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Mohammedi K, Marre M, Hadjadj S, Potier L, Velho G. Redox Genetic Risk Score and the Incidence of End-Stage Kidney Disease in People with Type 1 Diabetes. Cells 2022; 11:cells11244131. [PMID: 36552894 PMCID: PMC9777489 DOI: 10.3390/cells11244131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
End-stage kidney disease (ESKD) is a multifactorial condition influenced by genetic background, but the extent to which a genetic risk score (GRS) improves ESKD prediction is unknown. We built a redox GRS on the base of previous association studies (six polymorphisms from six redox genes) and tested its relationship with ESKD in three cohorts of people with type 1 diabetes. Among 1012 participants, ESKD (hemodialysis requirement, kidney transplantation, eGFR < 15 mL/min/1.73 m2) occurred in 105 (10.4%) during a 14-year follow-up. High redox GRS was associated with increased ESKD risk (adjusted HR for the upper versus the lowest GRS tertile: 2.60 (95% CI, 1.51-4.48), p = 0.001). Each additional risk-allele was associated with a 20% increased risk of ESKD (95% CI, 8-33, p < 0.0001). High GRS yielded a relevant population attributable fraction (30%), but only a marginal enhancement in c-statistics index (0.928 [0.903-0.954]) over clinical factors 0.921 (0.892-0.950), p = 0.04). This is the first report of an independent association between redox GRS and increased risk of ESKD in type 1 diabetes. Our results do not support the use of this GRS in clinical practice but provide new insights into the involvement of oxidative stress genetic factors in ESKD risk in type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Centre Hospitalier de Bordeaux, Department of Endocrinology, Diabetes and Nutrition, University Hospital of Bordeaux, 33604 Pessac, France
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, ON L8S 4L8, Canada
- Correspondence:
| | - Michel Marre
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
- Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, 44109 Nantes, France
| | - Louis Potier
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
- Clinique Ambroise Paré, 92200 Neuilly-sur-Seine, France
- Service d’Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, 75013 Paris, France
| | - Gilberto Velho
- Institut Necker-Enfants Malades, INSERM, Université de Paris, 75013 Paris, France
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2
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Camoin M, Velho G, Saulnier PJ, Potier L, Abouleka Y, Carpentier C, Dubois S, Larroumet A, Rigalleau V, Gand E, Bourron O, Bordier L, Scheen A, Hadjadj S, Roussel R, Marre M, Mohammedi K. Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes. Cardiovasc Diabetol 2022; 21:71. [PMID: 35534880 PMCID: PMC9088124 DOI: 10.1186/s12933-022-01487-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Background Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. Methods We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. Results Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15–18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34–3.01], p = 0.0008) or LLA (2.26 [1.56–3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14–9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54–1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26–4.32) and 3.38 (1.87–4.88) years, respectively. Combined conditions expose to 7.04 (4.76–9.31) less years of life expectancy (all p < 0.0001). Conclusions CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01487-8.
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Affiliation(s)
- Marion Camoin
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | | | - Pierre-Jean Saulnier
- UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France.,Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France.,Inserm, CIC 1402, Poitiers, France
| | - Louis Potier
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Yawa Abouleka
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Alice Larroumet
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France.,INSERM U1219, Bordeaux Population Health Research Center, Bordeaux, France
| | - Elise Gand
- Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Olivier Bourron
- Service de Diabétologie et Métabolisme, APHP, Groupe Hospitalier La Pitié-Salpêtrière, Sorbonne Université, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Sorbonne Université, Paris, France
| | - Lyse Bordier
- Service d'Endocrinologie, Hôpital Bégin, Saint Mandé, France
| | | | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Ronan Roussel
- Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Fédération de Diabétologie de Paris, AP-HP, Université de Paris, Paris, France.,INEM, INSERM, Université de Paris, Paris, France
| | - Michel Marre
- INEM, INSERM, Université de Paris, Paris, France.,Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, CEDEX, Bordeaux University Hospital, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac, France. .,Faculty of Medicine, University of Bordeaux, Bordeaux, France. .,Biology of Cardiovascular Diseases, INSERM Unit 1034, Pessac, France.
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3
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Mohammedi K, Abouleka Y, Carpentier C, Potier L, Dubois S, Foussard N, Rigalleau V, Gautier JF, Gourdy P, Charpentier G, Roussel R, Scheen A, Bauduceau B, Hadjadj S, Alhenc-Gelas F, Marre M, Velho G. Association Between the ACE Insertion/Deletion Polymorphism and Risk of Lower-Limb Amputation in Patients With Long-Standing Type 1 Diabetes. Diabetes Care 2022; 45:407-415. [PMID: 34853028 DOI: 10.2337/dc21-0973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/01/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The ACE insertion/deletion (I/D) polymorphism has been widely studied in people with diabetes, albeit not with regard to lower-limb amputation (LLA). We examined associations among this polymorphism, plasma ACE concentration, and LLA in people with type 1 diabetes. RESEARCH DESIGN AND METHODS ACE I/D genotype and plasma ACE were assessed in three prospective cohorts of participants with type 1 diabetes. LLA was defined as minor (below-the-ankle amputation consisting of at least one ray metatarsal resection) or major (transtibial or transfemoral) amputation. Linear, logistic, and Cox regression models were computed to evaluate the likelihood of prevalent and incident LLA by ACE genotype (XD [ID or ID] vs. II) and plasma ACE, after adjusting for confounders. RESULTS Among 1,301 participants (male 54%, age 41 ± 13 years), 90 (6.9%) had a baseline history of LLA. Baseline LLA was more prevalent in XD (7.4%) than in II genotype (4.5%, odds ratio [OR] 2.17 [95 %CI 1.03-4.60]). Incident LLA occurred in 53 individuals during the 14-year follow-up and was higher in XD versus II carriers (hazard ratio 3.26 [95% CI 1.16-13.67]). This association was driven by excess risk of minor, but not major, LLA. The D allele was associated with increased prevalent LLA at the end of follow-up (OR 2.48 [1.33-4.65]). LLA was associated with higher mean (95% CI) ACE levels in II (449 [360, 539] vs. 354 [286, 423] ng/mL), but not XD (512 [454, 570] vs. 537 [488, 586]), carriers. CONCLUSIONS This report is the first of an independent association between ACE D allele and excess LLA risk, mainly minor amputations, in patients with type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France.,Biology of Cardiovascular Diseases, INSERM U1034, Pessac, France
| | - Yawa Abouleka
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Louis Potier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Ninon Foussard
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetes and Nutrition, Bordeaux University Hospital, Hôpital Haut-Lévêque, Pessac, France.,Faculty of Medicine, University of Bordeaux, Bordeaux, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, AP-HP, Université de Paris, Paris, France
| | - Pierre Gourdy
- Service d'Endocrinologie Diabétologie Nutrition, CHU de Toulouse, Toulouse, France.,Institut des Maladies Métaboliques et Cardiovasculaires, UMR1297 INSERM/UPS, Université Toulouse 3, Toulouse, France
| | - Guillaume Charpentier
- 10Center for Study and Research for Improvement of the Treatment of Diabetes, Bioparc-Génopole Évry-Corbeil, Évry, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, AP-HP, Paris, France
| | | | | | - Samy Hadjadj
- 13Institut du Thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France
| | - François Alhenc-Gelas
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,14Clinique Ambroise Paré, Neuilly-sur-Seine, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
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4
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Abouleka Y, Mohammedi K, Carpentier C, Dubois S, Gourdy P, Gautier JF, Roussel R, Scheen A, Alhenc-Gelas F, Hadjadj S, Velho G, Marre M. ACE I/D Polymorphism, Plasma ACE Levels, and Long-term Kidney Outcomes or All-Cause Death in Patients With Type 1 Diabetes. Diabetes Care 2021; 44:1377-1384. [PMID: 33827803 PMCID: PMC8247517 DOI: 10.2337/dc20-3036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 02/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The deletion (D) allele of the ACE insertion/deletion (I/D) polymorphism is a risk factor for diabetic kidney disease. We assessed its contribution to long-term kidney outcomes and all-cause death in patients with long-standing type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 1,155 participants from three French and Belgian cohorts were monitored for a median duration of 14 (interquartile range 13) years. The primary outcome was the occurrence of end-stage kidney disease (ESKD) or a 40% drop in the estimated glomerular filtration rate (eGFR). Secondary outcomes were the individual components of the primary outcome, rapid decline in eGFR (steeper than -3 mL/min/1.73 m2 per year), incident albuminuria, all-cause death, and a composite ESKD or all-cause death. Hazard ratios (HRs) for XD versus II genotype and for baseline plasma ACE levels were computed by Cox analysis. Genotype performance in stratifying the primary outcome was tested. RESULTS Genotype distribution was 954 XD and 201 II. The primary outcome occurred in 20% of XD and 13% of II carriers: adjusted HR 2.07 (95% CI 1.32-3.40; P = 0.001). Significant associations were also observed for rapid decline in eGFR, incident albuminuria, ESKD, all-cause death, and ESKD or all-cause death. Baseline plasma ACE levels were higher in XD carriers and significantly associated with an increased risk of the primary outcome. The ACE genotype enhanced net reclassification improvement (0.154, 95% CI 0.007-0.279; P = 0.04) and integrated discrimination improvement (0.012, 95%CI 0.001-0.021; P = 0.02) for primary outcome stratification. CONCLUSIONS The D-allele of the ACE I/D polymorphism was associated with an increased risk of major kidney events and all-cause death in patients with long-standing type 1 diabetes.
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Affiliation(s)
- Yawa Abouleka
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Kamel Mohammedi
- Bordeaux University and Hospital, INSERM U1219, Bordeaux, France
| | - Charlyne Carpentier
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Severine Dubois
- Service d'Endocrinologie Diabétologie Nutrition, CHU d'Angers, Angers, France
| | - Pierre Gourdy
- Service d'Endocrinologie Diabétologie Nutrition, CHU de Toulouse, Toulouse, France.,Institut des Maladies Métaboliques et Cardiovasculaires, UMR1048 INSERM/UPS, Université Toulouse III - Paul Sabatier, Toulouse, France
| | - Jean-François Gautier
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service de Diabétologie et d'Endocrinologie, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France
| | - Ronan Roussel
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France.,Service d'Endocrinologie Diabétologie Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - François Alhenc-Gelas
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Samy Hadjadj
- Institut du Thorax, INSERM, CNRS, Université de Nantes, CHU Nantes, Nantes, France
| | - Gilberto Velho
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France
| | - Michel Marre
- Centre de Recherche des Cordeliers, INSERM, Université de Paris, Sorbonne Université, Paris, France .,Clinique Ambroise Paré, Neuilly-sur-Seine, France
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5
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Carpentier C, Dubois S, Mohammedi K, Belhatem N, Bouhanick B, Rohmer V, Briet C, Bumbu A, Hadjadj S, Roussel R, Potier L, Velho G, Marre M. Glycosuria amount in response to hyperglycaemia and risk for diabetic kidney disease and related events in Type 1 diabetic patients. Nephrol Dial Transplant 2020; 34:1731-1738. [PMID: 29982607 DOI: 10.1093/ndt/gfy197] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/15/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hyperglycaemia impairs tubulo-glomerular feedback. We tested whether variable tubulo-glomerular feedback during hyperglycaemia contributes to renal risk heterogeneity seen in Type 1 diabetes. METHODS During the period 1990-92, we studied the tubulo-glomerular feedback in Type 1 diabetic patients at high or low renal risk [21 of 54 with glomerular hyperfiltration and/or microalbuminuria against 11 of 55 with normal glomerular filtration rate (GFR) and urinary albumin despite uncontrolled diabetes]. The GFR, effective renal plasma flow, mean arterial pressure and fractional reabsorptions of glucose, osmols, sodium and lithium were measured sequentially during normo- and hyperglycaemia. All patients were followed up until 2016 for incident proteinuria, estimated GFR <60 mL/min/1.73 m2, doubling of serum creatinine, end-stage renal disease or all-cause death. RESULTS Glycaemia increased from 6.1 ± 1.3 to 15.1 ± 1.9 mmol/L in both high-risk and low-risk patients. Glycosuria was lower in the high- versus low-risk patients: 0.34 ± 0.25 versus 0.64 ± 0.44 mmol/min (P = 0.03). Both groups displayed similar kidney function during normoglycaemia. Hyperglycaemia increased more importantly GFR and fractional reabsorptions, and pre-glomerular vasodilatation in the high- than in the low-risk patients (all P < 0.05). Over 21 years, 31.5% high- versus 12.7% low-risk patients developed endpoints (adjusted P = 0.006). In a multi-adjusted survival analysis of patients having undergone renal tests, each 0.10 mmol/min glycosuria during hyperglycaemia reduced the outcome risk by 0.72 (95% confidence interval 0.49-0.97, P = 0.03). CONCLUSIONS Reduced tubulo-glomerular feedback and glycosuria during hyperglycaemia indicate high renal risk for Type 1 diabetic patients. Inter-individual variability in tubulo-glomerular feedback activity determines renal risk in Type 1 diabetes.
