathy (median (range), 26.3 (5.2-243.3) vs 18.3 (4.2-373.5) microU/ml in the normoalbuminuric group, P<0.0001). Prorenin levels were elevated out of proportion to renin levels in nephropathic patients (789 (88-5481) vs 302 (36-2226) microU/ml, P<0.0001). Proliferative retinopathy had an additive effect on plasma prorenin, but not on renin. DN was associated with a BglI RFLP in the first intron of the renin gene (bb-genotype: n=106 vs 82 in DN and normoalbuminuric patients respectively, P=0.037), but not with three other polymorphisms in the renin gene. A trend for association of higher prorenin levels with the DN-associated allele of this renin polymorphism was observed in a subgroup of patients with DN (bb vs Bb+BB, P=0.07). CONCLUSIONS The results indicate that in DN there is an increase in both renin and prorenin levels. A renin gene polymorphism may contribute weakly to DN. Although speculative, one of the renin gene alleles could lead to increased renin gene expression, leading to higher renin and prorenin levels. These may play a role in the pathogenesis of DN.
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Affiliation(s)
- J Deinum
- Department of Internal Medicine I, University Hospital Dijkzigt, Rotterdam, The Netherlands
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Hegele RA, Harris SB, Hanley AJ, Zinman B. Association between AGT codon 235 polymorphism and variation in serum concentrations of creatinine and urea in Canadian Oji-Cree. Clin Genet 1999; 55:438-43. [PMID: 10450860 DOI: 10.1034/j.1399-0004.1999.550607.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Finding the genetic determinants of intermediate quantitative traits, such as serum creatinine and urea, might aid in finding the determinants of disease phenotypes, such as renal failure, that are, in part, defined according to threshold values imposed upon such traits. We evaluated the association between common variation in the gene encoding angiotensinogen, AGT, and the serum concentrations of creatinine and urea in non-diabetic Canadian Oji-Cree. We determined genotypes of the AGT codon 235 polymorphism among 502 non-diabetic Oji-Cree. We used multivariate analysis of variance to identify significant determinants of variation in serum concentrations of creatinine and urea and of systolic and diastolic blood pressure. We found significant associations between the AGT codon 235 genotype and serum concentrations of creatinine and urea (p = 0.017 and 0.049, respectively) and systolic blood pressure (p = 0.041). Compared with subjects with the other two genotypes, homozygotes for AGT T235/T235 had significantly lower serum concentrations of creatinine and urea and significantly higher mean systolic blood pressure. The findings suggest that the AGT T235 allele is a determinant of intermediate traits related to renal function in these aboriginal Canadians.
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Affiliation(s)
- R A Hegele
- Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, London, Ontario, Canada.
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Wong TY, Chan JC, Poon E, Li PK. Lack of association of angiotensin-converting enzyme (DD/II) and angiotensinogen M235T gene polymorphism with renal function among Chinese patients with type II diabetes. Am J Kidney Dis 1999; 33:1064-70. [PMID: 10352194 DOI: 10.1016/s0272-6386(99)70143-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The prevalence of diabetic nephropathy is greater in nonwhite patients with type II diabetes, including the Chinese, and genetic variation appears to have a role. We examined angiotensin-converting enzyme (ACE) DD/II and angiotensinogen (Atg) M235T polymorphism in a cohort of Chinese patients with type II diabetes with an average duration of diabetes of 14 years. Group A (n = 88) did not have significant diabetic nephropathy (creatinine levels </= 130 micromol/L [</=1.48 mg/L], without macroalbuminuria), and group B (n = 80) had significant diabetic nephropathy (macroalbuminuria or creatinine level >130 micromol/L [>1.48 mg/d], and those undergoing dialysis). The two groups were matched in different aspects, including age, duration of diabetes, blood pressure, and glycemic control. The results showed: (1) no difference of genotype distribution between groups A and B (DD:DI:II, 14%:45%:41% v 8%:38%:54%; P = 0.20; TT:TM/MM, 70%:30% v 76%:24%; P = 0.43), (2) no evidence of synergistic effect of ACE (DD/II) and Atg M235T gene polymorphisms, (3) no difference of allele frequencies between groups A and B (D:I, 36%:64% v 27%:73%; P = 0.20 and T:M, 86%:16% v 86%:14%; P = 0.73), and (4) ACE activity was greatest in patients with DD genotype and least in those with II genotype (DD:DI:II = 66. 9 +/- 13.3 U/L:61.5 +/- 19.9 U/L:45.0 +/- 17.0 U/L; P < 0.005). The data do not support a role of ACE (DD/II) or Atg M235T polymorphism in the development of diabetic nephropathy in Chinese patients with type II diabetes, and no synergistic effect was found between them. Greater ACE activity was associated with DD genotype, and its role in diabetic nephropathy remains to be elucidated.
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Affiliation(s)
- T Y Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, Hong Kong
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Hegele RA, Harris SB, Hanley AJ, Zinman B. Association between AGT T235 variant and microalbuminuria in Canadian Oji-Cree with type 2 diabetes mellitus. Clin Biochem 1999; 32:201-5. [PMID: 10383081 DOI: 10.1016/s0009-9120(99)00005-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To assess the association between the common variation in the gene encoding angiotensinogen, AGT, and the presence of microalbuminuria in Canadian Oji-Cree with type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS We compared the frequencies of the AGT promoter and M235T polymorphisms among three subgroups of adult Oji-Cree: 50 subjects who had type 2 diabetes with microalbuminuria, 6 subjects who had type 2 diabetes without albuminuria and 302 non-diabetic, normotensive subjects. RESULTS We found the AGT T235 allele was present at a significantly higher frequency, and that T235/T235 homozygotes were significantly more prevalent, among the subjects who had type 2 diabetes with microalbuminuria than among the subjects in the other two groups. CONCLUSIONS The findings suggest that the AGT T235 allele is a determinant of the nephropathy susceptibility related to type 2 diabetes in these aboriginal Canadians.
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Affiliation(s)
- R A Hegele
- Blackburn Cardiovascular Genetics Laboratory, Robarts Research Institute, London, Ontario, Canada.
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