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Affiliation(s)
- Charlyne Carpentier
- Centre Hospitalier Universitaire d'Angers, Service EDN, Angers, France.,INSERM, UMRS 1063, SOPAM, Université d'Angers, Angers, France
| | - Séverine Dubois
- Centre Hospitalier Universitaire d'Angers, Service EDN, Angers, France.,INSERM, UMRS 1063, SOPAM, Université d'Angers, Angers, France
| | - Kamel Mohammedi
- Hôpital Haut-Lévêque, Service d'Endocrinologie, Diabétologie, Nutrition, Bordeaux, France.,Université de Bordeaux, Faculté de Médecine Paul Broca, Bordeaux, France.,Centre de Recherche INSERM-Université de Bordeaux U1219 'Bordeaux Population Health', Bordeaux, France
| | - Narimène Belhatem
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Béatrice Bouhanick
- Centre Hospitalier Universitaire Rangueil, Service d'Hypertension et de Thérapeutique, TSA, Toulouse, France.,INSERM UMRS 1027, Université Toulouse 3, Toulouse, France
| | - Vincent Rohmer
- Centre Hospitalier Universitaire d'Angers, Service EDN, Angers, France.,INSERM, UMRS 1063, SOPAM, Université d'Angers, Angers, France
| | - Claire Briet
- Centre Hospitalier Universitaire d'Angers, Service EDN, Angers, France.,INSERM, UMRS 1063, SOPAM, Université d'Angers, Angers, France
| | - Anisoara Bumbu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France
| | - Samy Hadjadj
- INSERM, CIC 0802, Poitiers, France.,Université de Poitiers, UFR de Médecine et Pharmacie, Poitiers, France.,INSERM, Research Unit 1082, Poitiers, France.,Centre Hospitalier Universitaire de Poitiers, Department of Endocrinology and Diabetology, Poitiers, France
| | - Ronan Roussel
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.,Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Louis Potier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.,Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Gilberto Velho
- Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Michel Marre
- Assistance Publique-Hôpitaux de Paris (AP-HP), Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France.,Inserm Research Unit 1138, Centre de Recherche des Cordeliers, Paris, France
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Alhenc-Gelas F, Bouby N, Girolami JP. Kallikrein/K1, Kinins, and ACE/Kininase II in Homeostasis and in Disease Insight From Human and Experimental Genetic Studies, Therapeutic Implication. Front Med (Lausanne) 2019; 6:136. [PMID: 31316987 PMCID: PMC6610447 DOI: 10.3389/fmed.2019.00136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 05/31/2019] [Indexed: 01/19/2023] Open
Abstract
Kallikrein-K1 is the main kinin-forming enzyme in organs in resting condition and in several pathological situations whereas angiotensin I-converting enzyme/kininase II (ACE) is the main kinin-inactivating enzyme in the circulation. Both ACE and K1 activity levels are genetic traits in man. Recent research based mainly on human genetic studies and study of genetically modified mice has documented the physiological role of K1 in the circulation, and also refined understanding of the role of ACE. Kallikrein-K1 is synthesized in arteries and involved in flow-induced vasodilatation. Endothelial ACE synthesis displays strong vessel and organ specificity modulating bioavailability of angiotensins and kinins locally. In pathological situations resulting from hemodynamic, ischemic, or metabolic insult to the cardiovascular system and the kidney K1 and kinins exert critical end-organ protective action and K1 deficiency results in severe worsening of the conditions, at least in the mouse. On the opposite, genetically high ACE level is associated with increased risk of developing ischemic and diabetic cardiac or renal diseases and worsened prognosis of these diseases. The association has been well-documented clinically while causality was established by ACE gene titration in mice. Studies suggest that reduced bioavailability of kinins is prominently involved in the detrimental effect of K1 deficiency or high ACE activity in diseases. Kinins are involved in the therapeutic effect of both ACE inhibitors and angiotensin II AT1 receptor blockers. Based on these findings, a new therapeutic hypothesis focused on selective pharmacological activation of kinin receptors has been launched. Proof of concept was obtained by using prototypic agonists in experimental ischemic and diabetic diseases in mice.
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Affiliation(s)
- Francois Alhenc-Gelas
- INSERM U1138-CRC, Paris, France.,CRC-INSERM U1138, Paris-Descartes University, Paris, France.,CRC-INSERM U1138, Sorbonne University, Paris, France
| | - Nadine Bouby
- INSERM U1138-CRC, Paris, France.,CRC-INSERM U1138, Paris-Descartes University, Paris, France.,CRC-INSERM U1138, Sorbonne University, Paris, France
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7
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Nicolas A, Mohammedi K, Bastard JP, Fellahi S, Bellili-Muñoz N, Roussel R, Hadjadj S, Marre M, Velho G, Fumeron F. T-cadherin gene variants are associated with nephropathy in subjects with type 1 diabetes. Nephrol Dial Transplant 2018; 32:1987-1993. [PMID: 28499019 DOI: 10.1093/ndt/gfx071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/16/2017] [Indexed: 01/08/2023] Open
Abstract
Background High plasma adiponectin levels are associated with diabetic nephropathy (DN). T-cadherin gene (CDH13) variants have been shown to be associated with adiponectin levels. We investigated associations between allelic variations of CDH13 and DN in subjects with type 1 diabetes. Methods Two CDH13 polymorphisms were analysed in 1297 Caucasian subjects with type 1 diabetes from the 'Survival Genetic Nephropathy' (SURGENE) (n = 340, 10-year follow-up), 'Genesis France-Belgium' (GENESIS) (n = 501, 5-year follow-up for n = 462) and 'Génétique de la Néphropathie Diabétique' (GENEDIAB) (n = 456, 9-year follow-up for n = 283) cohorts. Adiponectin levels were measured in plasma samples from GENESIS and GENEDIAB cohorts. Results Pooled analysis of GENEDIAB and GENESIS studies showed that baseline plasma adiponectin levels were higher in subjects with established/advanced DN at inclusion (P < 0.0001) and in subjects who developed end-stage renal disease (ESRD) at follow-up (P < 0.0001). The minor allele of rs3865188 was associated with lower adiponectin levels (P = 0.006). rs11646213 [odds ratio (OR) 1.47; 95% confidence interval (CI) 1.18-1.85; P = 0.0009] and rs3865188 (OR 0.71; 95% CI 0.57-0.90; P = 0.004) were associated with baseline prevalence of established/advanced DN. These polymorphisms were also associated with the risk of ESRD (0.006 < P < 0.03). The association between rs11646213 (but not rs3865188) and renal function remained significant after adjustment for plasma adiponectin. In SURGENE, rs11646213 [hazard ratio (HR) 1.69; 95% CI 1.01-2.71; P = 0.04] and rs3865188 (HR 0.74; 95% CI 0.55-0.99; P = 0.04) were associated with risk of renal events (defined as progression to more severe DN stages). Conclusions Plasma adiponectin levels are associated with the prevalence of DN and the incidence of ESRD in patients with type 1 diabetes. CDH13 polymorphisms are also associated with the prevalence and incidence of DN, and with the incidence of ESRD in these patients. The association between CDH13 and DN may be due to pleiotropic effects, both dependent and independent of plasma adiponectin levels.
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Affiliation(s)
- Anthony Nicolas
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Kamel Mohammedi
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jean-Philippe Bastard
- Biochemistry and Hormonology Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Soraya Fellahi
- Biochemistry and Hormonology Department, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Ronan Roussel
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samy Hadjadj
- Université de Poitiers, UFR Médecine Pharmacie, CIC1402, Poitiers, France.,Department of Diabetology and Endocrinology, Pole DUNE & Centre d'investigation clinique, University Hospital, Poitiers, France.,INSERM, CIC1402, Poitiers, France
| | - Michel Marre
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Department of Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilberto Velho
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France
| | - Frédéric Fumeron
- INSERM, UMR-S 1138, Centre de Recherches des Cordeliers, Paris, France.,Sorbonne Universités, UPMC Univ Paris 06, UMR-S 1138, Centre de Recherche des Cordeliers, Paris, France.,Université Paris Descartes, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France.,Univ Paris Diderot, Sorbonne Paris Cité, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
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8
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Barbieux P, György B, Gand E, Saulnier PJ, Ducrocq G, Halimi JM, Feigerlova E, Hulin-Delmotte C, Llaty P, Montaigne D, Rigalleau V, Roussel R, Sosner P, Zaoui P, Ragot S, Marre M, Tregouët DA, Hadjadj S. No prognostic role of a GWAS-derived genetic risk score in renal outcomes for patients from French cohorts with type 1 and type 2 diabetes. DIABETES & METABOLISM 2018. [PMID: 29540294 DOI: 10.1016/j.diabet.2018.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- P Barbieux
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France
| | - B György
- Inserm UMR-S1166, Sorbonne universités, UPMC université Paris 06, 75013, Paris, France; ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - E Gand
- CHU de Poitiers, pôle Dune, 86000 Poitiers, France
| | - P-J Saulnier
- UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | - G Ducrocq
- Inserm U698, 75018 Paris, France; Département de cardiologie, groupe hospitalier Bichat Claude-Bernard, Assistance publique-Hôpitaux de Paris (AP-HP), 75018 Paris, France
| | - J-M Halimi
- Service néphrologie, dialyse et transplantation, CHU de Tours, 37000 Tours, France; Inserm, centre d'investigation clinique 0202, 37000 Tours, France
| | - E Feigerlova
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France; UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | | | - P Llaty
- Service de cardiologie, CHU de Poitiers, 86000 Poitiers, France
| | - D Montaigne
- Service d'explorations fonctionnelles cardiovasculaires, CHU de Lille, 59000 Lille, France; Université de Lille, 59000 Lille, France; Inserm, U1011, 59000 Lille, France; EGID, 59000 Lille, France; Institut Pasteur de Lille, 59019 Lille, France
| | - V Rigalleau
- Service endocrinologie, diabétologie maladies métaboliques et nutrition, CHU de Bordeaux, 33604 Pessac cedex, France; Université Victor-Segalen, faculté de médecine, 33000 Bordeaux, France
| | - R Roussel
- UMR_S 1138, centre de recherche des Cordeliers, Sorbonne Paris-Cité, université Paris-Diderot, 75006 Paris, France; Diabetologie endocrinologie nutrition, DHU FIRE, AP-HP, hôpital Bichat, 75018 Paris, France; Inserm UMR-S 1138, centre de recherche des Cordeliers, 75006 Paris, France
| | - P Sosner
- Service de cardiologie, CHU de Poitiers, 86000 Poitiers, France; Complexe médico-sportif Mon Stade, 75013 Paris, France; Laboratoire MOVE (EA 6314), université de Poitiers, 86000 Poitiers, France
| | - P Zaoui
- Service néphrologie, dialyse et transplantation, CHU de Grenoble, 38000 Grenoble, France; Faculté de médecine, université Grenoble Alpes, 38000 Grenoble, France
| | - S Ragot
- UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France
| | - M Marre
- UMR_S 1138, centre de recherche des Cordeliers, Sorbonne Paris-Cité, université Paris-Diderot, 75006 Paris, France; Diabetologie endocrinologie nutrition, DHU FIRE, AP-HP, hôpital Bichat, 75018 Paris, France; Inserm UMR-S 1138, centre de recherche des Cordeliers, 75006 Paris, France
| | - D-A Tregouët
- Inserm UMR-S1166, Sorbonne universités, UPMC université Paris 06, 75013, Paris, France; ICAN Institute for Cardiometabolism and Nutrition, 75013 Paris, France
| | - S Hadjadj
- Service d'endocrinologie, CHU de Poitiers, 86000 Poitiers, France; UFR médecine pharmacie, centre d'investigation clinique, université de Poitiers, 86000 Poitiers, France; CHU de Poitiers, centre d'investigation clinique, 86000 Poitiers, France; Inserm, CIC 1402 & U1082, 86000 Poitiers, France; UFR médecine pharmacie, université de Poitiers, 86000 Poitiers, France.
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9
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Chollet C, Placier S, Chatziantoniou C, Hus-Citharel A, Caron N, Roussel R, Alhenc-Gelas F, Bouby N. Genetically increased angiotensin I-converting enzyme alters peripheral and renal vascular reactivity to angiotensin II and bradykinin in mice. Am J Physiol Heart Circ Physiol 2018; 314:H350-H358. [DOI: 10.1152/ajpheart.00356.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Angiotensin I-converting enzyme (ACE) levels in humans are under strong genetic influence. Genetic variation in ACE has been linked to risk for and progression of cardiovascular and renal diseases. Causality has been documented in genetically modified mice, but the mechanisms underlying causality are not completely elucidated. To further document the vascular and renal consequences of a moderate genetic increase in ACE synthesis, we studied genetically modified mice carrying three copies of the ACE gene (three-copy mice) and littermate wild-type animals (two-copy mice). We investigated peripheral and renal vascular reactivity to angiotensin II and bradykinin in vivo by measuring blood pressure and renal blood flow after intravenous administration and also reactivity of isolated glomerular arterioles by following intracellular Ca2+ mobilization. Carrying three copies of the ACE gene potentiated the systemic and renal vascular responses to angiotensin II over the whole range of peptide concentration tested. Consistently, the response of isolated glomerular afferent arterioles to angiotensin II was enhanced in three-copy mice. In these mice, signaling pathways triggered by endothelial activation by bradykinin or carbachol in glomerular arterioles were also altered. Although the nitric oxide (NO) synthase (NOS)/NO pathway was not functional in arterioles of two-copy mice, in muscular efferent arterioles of three-copy mice NOS3 gene expression was induced and NO mediated the effect of bradykinin or carbachol. These data document new and unexpected vascular consequences of a genetic increase in ACE synthesis. Enhanced vasoconstrictor effect of angiotensin II may contribute to the risk for cardiovascular and renal diseases linked to genetically high ACE levels. NEW & NOTEWORTHY A moderate genetic increase in angiotensin I-converting enzyme (ACE) in mice similar to the effect of the ACE gene D allele in humans unexpectedly potentiates the systemic and renal vasoconstrictor responses to angiotensin II. It also alters the endothelial signaling pathways triggered by bradykinin or carbachol in glomerular efferent arterioles.
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Affiliation(s)
- Catherine Chollet
- Institut National de la Santé Et de la Recherche Medicale (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
- Université Pierre and Marie Curie, Paris, France
- Université Paris Descartes, Paris, France
| | - Sandrine Placier
- Université Pierre and Marie Curie, Paris, France
- INSERM, UMRS 1155, Hopital Tenon, Paris, France
| | - Christos Chatziantoniou
- Université Pierre and Marie Curie, Paris, France
- INSERM, UMRS 1155, Hopital Tenon, Paris, France
| | - Annette Hus-Citharel
- College de France, Center for Interdisciplinary Research in Biology, INSERM U1050, Paris, France
| | - Nathalie Caron
- Université de Namur, Faculté de Medecine, Namur, Belgium
| | - Ronan Roussel
- Institut National de la Santé Et de la Recherche Medicale (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
- Université Pierre and Marie Curie, Paris, France
- Université Paris Descartes, Paris, France
- Université Paris Diderot, Paris, France
- Department of Diabetology-Endocrinology-Nutrition, DHU FIRE, Bichat Hospital, AP-HP, Paris, France
| | - François Alhenc-Gelas
- Institut National de la Santé Et de la Recherche Medicale (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
- Université Pierre and Marie Curie, Paris, France
- Université Paris Descartes, Paris, France
| | - Nadine Bouby
- Institut National de la Santé Et de la Recherche Medicale (INSERM) U1138, Centre de Recherche des Cordeliers, Paris, France
- Université Pierre and Marie Curie, Paris, France
- Université Paris Descartes, Paris, France
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10
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Yoo KH, Yim HE, Bae ES, Hong YS. Genetic Contributions to Childhood Obesity: Association of Candidate Gene Polymorphisms and Overweight/Obesity in Korean Preschool Children. J Korean Med Sci 2017; 32:1997-2004. [PMID: 29115082 PMCID: PMC5680499 DOI: 10.3346/jkms.2017.32.12.1997] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/03/2017] [Indexed: 01/26/2023] Open
Abstract
This study was aimed to investigate the association of candidate gene polymorphisms and obesity or overweight in young Korean children. A total of 190 Korean preschool children (96 control, 48 overweight, and 46 obese children) were genotyped for the angiotensin converting enzyme (ACE) insertion (I)/deletion (D), angiotensin II type 2 receptor (AT2) C3123A, transforming growth factor (TGF)-β1 T869C, vascular endothelial growth factor (VEGF) T460C, and tumor necrosis factor (TNF)-α G308A polymorphisms. No differences were found among the groups with respect to age, sex, birth weight, blood pressure levels, and serum concentrations of glucose and total cholesterol. Obese children showed a higher incidence of ACE DD genotype and D allelic frequency compared to the controls (odds ratio [OR], 2.7, 95% confidence interval [CI], 1.01-7.21; OR, 2.5, 95% CI, 1.49-4.19; all P < 0.05). The frequency of TC genotype and C allele in the TGF-β1 T869C polymorphism (OR, 2.08, 95% CI, 1.01-4.27; OR, 1.93, 95% CI, 1.15-3.21) and that in the VEGF T460C polymorphism (OR, 2.5, 95% CI, 1.19-5.28; OR, 2.15, 95% CI, 1.26-3.68) was also higher in obese children than in control subjects (all P < 0.05). Overweight children exhibited a higher frequency of the A allele in the AT2 C3123A polymorphism compared to the controls (OR, 1.72, 95% CI, 1.03-2.88, P < 0.05). There were no differences in the TNF-α G308A polymorphism among the groups. The ACE I/D, AT2 C3123A, TGF-β1 T869C, and VEGF T460C polymorphisms can affect susceptibility to obesity or overweight in Korean children.
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Affiliation(s)
- Kee Hwan Yoo
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Hyung Eun Yim
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea.
| | - Eun Soo Bae
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
| | - Young Sook Hong
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Korea
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11
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Šeruga M, Makuc J, Završnik M, Cilenšek I, Ekart R, Petrovič D. Polymorphism of angiotensin-converting enzyme (rs4340) and diabetic nephropathy in Caucasians with type 2 diabetes mellitus. Balkan J Med Genet 2016; 19:29-34. [PMID: 28289586 PMCID: PMC5343328 DOI: 10.1515/bjmg-2016-0033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diabetic nephropathy (DN) is the leading cause of endstage renal disease (ESRD) in developed countries. Several environmental and genetic factors predict the development and progression of DN. The renin-angiotensin system was demonstrated to be involved in the development of DN. We evaluated the association between rs4340 of the angiotensin-converting enzyme (ACE) gene and DN in Caucasians with type 2 diabetes mellitus (T2DM) in 276 Slovenian patients with T2DM who had DN, and 375 patients without clinical signs of DN. Genetic analysis was performed with either standard polymerase chain reaction (PCR) (for rs4340). Results were analyzed using the χ2 test and multivariate logistic regression analyses. We found no association between rs4340 and DN. Cystatin C was significantly higher in the DN+ group (p <0.001) than in the DN group. Cystatin C was a better marker for the estimation of renal function than estimated glomerular filtration rate (eGFR) according to the modification diet in renal disease (MDRD) equation mL/ min. We concluded that there was no association between the rs4340 of the ACE gene and DN in Caucasian patients who have T2DM.
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Affiliation(s)
- M Šeruga
- Department of Internal Medicine, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - J Makuc
- Department of Internal Medicine, General Hospital Slovenj Gradec, Slovenj Gradec, Slovenia
| | - M Završnik
- Department of Endocrinology and Diabetology, University Medical Centre Maribor, Division of Internal Medicine, Maribor, Slovenia
| | - I Cilenšek
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - R Ekart
- Department of Haemodialysis, University Medical Centre Maribor, Division of Internal Medicine, Maribor, Slovenia
| | - D Petrovič
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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12
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Sarkar T, Singh NP, Kar P, Husain SA, Kapoor S, Pollipalli SK, Kumar A, Garg N. Does angiotensin-converting enzyme-1 (ACE-1) gene polymorphism lead to chronic kidney disease among hypertensive patients? Ren Fail 2016; 38:765-9. [PMID: 27050505 DOI: 10.3109/0886022x.2016.1160247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Hypertension is one of the important contributing factors linked with both causation and development of kidney disease. It is a multifactorial, polygenic, and complex disorder due to interaction of several risk genes with environmental factors. The present study was aimed to explore genetic polymorphism in ACE-1 gene as a risk factor for CKD among hypertensive patients. METHODS Three hundred patients were enrolled in the study. Ninety were hypertensive patients with CKD taken as cases, whereas 210 hypertensive patients without CKD were taken as controls. Demographic data including age, sex, Body mass index (BMI), and other risk factors were also recorded. DNA was extracted from blood by salting out method. Genotyping of ACE gene was done by PCR technique. All the statistical analysis was done by using Epi Info and SPSS version 16 software (SPSS Inc., Chicago, IL). RESULTS Mean age was higher in the control group (p < 0.05). Variables among two groups were compared out of which age, BMI, hemoglobin (Hb) was found to be statistically significant whereas other variables like systolic blood pressure, triglyceride and low-density lipoprotein were not. Blood urea and serum creatinine levels were statistically significant in the two genotypes (p < 0.05). Total and HDL cholesterol were statistically significant for DD genotype of ACE gene (OR = 1.42, 95% CI = 0.72-2.81). Similarly, the risk for CKD among hypertensive patients was also associated with D allele of ACE gene (OR = 1.25, 95% CI = 0.86-1.79). CONCLUSION It is concluded that ACE-DD genotype may be a risk factor for the causation and development of chronic kidney failure among hypertensive patients.
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Affiliation(s)
- Taposh Sarkar
- a Department of Medicine , Maulana Azad Medical College , New Delhi , India
| | - Narinder Pal Singh
- a Department of Medicine , Maulana Azad Medical College , New Delhi , India ;,b Max Super Specialty Hospital , Vaishali , Ghaziabad , Uttar Pradesh , India
| | - Premashish Kar
- a Department of Medicine , Maulana Azad Medical College , New Delhi , India
| | - Syed Akhtar Husain
- c Department of Biotechnology , Jamia Milia Islamia University , New Delhi , India
| | - Seema Kapoor
- d Department of Pediatrics, Genetics Research Lab , Maulana Azad Medical College , New Delhi , India
| | | | - Anish Kumar
- b Max Super Specialty Hospital , Vaishali , Ghaziabad , Uttar Pradesh , India
| | - Neena Garg
- b Max Super Specialty Hospital , Vaishali , Ghaziabad , Uttar Pradesh , India
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13
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Mohammedi K, Patente TA, Bellili-Muñoz N, Driss F, Le Nagard H, Fumeron F, Roussel R, Hadjadj S, Corrêa-Giannella ML, Marre M, Velho G. Glutathione peroxidase-1 gene (GPX1) variants, oxidative stress and risk of kidney complications in people with type 1 diabetes. Metabolism 2016; 65:12-9. [PMID: 26773925 DOI: 10.1016/j.metabol.2015.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 09/24/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIM Glutathione peroxidase (GPX) is a class of antioxidant enzymes that catalyze the reduction of hydrogen peroxide to water. GPX1 is the most abundant isoform and is expressed in all kidney cells. Isoprostane and advanced oxidation protein products (AOPP) were identified as markers of oxidative stress in patients with kidney disease. We investigated associations of GPX1 genotypes with kidney complications, and with plasma concentrations of isoprostane and AOPP in type 1 diabetic patients. METHODS Four SNPs in the GPX1 gene region were genotyped in SURGENE (n=340; 10-year follow-up); GENEDIAB (n=461) and GENESIS (n=584) cohorts of type 1 diabetic patients. Subsets of GENEDIAB (n=237) and GENESIS (n=466) participants were followed up for 9 and 5years, respectively. Plasma concentrations of isoprostane and AOPP were measured at baseline in GENEDIAB. Hazard ratios (HR) were estimated for incidence of kidney complications. RESULTS In SURGENE, 98 renal events (new cases of microalbuminuria or progression to more severe stage of diabetic nephropathy) occurred during follow-up. The minor T-allele of rs3448 was associated with the incidence of renal events (HR 1.81, 95% CI 1.16-2.84, p=0.008). In GENESIS/GENEDIAB pooled study, end stage renal disease (ESRD) occurred during follow-up in 52 individuals. The same variant was associated with the incidence of ESRD (HR 3.34, 95% CI, 1.69-6.98, p=0.0004). The variant was also associated with higher plasma isoprostane concentration in GENEDIAB cohort: 2.02±0.12 (TT+CT) vs 1.75±0.13 (CC) ng/mL (p=0.009), and with higher plasma AOPP in the subset of participants with the baseline history of ESRD (TT+CT 67±6 vs CC 48±6μmol/L, p=0.006). CONCLUSIONS The minor T-allele of rs3448 was associated with kidney complications (incidences of microalbuminuria, renal events and ESRD) in patients with type 1 diabetes. The risk allele was associated with higher plasma concentrations of isoprostane and AOPP. Our results are consistent with the implication of GPX1 in the mechanism of renal protection against oxidative stress in type 1 diabetic patients.
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Affiliation(s)
- Kamel Mohammedi
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France
| | - Thiago A Patente
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Naima Bellili-Muñoz
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France
| | - Fathi Driss
- INSERM, Research Unit 773, 16 rue Henri Huchard, 75018, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, Department of Biochemistry, 46 rue Henri Huchard, 75018, Paris, France
| | - Hervé Le Nagard
- INSERM, Research Unit 1137 - IAME, 16 rue Henri Huchard, 75018, Paris, France
| | - Frédéric Fumeron
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Ronan Roussel
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Samy Hadjadj
- Centre Hospitalier Universitaire de Poitiers, Department of Endocrinology and Diabetology, 2 rue de la Milétrie, 86021, Poitiers, France; INSERM, Research Unit 1082, 2 rue de la Milétrie, 86021, Poitiers, France; INSERM, CIC 1402, 2 rue de la Milétrie, 86021, Poitiers, France; Université de Poitiers, UFR de Médecine et Pharmacie, 6 rue de la Milétrie, 86073, Poitiers, France
| | - Maria Lúcia Corrêa-Giannella
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil; Centro de Terapia Celular e Molecular (NUCEL/NETCEM) da FMUSP, Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Michel Marre
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018, Paris, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, 15 rue de l'École de Médecine, 75006, Paris, France.
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Patente TA, Mohammedi K, Bellili-Muñoz N, Driss F, Sanchez M, Fumeron F, Roussel R, Hadjadj S, Corrêa-Giannella ML, Marre M, Velho G. Allelic variations in the CYBA gene of NADPH oxidase and risk of kidney complications in patients with type 1 diabetes. Free Radic Biol Med 2015; 86:16-24. [PMID: 25862415 DOI: 10.1016/j.freeradbiomed.2015.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 03/03/2015] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
Oxidative stress plays a pivotal role in the pathophysiology of diabetic nephropathy, and the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase system is an important source of reactive oxygen species in hyperglycemic conditions in the kidney. Plasma concentration of advanced oxidation protein products (AOPP), a marker of oxidative stress, is increased in patients with diabetic nephropathy. We investigated associations of variants in the CYBA gene, encoding the regulatory subunit p22(phox) of NADPH oxidase, with diabetic nephropathy and plasma AOPP and myeloperoxidase (MPO) concentrations in type 1 diabetic patients. Seven SNPs in the CYBA region were analyzed in 1357 Caucasian subjects with type 1 diabetes from the SURGENE (n=340), GENEDIAB (n=444), and GENESIS (n=573) cohorts. Duration of follow-up was 10, 9, and 6 years, respectively. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios (HR) or odds ratios (OR) for incidence and prevalence of diabetic nephropathy. The major G-allele of rs9932581 was associated with the incidence of renal events defined as new cases of microalbuminuria or the progression to a more severe stage of nephropathy during follow-up (HR 1.59, 95% CI 1.17-2.18, P=0.003) in SURGENE. The same allele was associated with established/advanced nephropathy (OR 1.52, 95% CI 1.22-1.92, P=0.0001) and with the incidence of end-stage renal disease (ESRD) (HR 2.01, 95% CI 1.30-3.24, P=0.001) in GENEDIAB/GENESIS pooled studies. The risk allele was also associated with higher plasma AOPP concentration in subsets of SURGENE and GENEDIAB, with higher plasma MPO concentration in a subset of GENEDIAB, and with lower estimated glomerular filtration rate (eGFR) in the three cohorts. In conclusion, a functional variant in the promoter of the CYBA gene was associated with lower eGFR and with prevalence and incidence of diabetic nephropathy and ESRD in type 1 diabetic patients. These results are consistent with a role for NADPH oxidase in the pathophysiology of kidney complications of diabetes.
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Affiliation(s)
- Thiago A Patente
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Kamel Mohammedi
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France
| | - Naïma Bellili-Muñoz
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France
| | - Fathi Driss
- INSERM, Research Unit 773, 16 rue Henri Huchard, 75018 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, Department of Biochemistry, 46 rue Henri Huchard, 75018 Paris, France
| | - Manuel Sanchez
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France
| | - Frédéric Fumeron
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Ronan Roussel
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Samy Hadjadj
- Centre Hospitalier Universitaire de Poitiers, Department of Endocrinology and Diabetology, 2 Rue de la Milétrie, 86021 Poitiers, France; INSERM, Research Unit 1082, 2 Rue de la Milétrie, 86021 Poitiers, France; INSERM, CIC 1402, 2 Rue de la Milétrie, 86021 Poitiers, France; Université de Poitiers, UFR de Médecine et Pharmacie, 6 Rue de la Milétrie, 86073 Poitiers, France
| | - Maria Lúcia Corrêa-Giannella
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil; Centro de Terapia Celular e Molecular (NUCEL/NETCEM) da FMUSP, Avenida Dr. Arnaldo 455, CEP 01246903, São Paulo, SP, Brazil
| | - Michel Marre
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France; Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, 46 rue Henri Huchard, 75018 Paris, France; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, 16 rue Henri Huchard, 75018 Paris, France
| | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, 15 rue de l׳École de Médecine, 75006 Paris, France.
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Parchwani DN, Palandurkar KM, Hema Chandan Kumar D, Patel DJ. Genetic Predisposition to Diabetic Nephropathy: Evidence for a Role of ACE (I/D) Gene Polymorphism in Type 2 Diabetic Population from Kutch Region. Indian J Clin Biochem 2015; 30:43-54. [PMID: 25646040 PMCID: PMC4310839 DOI: 10.1007/s12291-013-0402-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 10/28/2013] [Indexed: 01/23/2023]
Abstract
Genetic polymorphism as described with angiotensin-converting enzyme gene has been proposed as a putative mediator of diabetic nephropathy. We substantiate the hypothesis that genetic variants of the ACE have significant impacts on diabetic nephropathy. To assess the possible association between the three ACE polymorphic variants and DN in an ethnically homogeneous type 2 diabetic population from Kutch region. A 287-bp insertion/deletion polymorphism in intron 16 of the ACE gene was examined by polymerase chain reaction using a case-control approach conducted with 309 unrelated type 2 diabetic patients of Kutch origin (159 Ahir and 150 Rabari, with >10 years duration of T2DM). Of the patients, 143 had nephropathy {AER >30 mg/day (Ahir, n:73 and Rabari, n:70)} and were considered as cases; all others {n:166 (86 Ahir and 80 Rabari)} were normoalbuminuric (AER <30 mg/day) and were treated as controls. Suitable descriptive statistics was used for different variables. Genotype frequencies in all groups were all in accordance with the Hardy-Weinberg equilibrium. Genotypic distribution was significantly different between cases and controls (Ahir: x(2) :8.87, 2 d.f. p = 0.0118; Rabari: x(2) :11.01, 2 d.f. p = 0.0041). Multivariate logistic regression analysis revealed that DD genotype was a significant and strongest independent predictor of microalbuminuria (Ahir: p = 0.0362, OR = 2.65, 95 % CI 1.89-6.36; Rabari: p = 0.024, OR = 2.81, 95 % CI 1.9-6.65). However, it did not independently change the odds of having macroalbuminuria versus microalbuminuria. Analysis of the association under various genetic models revealed that ACE I/D polymorphic variant contribute to DN susceptibility under recessive mode only. Genetic variation at the ACE locus as D/D variant in intron 16, contribute to an increased risk of nephropathy in T2DM patients but not extent of DN severity, and thus this polymorphism might be considered as genetic risk factors for DN among patients with type 2 diabetes.
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Affiliation(s)
- Deepak N. Parchwani
- G.K.General Hospital, Gujarat Adani Institute of Medical Sciences, H/No-B/10 New, Bhuj, Gujarat India
| | - Kamlesh M. Palandurkar
- G.K.General Hospital, Gujarat Adani Institute of Medical Sciences, H/No-B/10 New, Bhuj, Gujarat India
| | - D. Hema Chandan Kumar
- G.K.General Hospital, Gujarat Adani Institute of Medical Sciences, H/No-B/10 New, Bhuj, Gujarat India
| | - Darshan J. Patel
- G.K.General Hospital, Gujarat Adani Institute of Medical Sciences, H/No-B/10 New, Bhuj, Gujarat India
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Mohammedi K, Bellili-Muñoz N, Driss F, Roussel R, Seta N, Fumeron F, Hadjadj S, Marre M, Velho G. Manganese superoxide dismutase (SOD2) polymorphisms, plasma advanced oxidation protein products (AOPP) concentration and risk of kidney complications in subjects with type 1 diabetes. PLoS One 2014; 9:e96916. [PMID: 24819633 PMCID: PMC4018399 DOI: 10.1371/journal.pone.0096916] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 04/14/2014] [Indexed: 11/23/2022] Open
Abstract
Aims Oxidative stress is involved in the pathophysiology of diabetic nephropathy. Manganese superoxide dismutase (SOD2) catalyses the dismutation of superoxide, regulates the metabolism of reactive oxygen species in the mitochondria and is highly expressed in the kidney. Plasma concentration of advanced oxidation protein products (AOPP), a marker of oxidative stress, was found to be increased in patients with kidney disease. We investigated associations of SOD2 allelic variations, plasma SOD activity and AOPP concentration with diabetic nephropathy in type 1 diabetic subjects. Methods Eight SNPs in the SOD2 region were analysed in 1285 Caucasian subjects with type 1 diabetes from the SURGENE prospective study (n = 340; 10-year follow-up), GENESIS (n = 501) and GENEDIAB (n = 444) cross-sectional studies. Baseline plasma concentration of AOPP and SOD activity were measured in GENEDIAB participants. Hazard ratio (HR) and odds ratio (OR) were determined for incidence and prevalence of nephropathy. Analyses were adjusted or stratified by retinopathy stages. Results In the SURGENE cohort, the T-allele of rs4880 (V16A) was associated with the incidence of renal events (new cases, or the progression to a more severe stage of nephropathy; HR 1.99, 95% CI 1.24–3.12, p = 0.004) and with the decline in estimated glomerular filtration rate (eGFR) during follow-up. Similar associations were observed for rs2758329 and rs8031. Associations were replicated in GENESIS/GENEDIAB cohorts, in the subset of participants without proliferative retinopathy, and were confirmed by haplotype analyses. Risk allele and haplotype were also associated with higher plasma AOPP concentration and lower SOD activity. Conclusions SOD2 allelic variations were associated with the incidence and the progression of diabetic nephropathy, with a faster decline in eGFR and with plasma AOPP concentration and SOD activity in subjects with type 1 diabetes. These results are consistent with a role for SOD2 in the protection against oxidative stress and kidney disease in type 1 diabetes.
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Affiliation(s)
- Kamel Mohammedi
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France
| | | | - Fathi Driss
- Research Unit 773, INSERM, Paris, France; Department of Biochemistry, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France
| | - Ronan Roussel
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nathalie Seta
- Department of Biochemistry, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Pharmacie, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Frédéric Fumeron
- Research Unit 1138, INSERM, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Samy Hadjadj
- Department of Endocrinology and Diabetology, Centre Hospitalier Universitaire de Poitiers, Poitiers, France; Research Unit 1082, INSERM, Poitiers, France; Centre d'Investigation Clinique (CIC) 0802, INSERM, Poitiers, France; UFR de Médecine et Pharmacie, Université de Poitiers, Poitiers, France
| | - Michel Marre
- Research Unit 1138, INSERM, Paris, France; Department of Diabetology, Endocrinology and Nutrition, Assistance Publique Hôpitaux de Paris - Bichat Hospital, Paris, France; UFR de Médecine, Univ Paris Diderot, Sorbonne Paris Cité, Paris, France
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Lin C, Yang HY, Wu CC, Lee HS, Lin YF, Lu KC, Chu CM, Lin FH, Kao SY, Su SL. Angiotensin-converting enzyme insertion/deletion polymorphism contributes high risk for chronic kidney disease in Asian male with hypertension--a meta-regression analysis of 98 observational studies. PLoS One 2014; 9:e87604. [PMID: 24498151 PMCID: PMC3909221 DOI: 10.1371/journal.pone.0087604] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/24/2013] [Indexed: 12/22/2022] Open
Abstract
Background Associations between angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphisms and chronic kidney disease (CKD) have been extensively studied, with most studies reporting that individuals with the D allele have a higher risk. Although some factors, such as ethnicity, may moderate the association between ACE I/D polymorphisms and CKD risk, gender-dependent effects on the CKD risk remain controversial. Objectives This study investigated the gender-dependent effects of ACE I/D polymorphisms on CKD risk. Data sources PubMed, the Cochrane library, and EMBASE were searched for studies published before January 2013. Study eligibility criteria, participants, and interventions Cross-sectional surveys and case–control studies analyzing ACE I/D polymorphisms and CKD were included. They were required to match the following criteria: age >18 years, absence of rare diseases, and Asian or Caucasian ethnicity. Study appraisal and synthesis methods The effect of carrying the D allele on CKD risk was assessed by meta-analysis and meta-regression using random-effects models. Results Ethnicity [odds ratio (OR): 1.24; 95% confidence interval (CI): 1.08–1.42] and hypertension (OR: 1.55; 95% CI: 1.04–2.32) had significant moderate effects on the association between ACE I/D polymorphisms and CKD risk, but they were not significant in the diabetic nephropathy subgroup. Males had higher OR for the association between ACE I/D polymorphisms and CKD risk than females in Asians but not Caucasians, regardless of adjustment for hypertension (p<0.05). In subgroup analyses, this result was significant in the nondiabetic nephropathy group. Compared with the I allele, the D allele had the highest risk (OR: 3.75; 95% CI: 1.84–7.65) for CKD in hypertensive Asian males. Conclusions and implications of key findings The ACE I/D polymorphisms may incur the highest risk for increasing CKD in hypertensive Asian males.
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Affiliation(s)
- Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsin-Yi Yang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chia-Chao Wu
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Herng-Sheng Lee
- Division of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Yuh-Feng Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
- Division of Nephrology, Department of Medicine, Shuang Ho Hospital, Graduate Institute of Clinical Medicine, Taipei Medical University, New Taipei City, Taiwan, ROC
| | - Kuo-Cheng Lu
- Division of Nephrology, Department of Medicine, Cardinal Tien Hospital, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sen-Yeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
- * E-mail:
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Mohammedi K, Patente TA, Bellili-Muñoz N, Driss F, Monteiro MB, Roussel R, Pavin EJ, Seta N, Fumeron F, Azevedo MJ, Canani LH, Hadjadj S, Marre M, Corrêa-Giannella ML, Velho G. Catalase activity, allelic variations in the catalase gene and risk of kidney complications in patients with type 1 diabetes. Diabetologia 2013; 56:2733-42. [PMID: 24057136 DOI: 10.1007/s00125-013-3057-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 09/02/2013] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Oxidative stress is involved in the pathogenesis of diabetic nephropathy. The antioxidant enzyme catalase plays a key role in redox regulation in the kidney. We investigated associations of catalase gene (CAT) polymorphisms and plasma catalase activity with diabetic nephropathy in type 1 diabetic patients. METHODS We genotyped nine single nucleotide polymorphisms (SNPs) in the CAT region in participants from the Survival Genetic Nephropathy (SURGENE) (340 French participants, 10 year follow-up) and the Génétique de la Néphropathie Diabétique (GENEDIAB) (444 Belgian and French participants, 8 year follow-up) study cohorts. Replication was performed in a Brazilian cross-sectional cohort (n = 451). Baseline plasma catalase activity was measured in SURGENE (n = 120) and GENEDIAB (n = 391) participants. RESULTS The A allele of rs7947841 was associated with the prevalence of incipient (OR 2.79, 95% CI 1.21, 6.24, p = 0.01) and established or advanced nephropathy (OR 5.72, 95% CI 1.62, 22.03, p = 0.007), and with the incidence of renal events, which were defined as new cases of microalbuminuria or progression to a more severe stage of nephropathy during follow-up (HR 1.82, 95% CI 1.13, 2.81, p = 0.01) in SURGENE participants. The same risk allele was associated with incipient nephropathy (OR 3.13, 95% CI 1.42, 7.24, p = 0.004) and with the incidence of end-stage renal disease (ESRD) (HR 2.11, 95% CI 1.23, 3.60, p = 0.008) in GENEDIAB participants. In both cohorts, the risk allele was associated with lower catalase activity. Associations with incipient and established or advanced nephropathy were confirmed in the replication cohort. CONCLUSIONS/INTERPRETATION CAT variants were associated with the prevalence and incidence of diabetic nephropathy and ESRD in type 1 diabetic patients. Our results confirm the protective role of catalase against oxidative stress in the kidney.
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Affiliation(s)
- Kamel Mohammedi
- Inserm Research Unit 695, 16 rue Henri Huchard, 75018, Paris, France
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Lemes VAF, Neves AL, Guazzelli IC, Frazzatto E, Nicolau C, Corrêa-Giannella ML, Velho G, Villares SMF. Angiotensin converting enzyme insertion/deletion polymorphism is associated with increased adiposity and blood pressure in obese children and adolescents. Gene 2013; 532:197-202. [PMID: 24076353 DOI: 10.1016/j.gene.2013.09.065] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/14/2013] [Accepted: 09/18/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND The insertion/deletion polymorphism in the gene encoding the angiotensin-converting enzyme (ACE I/D) was associated with arterial hypertension and obesity in adults, but the data in children are scarce and yielded contrasting results. We assessed the impact of the ACE I/D on blood pressure and obesity related traits in a Brazilian cohort of obese children and adolescents. METHODS AND RESULTS ACE I/D was genotyped in 320 obese children and adolescents (64% of girls) aged 7-16years, referred for a weight-loss program. We observed an association of the D-allele with blood pressure and with pre-hypertension/hypertension in boys (odds ratio 2.44, 95% C.I. 1.34-4.68, p=0.005 for a codominant model). The D-allele, insulin resistance and body fat mass had independent and additive effects and explained 14% of the variance of pre-hypertension/hypertension. The BMI, waist circumference, and body fat mass were significantly higher in DD/ID boys than in II boys (p<0.005). Allelic associations with obesity related traits were independent of the association with blood pressure. No genotype associations were observed in girls. CONCLUSIONS The D-allele of the ACE I/D polymorphism was associated with arterial hypertension and with obesity related traits in boys, but not in girls, in a cohort of obese children and adolescents. These associations were independent of each other, as well as of the effects of other confounding traits such as insulin secretion, insulin sensitivity and glucose tolerance. Our results are in agreement with experimental evidences suggesting that the renin-angiotensin system plays a role in the regulation of visceral adipose tissue accumulation.
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Affiliation(s)
- Vinícius A F Lemes
- Laboratório de Endocrinologia Celular e Molecular (LIM-25), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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20
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El-Baz R, Settin A, Ismaeel A, Khaleel AA, Abbas T, Tolba W, Abd Allah W, Sobh MAEK. MTHFR C677T, A1298C and ACE I/D polymorphisms as risk factors for diabetic nephropathy among type 2 diabetic patients. J Renin Angiotensin Aldosterone Syst 2012; 13:472-477. [DOI: 10.1177/1470320312444651] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Affiliation(s)
| | | | - Azza Ismaeel
- Zoology Department, Faculty Of Science, Mansoura University, Egypt
| | | | - Tarek Abbas
- Urology and Nephrology Center, Mansoura University, Egypt
| | - Wafaa Tolba
- Zoology Department, Faculty Of Science, Mansoura University, Egypt
| | - Wafaa Abd Allah
- Zoology Department, Faculty Of Science, Mansoura University, Egypt
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Mohammedi K, Maimaitiming S, Emery N, Bellili-Muñoz N, Roussel R, Fumeron F, Hadjadj S, Marre M, Velho G. Allelic variations in superoxide dismutase-1 (SOD1) gene are associated with increased risk of diabetic nephropathy in type 1 diabetic subjects. Mol Genet Metab 2011; 104:654-60. [PMID: 21963083 DOI: 10.1016/j.ymgme.2011.08.033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 08/30/2011] [Accepted: 08/30/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Oxidative stress is involved in the pathophysiology of diabetic nephropathy. The superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and have a protective effect against diabetic nephropathy. We investigated associations of allelic variations in SOD1 gene with nephropathy in patients with type 1 diabetes. METHODS Seven SNPs in SOD1 region were analyzed in 1285 type 1 European Caucasian diabetic patients from the SURGENE prospective study (n=340; ten year follow-up), and the Genesis France-Belgium (n=501) and GENEDIAB (n=444) cross-sectional studies. Cox proportional hazards and logistic regression analyses were used to estimate hazard ratios or odds ratios for incidence and prevalence of diabetic nephropathy. RESULTS In the SURGENE study, the T-allele of rs1041740 was associated with the prevalence of incipient (OR 5.75, 95% CI 1.78-19.39, p=0.004) and established/advanced nephropathy at baseline (OR 8.95, 95% CI 1.51-58.42, p=0.02), and with the incidence of incipient nephropathy during follow-up (HR 1.46, 95% C.I. 1.13-1.90, p=0.004). The variant was also associated with decreased estimated glomerular filtration rate (eGFR) throughout the study. In cross-sectional study of Genesis/GENEDIAB cohorts, the G-allele of rs17880135 was associated with incipient (OR 7.53, 95% CI 2.30-25.45, p=0.001), established (OR 6.04, 95% CI 1.52-23.91, p=0.01) and advanced nephropathy (OR 10.03, 95% CI 2.95-35.44, p=0.0003). CONCLUSIONS SOD1 allelic variations were associated with the prevalence of diabetic nephropathy, with the incidence of microalbuminuria and with decreased eGFR in type 1 diabetic subjects. These results are consistent with an implication of oxidative stress in the pathophysiology of diabetic nephropathy and with the major role for antioxidant enzymes as a mechanism of renal protection.
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22
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Alasehirli B, Balat A, Büyükçelik M. DD Genotype of ACE Gene in Boys: May it be a Risk Factor for Minimal Change Nephrotic Syndrome? Ren Fail 2011; 34:19-23. [DOI: 10.3109/0886022x.2011.623493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Belgin Alasehirli
- Department of Pharmacology, School of Medicine, Gaziantep University, Gaziantep, Turkey
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23
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Ding W, Wang F, Fang Q, Zhang M, Chen J, Gu Y. Association between two genetic polymorphisms of the renin-angiotensin-aldosterone system and diabetic nephropathy: a meta-analysis. Mol Biol Rep 2011; 39:1293-303. [DOI: 10.1007/s11033-011-0862-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 05/12/2011] [Indexed: 12/20/2022]
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Ezzidi I, Mtiraoui N, Kacem M, Chaieb M, Mahjoub T, Almawi WY. Identification of specific angiotensin-converting enzyme variants and haplotypes that confer risk and protection against type 2 diabetic nephropathy. Diabetes Metab Res Rev 2009; 25:717-24. [PMID: 19787680 DOI: 10.1002/dmrr.1006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cross-sectional and family studies identified angiotensin-converting enzyme (ACE) gene as a risk factor for diabetic nephropathy (DN). The contribution of ACE gene variants to DN development and progression is controversial and varies among different ethnic/racial groups. METHODS We investigated the association of three ACE gene variants with DN, rs1799752 insertion/deletion (I/D), rs1800764T/C and rs12449782A/G in 917 Tunisian type 2 diabetic (T2DM) patients: 515 with (DN) and 402 without (DWN) nephropathy. ACE genotyping was done by PCR-based assays; haplotype estimation was performed using H-Plus software (chi(2)-test based). RESULTS Genotype frequency distributions of the three studied variants were in Hardy-Weinberg equilibrium. Minor allele frequency of rs1800764 was higher in DN patients than DWN patients or healthy controls, and minor allele frequency of rs1799752 was higher in DN than DWN patients. Higher frequency of rs1799752 and rs1800764 homozygous mutant genotypes was seen in DN compared to DWN patients. Of the three variants, only rs1799752 deletion/deletion (D/D) genotype was associated with a significant increase in albumin to creatinine ratios levels, and D/D carriers had elevated low-density lipoprotein, total cholesterol and urea. Three locus haplotype [rs1799752(I/D)/rs1800764(T/C)/rs12449782(A/G)] analysis revealed that the frequency of DCG haplotype was higher, while that of ITG and ICA haplotypes were lower among unselected type 2 diabetic patients. Taking ITA haplotype as reference, multivariate regression analysis confirmed the negative (ITG), and positive (DCG, DTG, DCA and DTA) association of specific ACE haplotypes with DN, after adjusting for potential nephropathy-linked covariates. CONCLUSIONS Our results support the involvement of specific ACE variants in DN pathogenesis and demonstrate the presence of DN-specific haplotypes at the ACE locus.
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Affiliation(s)
- Intissar Ezzidi
- Research Unit of Biology and Genetics of Cancer and Haematological and Autoimmune Diseases, Faculty of Pharmacy of Monastir, Monastir University, Monastir, Tunisia
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Nikzamir A, Esteghamati A, Feghhi M, Nakhjavani M, Rashidi A, Reza JZ. The insertion/deletion polymorphism of the angiotensin-converting enzyme gene is associated with progression, but not development, of albuminuria in Iranian patients with type 2 diabetes. J Renin Angiotensin Aldosterone Syst 2009; 10:109-14. [PMID: 19502259 DOI: 10.1177/1470320309104872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene has been shown to be associated with a number of complications of type 2 diabetes. RESULTS on the development and progression of albuminuria, however, have remained controversial, with ethnic differences being a potential reason.The present study is the first report to examine Iranian patients. METHODS Patients (322; 162 males) with type 2 diabetes were categorised in this cross-sectional study into the following groups: normoalbuminuria (n=145), microalbuminuria (n=129) and macroalbuminuria (n=48).ACE gen I/D polymorphism genotypes were determined using the polymerase chain reaction method. RESULT s. The distribution of ACE genotypes was significantly different among the groups (p<0.001), with the II genotype decreasing and the DD genotype increasing in frequency with increasing severity of albuminuria. Multivariate regression analysis showed that the ACE genotype did not change the odds of having microalbuminuria versus normoalbuminuria, while the D allele independently increased the odds of having macroalbuminuria versus microalbuminuria approximately threefold (p<0.01). CONCLUSIONS In Iranian patients with type 2 diabetes, the D allele is associated with progression, but not development, of albuminuria.
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Affiliation(s)
- Abdolrahim Nikzamir
- Department of Biochemistry, Faculty of Medicine, Ahwaz Jondi Shapour University of Medical Sciences, Ahwaz, Iran
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Rudnicki M, Mayer G. Significance of genetic polymorphisms of the renin–angiotensin–aldosterone system in cardiovascular and renal disease. Pharmacogenomics 2009; 10:463-76. [DOI: 10.2217/14622416.10.3.463] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The angiotensin converting enzyme (ACE) is a component of the renin–angiotensin–aldosterone system (RAAS). The RAAS – involved primarily in blood pressure and sodium homeostasis – is activated in many renal and cardiovascular diseases, and therapy with ACE inhibitors and other blockers of the RAAS has proven to be clinically beneficial. Plasma and tissue levels of ACE are at least partially determined by a genetic polymorphism based on the presence (insertion [I]) or absence (deletion [D]) of a 287 base pair element in intron 16. In particular Asian subjects with the DD genotype (and increased ACE activity) have been reported to be at higher risk for cardiovascular disorders and nephropathy. Numerous studies evaluated the role of the ACE I/D polymorphism as well as other genetic variants of the RAAS in the context of RAAS inhibitor therapy. However, as race and environmental factors, such as salt intake also affect treatment response most studies were underpowered leading to conflicting results.
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Affiliation(s)
- Michael Rudnicki
- Department of Internal Medicine IV, (Nephrology and Hypertension), Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gert Mayer
- Department of Internal Medicine IV, (Nephrology and Hypertension), Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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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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Cardoso RL, Nogueira AR, Salis LHA, Urményi TP, Silva R, Moura-Neto RS, Pereira BB, Rondinelli E, Souza e Silva NAD. The association of ACE gene D/I polymorphism with cardiovascular risk factors in a population from Rio de Janeiro. Braz J Med Biol Res 2009; 41:512-8. [PMID: 18622495 DOI: 10.1590/s0100-879x2008000600013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2007] [Accepted: 06/04/2008] [Indexed: 11/22/2022] Open
Abstract
Our aim was to determine the frequencies of the angiotensin-converting enzyme (ACE) gene alleles D and I and any associations to cardiovascular risk factors in a population sample from Rio de Janeiro, Brazil. Eighty-four adults were selected consecutively during a 6-month period from a cohort subgroup of a previous large cross-sectional survey in Rio de Janeiro. Anthropometric data and blood pressure measurements, echocardiogram, albuminuria, glycemia, lipid profile, and ACE genotype and serum enzyme activity were determined. The frequency of the ACE*D and I alleles in the population under study, determined by PCR, was 0.59 and 0.41, respectively, and the frequencies of the DD, DI, and II genotypes were 0.33, 0.51, and 0.16, respectively. No association between hypertension and genotype was detected using the Kruskal-Wallis method. Mean plasma ACE activity (U/mL) in the DD (N = 28), DI (N = 45) and II (N = 13) groups was 43 (in males) and 52 (in females), 37 and 39, and 22 and 27, respectively; mean microalbuminuria (mg/dL) was 1.41 and 1.6, 0.85 and 0.9, and 0.6 and 0.63, respectively; mean HDL cholesterol (mg/dL) was 40 and 43, 37 and 45, and 41 and 49, respectively, and mean glucose (mg/dL) was 93 and 108, 107 and 98, and 85 and 124, respectively. A high level of ACE activity and albuminuria, and a low level of HDL cholesterol and glucose, were found to be associated with the DD genotype. Finally, the II genotype was found to be associated with variables related to glucose intolerance.
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Affiliation(s)
- R L Cardoso
- Hospital Universitário Clementino Fraga Filho, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Angiotensin converting enzyme insertion/deletion genetic polymorphism: its impact on renal function in critically ill patients. Crit Care Med 2008; 36:3178-83. [PMID: 19020433 DOI: 10.1097/ccm.0b013e318186a299] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Previous clinical studies have suggested an association between the insertion/deletion (I/D) genetic polymorphism of angiotensin converting enzyme and acute or chronic diseases. We aimed to test the prognostic value of the I-allele, which is associated with lower angiotensin converting enzyme activity, on acute kidney injury. DESIGN Prospective 6-month noninterventional study. SETTING Intensive care unit of a University Hospital. PATIENTS AND METHODS One hundred eighty consecutive admitted white patients for an expected intensive care unit stay >48 hr. Angiotensin converting enzyme genetic polymorphism was screened for genotype (I/D polymorphism analysis by polymerase chain reaction amplification) and phenotype (measurement of the circulating rate of angiotensin converting enzyme by spectrophotometry). Acute kidney injury was assessed according to Risk, Injury, Failure, Loss, and End-stage Kidney classification. INTERVENTION None. RESULTS II, ID, and DD genotype frequencies were 25%, 48%, and 27%, respectively. II and ID genotypes were associated with lower baseline circulating rates of angiotensin converting enzyme (20 +/- 14 and 22 +/- 18 U/L, respectively, vs. 30 +/- 23 U/L for DD genotype; p = 0.04). Repartition of angiotensin converting enzyme genotypes were different in patients with and without acute kidney injury (p < 0.0001), with greater II genotype proportion in acute kidney injury patients (42% vs. 13% for those without acute kidney injury). After adjustment on the identified prognostic factors, II genotype was independently associated with increased risk of acute kidney injury (adjusted odds ratio, 6.5; 95% confidence interval, 2.4-17.7; p = 0.0002), then death among patients with acute kidney injury (adjusted odds ratio, 1.7; 95% confidence ratio, 1.1-2.6; p = 0.02). CONCLUSION These data confirm the key role of the renin-angiotensin system to maintain glomerular filtration rate, and highlight an association between a genetic factor and susceptibility to and prognosis of acute kidney disease.
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Hadjadj S, Fumeron F, Roussel R, Saulnier PJ, Gallois Y, Ankotche A, Travert F, Abi Khalil C, Miot A, Alhenc-Gelas F, Lievre M, Marre M. Prognostic value of the insertion/deletion polymorphism of the ACE gene in type 2 diabetic subjects: results from the Non-insulin-dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR), Diabete de type 2, Nephropathie et Genetique (DIAB2NEPHROGENE), and Survie, Diabete de type 2 et Genetique (SURDIAGENE) studies. Diabetes Care 2008; 31:1847-52. [PMID: 18523145 PMCID: PMC2518357 DOI: 10.2337/dc07-2079] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested whether determination of the ACE insertion/deletion polymorphism is useful for renal and cardiovascular prognoses of type 2 diabetic subjects. RESEARCH DESIGN AND METHODS The French participants (3,126 of 4,912) in the Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial were studied for their prognosis over 4 years according to their ACE insertion/deletion polymorphism. We used two cohorts of French type 2 diabetic patients for replication: a 3-year follow-up study (n = 917; Survie, Diabete de type 2 et Genetique [SURDIAGENE] study) and a case-control study on diabetic nephropathy (n = 1,277; Diabete de type 2, Nephropathie et Genetique [DIAB2NEPHROGENE] study). We investigated the effect of the insertion/deletion polymorphism on the primary outcome in the DIABHYCAR trial (defined as the first of the following events to occur: cardiovascular death, nonfatal myocardial infarction, stroke, heart failure leading to hospital admission, or end-stage renal failure) and its components. RESULTS In DIABHYCAR, the primary outcome and most of its components were not affected by the ACE insertion/deletion genotype. Only renal outcome was favored by the I allele (P = 0.03). The risk of myocardial infarction was not affected by ACE genotype, but the probability of fatal outcome increased with the number of D alleles (P < 0.03). In SURDIAGENE, the association between the ACE I allele and renal outcome was not replicated. In DIAB2NEPHROGENE, no association was found with nephropathy. CONCLUSIONS We were not able to demonstrate the manifest usefulness of the ACE insertion/deletion polymorphism for the prognosis of type 2 diabetic subjects.
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Affiliation(s)
- Samy Hadjadj
- Centre Hospitalier Universitaire Poitiers, Endocrinology, Diabetology, Poitiers, France.
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Tang FY, Liu FY, Xie XW. Association of angiotensin-converting enzyme and endothelial Nitric Oxide synthase gene polymorphisms with vascular disease in ESRD patients in a Chinese population. Mol Cell Biochem 2008; 319:33-9. [DOI: 10.1007/s11010-008-9874-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 07/03/2008] [Indexed: 11/28/2022]
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Ruggenenti P, Bettinaglio P, Pinares F, Remuzzi G. Angiotensin converting enzyme insertion/deletion polymorphism and renoprotection in diabetic and nondiabetic nephropathies. Clin J Am Soc Nephrol 2008; 3:1511-25. [PMID: 18550651 DOI: 10.2215/cjn.04140907] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite the huge amount of studies looking for candidate genes, the ACE gene remains the unique, well-characterized locus clearly associated with pathogenesis and progression of chronic kidney disease, and with response to treatment with drugs that directly interfere with the renin angiotensin system (RAS), such as angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARA). The II genotype is protective against development and progression of type I and type II nephropathy and is associated with a slower progression of nondiabetic proteinuric kidney disease. ACE inhibitors are particularly effective at the stage of normoalbuminuria or microalbuminuria in both type I and type II diabetics with the II genotype, whereas the DD genotype is associated with a better response to ARA therapy in overt nephropathy of type II diabetes and to ACE inhibitors in male patients with nondiabetic proteinuric nephropathies. The role of other RAS or non-RAS polymorphisms and their possible interactions with different ACE I/D genotypes are less clearly defined. Thus, evaluating the ACE I/D polymorphism is a reliable tool to identify patients at risk and those who may benefit the most of renoprotective therapy with ACE inhibitors or ARA. This may guide pharmacologic therapy in individual patients and help design clinical trials in progressive nephropathies. Moreover, it might help optimize prevention and intervention strategies at population levels, in particular, in countries where resources are extremely limited and 1 million patients continue to die every year of cardiovascular or renal disease.
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Affiliation(s)
- Piero Ruggenenti
- Clinical Research Centre for Rare Diseases Aldo e Cele Daccò, Mario Negri Institute for Pharmacological Research, Villa Camozzi, Ranica, Italy
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Bogdanović R. Diabetic nephropathy in children and adolescents. Pediatr Nephrol 2008; 23:507-25. [PMID: 17940807 DOI: 10.1007/s00467-007-0583-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/09/2007] [Accepted: 07/12/2007] [Indexed: 12/12/2022]
Abstract
Type 1 diabetes mellitus (T1DM) commonly occurs in childhood or adolescence, although the rising prevalence of type 2 diabetes mellitus (T2DM) in these age groups is now being seen worldwide. Diabetic nephropathy (DN) develops in 15-20% of subjects with T1DM and in similar or higher percentage of T2DM patients, causing increased morbidity and premature mortality. Although overt DN or kidney failure caused by either type of diabetes are very uncommon during childhood or adolescence, diabetic kidney disease in susceptible patients almost certainly begins soon after disease onset and may accelerate during adolescence, leading to microalbuminuria or incipient DN. Therefore, all diabetics warrant ongoing assessment of kidney function and screening for the earliest manifestations of renal injury. Pediatric health care professionals ought to understand about risk factors, strategy for prevention, method for screening, and treatment of early DN. This review considers each form of diabetes separately, including natural history, risk factors for development, screening for early manifestations, and strategy recommended for prevention and treatment of DN in children and adolescents.
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Affiliation(s)
- Radovan Bogdanović
- The Institute of Mother and Child Healthcare of Serbia Dr Vukan Cupic, Belgrade, Serbia.
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Zhang G, Wang H, Wang F, Yu L, Yang X, Meng J, Qin W, Wu G, Li J, Yang A, Zhou Y, Zhang R. Gene polymorphisms of the renin-angiotensin-aldosterone system and angiotensin II type 1-receptor activating antibodies in renal rejection. TOHOKU J EXP MED 2008; 213:203-14. [PMID: 17984617 DOI: 10.1620/tjem.213.203] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Steroid refractory acute rejection (SRAR) is a major vital factor in renal transplantation recipients. The pathogenesis of SRAR may involve both immune and non-immune mechanisms. A decreased renal allograft function has also been associated with increased activity of renin-angiotensin-aldosterone system (RAS), which may be genetically determined. A total 206 renal transplant recipients, 116 males and 90 females, were included. The effects of gene polymorphisms of the four components of RAS including angiotensinogen (AGT), angiotensin-converting enzyme (ACE), angiotensin type 1 receptor (AT1R), and aldosterone synthase (CYP11B2) were investigated in 19 cases of renal transplant patients with SRAR. The association between SRAR and the activating antibodies targeting the AT1R were also investigated. Genotyping was performed for the M235T-AGT, the I/D-ACE, the A1166C-AT1R, and the -344T/C-CYP11B2 gene polymorphisms using polymerase chain reaction. Our results showed that renal allograft recipients with SRAR had significantly higher occurrences of the DD genotype of ACE and CC genotype of AT1R than recipients without SRAR. The other genetic polymorphisms of the RAS were not associated with SRAR. Activating antibodies targeting the AT1R were detected in the sera from 14 SRAR victims with malignant hypertension and without anti-HLA antibodies. This study provides evidence that determination before transplantation of the polymorphism of the gene encoding components of RAS may help identify patients who are at risk for SRAR. The detection of the antibodies of AT1R may contribute to the prevention of SRAR.
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Affiliation(s)
- Geng Zhang
- Department of Urology, Xijing Hospital, Xi'an, china.
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Arfa I, Abid A, Nouira S, Elloumi-Zghal H, Malouche D, Mannai I, Zorgati MM, Ben Alaya N, Rebai A, Zouari B, Ben Ammar S, Ben Rayana MC, Hmida S, Blousa-Chabchoub S, Abdelhak S. Lack of association between the angiotensin-converting enzyme gene (I/D) polymorphism and diabetic nephropathy in Tunisian type 2 diabetic patients. J Renin Angiotensin Aldosterone Syst 2008; 9:32-6. [DOI: 10.3317/jraas.2008.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objective. The aim of the present study was to investigate whether the angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism is associated with diabetic nephropathy and type 2 diabetes in the Tunisian population.Design. A case-control study was conducted among 141 unrelated type 2 diabetic patients with (90 patients) or without nephropathy (51 patients) and 103 non-diabetic controls with normal fasting blood glucose. Genotyping was performed using a nested polymerase chain reaction amplification in order to identify correctly heterozygous individuals.Results. The distribution of DD, ID and II genotypes did not significantly differ between type 2 diabetic patients with or without nephropathy (DD: 44%; ID: 46%; II: 10% vs. DD: 41%; ID: 47 %; II: 12%, respectively).There was also no significant statistical difference between the genotype distribution and allele frequencies of the (I/D) polymorphism in all type 2 diabetic subjects compared to non-diabetic controls with normal fasting blood glucose (DD: 43%; ID: 46%; II: 11% vs. DD: 37%; ID: 48% ;II: 15%, respectively).Conclusions. In the present preliminary study, the (I/D) polymorphis within the ACE gene is likely not associated with diabetic nephropathy nor with type 2 diabetes in the Tunisian studied population.
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Affiliation(s)
- Imen Arfa
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Sonia Nouira
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, sonia.abdelhak @pasteur.rns.tn
| | - Houda Elloumi-Zghal
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Dhafer Malouche
- Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Imen Mannai
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia, Engineering school of statistic and information analysis (LEGI-EPT-ESSAIT), University of 7th November at Carthage Tunis, Tunisia
| | - Mohamed Majdi Zorgati
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | - Nissaf Ben Alaya
- Laboratory of Epidemiology. Institut Pasteur de Tunis, Tunis, Tunisia
| | | | - Béchir Zouari
- Department of Epidemiology and Statistics, School University of Medicine, Tunis, Tunisia
| | - Slim Ben Ammar
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
| | | | - Slama Hmida
- National Center of Blood Transfusion Tunis, Tunisia
| | | | - Sonia Abdelhak
- Molecular Investigation of Genetic Orphan Diseases Research Unit, Institut Pasteur de Tunis. Tunis, Tunisia
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Freedman BI, Bostrom M, Daeihagh P, Bowden DW. Genetic Factors in Diabetic Nephropathy. Clin J Am Soc Nephrol 2007; 2:1306-16. [DOI: 10.2215/cjn.02560607] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hadjadj S, Tarnow L, Forsblom C, Kazeem G, Marre M, Groop PH, Parving HH, Cambien F, Tregouet DA, Gut IG, Théva A, Gauguier D, Farrall M, Cox R, Matsuda F, Lathrop M, Hager-Vionnet N. Association between angiotensin-converting enzyme gene polymorphisms and diabetic nephropathy: case-control, haplotype, and family-based study in three European populations. J Am Soc Nephrol 2007; 18:1284-91. [PMID: 17376814 DOI: 10.1681/asn.2006101102] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Angiotensin 1-converting enzyme gene (ACE) is a risk factor for diabetic nephropathy (DN) in patients with type 1 diabetes. The selection of this candidate gene is supported by cross-sectional and follow-up studies, but no convincing family-based studies are available. Recruited were 1057 patients (with DN: persistent albuminuria with or without renal failure) and 1127 control subjects (long-standing [> or =15 yr] normoalbuminuric patients with type 1 diabetes) in Denmark, Finland, and France and 532 family trios that were composed of 244 trios with DN probands and 288 trios with non-DN probands. Five ACE polymorphisms were studied. In the case-control analysis, the rs1800764-C, rs4311-T, Insertion/deletion (I/D or rs1799752)-D, rs4366-G, and rs12449782-G alleles were associated with an increased risk for DN, homogeneously across populations, with allelic odds ratios of 1.11 (95% confidence interval 1.00 to 1.22), 1.18 (1.04 to 1.33), 1.13 (1.02 to 1.23), 1.10 (0.99 to 1.20), and 1.12 (1.01 to 1.23), respectively. Haplotype analysis further demonstrated that the haplotype defined by the D, rs4366_G and rs12449782_G alleles was associated with a greater risk for DN. Even though no significant allelic overtransmission to DN or non-DN probands was detected, the family-based study provided consistent results with the case-control analysis. In a large case-control study, it was shown that the ACE polymorphisms were associated with DN; these findings were not confirmed in a family-based association study. This study population is suitable to search for additional candidate genes for DN.
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Affiliation(s)
- Samy Hadjadj
- CHU de Poitiers, Department of Diabetology, Poitiers University Hospital, Poitiers, France.
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Van de Wal RMA, Voors AA, Gansevoort RT. Urinary albumin excretion and the renin-angiotensin system in cardiovascular risk management. Expert Opin Pharmacother 2007; 7:2505-20. [PMID: 17150005 DOI: 10.1517/14656566.7.18.2505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Microalbuminuria has been shown to be a strong predictor of cardiovascular morbidity and mortality in diabetic and hypertensive patients, but also in the general population. Moreover, several reports suggest that reduction of urinary albumin excretion (UAE) is associated with improvement of cardiovascular prognosis. Reduction of UAE can be achieved by lowering arterial blood pressure, but blockers of the renin-angiotensin system (RAS) with their specific renal actions have demonstrated to be able to reduce UAE more than might be expected from reduction of blood pressure alone. Consequently, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may also provide superior cardiovascular protection, especially in subjects with higher levels of albuminuria, but evidence is still scarce. The ability of both angiotensin-converting enzyme inhibitors and angiotensin receptor blockers to reduce UAE and provide cardiovascular protection suggests that the RAS may play a central role. New developments in this area include the use of aldosterone antagonists in albuminuric/proteinuric subjects, and the development of oral renin inhibitors. Combinations of the aforementioned drugs may have the ability to fully block the RAS, potentially avoiding all detrimental effects of this hormonal cascade. However, combination therapy is expected to also increase the incidence of side effects, such as hyperkalaemia and acute renal insufficiency. The current knowledge of microalbuminuria represents the proverbial tip of the iceberg, and future studies should focus on the underlying pathophysiological mechanism of urinary albumin excretion in relation to cardiovascular protection. Only then can a better understanding of the problem be achieved and the optimal pharmacological approach be ascertained.
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Affiliation(s)
- R M A Van de Wal
- St Antonius Hospital, Department of Cardiology, Nieuwegein, The Netherlands
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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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Affiliation(s)
- Trevor J Orchard
- MBBCh, MMedSci, Diabetes and Lipid Research Bldg., 3512 Fifth Ave., Pittsburgh, PA 15213, USA.
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Remuzzi G, Benigni A, Remuzzi A. Mechanisms of progression and regression of renal lesions of chronic nephropathies and diabetes. J Clin Invest 2006; 116:288-96. [PMID: 16453013 PMCID: PMC1359063 DOI: 10.1172/jci27699] [Citation(s) in RCA: 425] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The incidence of chronic kidney diseases is increasing worldwide, and these conditions are emerging as a major public health problem. While genetic factors contribute to susceptibility and progression of renal disease, proteinuria has been claimed as an independent predictor of outcome. Reduction of urinary protein levels by various medications and a low-protein diet limits renal function decline in individuals with nondiabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been observed in experimental animals and even in humans. In animal models, regression of glomerular structural changes is associated with remodeling of the glomerular architecture. Instrumental to this discovery were 3D reconstruction studies of the glomerular capillary tuft, which allowed the quantification of sclerosis volume reduction and capillary regeneration upon treatment. Regeneration of capillary segments might result from the contribution of resident cells, but progenitor cells of renal or extrarenal origin may also have a role. This review describes recent advances in our understanding of the mechanisms and mediators underlying renal tissue repair ultimately responsible for regression of renal injury.
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Affiliation(s)
- Giuseppe Remuzzi
- Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
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Gallon L, Akalin E, Lynch P, Rothberg L, Parker M, Schiano T, Abecassis M, Murphy B. ACE Gene D/D Genotype as a Risk Factor for Chronic Nephrotoxicity from Calcineurin Inhibitors in Liver Transplant Recipients. Transplantation 2006; 81:463-8. [PMID: 16477235 DOI: 10.1097/01.tp.0000185305.63759.d3] [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] [Indexed: 11/26/2022]
Abstract
BACKGROUND Chronic renal failure (CRF) is a major cause of morbidity and mortality after orthotopic liver transplantation (OLTX) and is predominantly caused by calcineurin inhibitors (CI)-induced nephrotoxicity. The activation of the renin angiotensin system (RAS) has been implicated in the pathogenesis of chronic nephrotoxicity from CI. METHODS We retrospectively investigated the genes coding for components of the RAS (ACE gene, Angiotensin II receptor 1 gene, Angiotensinogen gene) in 233 liver transplant recipients receiving Cyclosporine (CsA) or Tacrolimus (Tac) as maintenance immunosuppressant. All patients with serum creatinine (sCr) <1.0 mg/dL (n=143) before orthotopic liver transplantation (OLTX) were included in the final analysis. Patients were than categorized into two groups based upon their most recent postliver transplant sCr level: Group 1 (n=83) with sCr <1.5 mg/dL (mean 1.1+/-0.2) and group 2 (n=60) with sCr > or =1.5 mg/dL (mean 2.5+/-1.3) RESULTS ACE D/D genotype was found in 57% of patients with sCr > or =1.5 mg/dL compared to 20% of patients with sCr <1.5 mg/dL (P<0.0001) CONCLUSIONS Our analysis strongly suggests that liver transplant patients with ACE gene D/D genotype are at a significant higher risk of developing CI-induced chronic nephrotoxicity.
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Affiliation(s)
- Lorenzo Gallon
- Department of Medicine, Division of Nephrology, Northwestern University, Chicago, IL 60611, USA.
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van der Sman-de Beer F, Verhagen C, Rombach SM, Boorsma P, van Manen JG, Korevaar JC, van den Bogaard R, Boeschoten EW, Krediet RT, Navis GJ, Vandenbroucke JP, Dekker FW. ACE I/D polymorphism is associated with mortality in a cohort study of patients starting with dialysis. Kidney Int 2006; 68:2237-43. [PMID: 16221224 DOI: 10.1111/j.1523-1755.2005.00681.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND In dialysis patients, only a few follow-up studies have addressed the relationship between the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme (ACE) gene and mortality, but the available data are contradictory. METHODS A cohort of 453 consecutive patients starting dialysis between January 1999 and January 2002 and participating in a Dutch multicenter prospective study was examined. Patients who died within 3 months after the start of dialysis were excluded. Patients were followed until date of death or censoring in November 2003. RESULTS The ACE II, ID, and DD genotype frequencies were 24.3% (N = 110), 50.1% (N = 227), and 25.6% (N = 116). Besides a slightly higher number of Caucasians in the DD group, all other patient characteristics of the 3 ACE groups were similar at the start of dialysis. After adjustment for age, comorbidity, and ethnic background, patients with the ID and DD genotype showed an increased hazard ratio (HR) for all-cause mortality of 1.55 (95% CI 1.00-2.42) and 2.30 (95% CI 1.41-3.75), compared to patients with the II genotype. Slightly lower HRs were found for cardiovascular mortality. All groups of primary kidney disease showed a 2- to 3-fold increased adjusted HR for DD. CONCLUSION The DD genotype identifies dialysis patients at an increased risk for mortality.
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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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Ayed K, Ayed-Jendoubi S, Ben Abdallah T, Bardi R, Gorgi Y, Sfar I, Dhrif B, Abderrahim E, Kheder A. Polymorphism of the renin-angiotensin-aldosterone system in patients with chronic allograft dysfunction. Transpl Immunol 2005; 15:303-9. [PMID: 16635753 DOI: 10.1016/j.trim.2005.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 09/27/2005] [Indexed: 11/21/2022]
Abstract
Polymorphism of the gene encoding components of the renin-angiotensin-aldosterone synthase system (RAAS) represents an area of intense research of cardiovascular disease associations. Numerous studies have addressed the role of RAAS gene polymorphisms in the development and progression of renal disease. Also, it has been reported that patient with ACE (DD) and angiotensinogen AGT (TT) genotypes are associated with chronic allograft dysfunction (CAD). We investigated the effects of gene polymorphisms of the renin-angiotensin-aldosterone system in renal transplant patients (81 males and 50 females; mean age 29.6+/-10.2 years). Genotypes were determined using polymerase chain reaction sequence specific primers and PCR followed by RFLP analysis. Renal allograft recipients with chronic allograft dysfunction had significantly higher frequencies of the MM genotype than those without CAD (P<0.05). The other genetic polymorphisms of the RAAS were not associated with CAD. This study proves that determination of AGT M235T genotype before transplantation may help identify patients who are at risk for chronic renal transplant dysfunction.
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Affiliation(s)
- Kh Ayed
- Immunology Laboratory EPS. Ch. Nicolle Hospital, Tunis, Tunisia.
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Weekers L, Bouhanick B, Hadjadj S, Gallois Y, Roussel R, Pean F, Ankotche A, Chatellier G, Alhenc-Gelas F, Lefebvre PJ, Marre M. Modulation of the renal response to ACE inhibition by ACE insertion/deletion polymorphism during hyperglycemia in normotensive, normoalbuminuric type 1 diabetic patients. Diabetes 2005; 54:2961-7. [PMID: 16186399 DOI: 10.2337/diabetes.54.10.2961] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ACE inhibition protects kidney function, but ACE insertion/deletion (I/D) polymorphism affects renal prognosis in type 1 diabetic patients. ACE genotype may influence the renal benefits of ACE inhibition. We studied the impact of ACE I/D polymorphism on the renal hemodynamic changes induced by ACE inhibition in type 1 diabetes. We studied renal hemodynamics (glomerular filtration rate [GFR], effective renal plasma flow [ERPF], filtration fraction [GFR/ERPF], mean arterial pressure [MAP], and total renal resistances [MAP/ERPF]) repeatedly during normoglycemia and then hyperglycemia in 12 normotensive, normoalbuminuric type 1 diabetes and the II genotype (associated with nephroprotection) versus 22 age- and sex-matched subjects with the ACE D allele after three randomly allocated 2- to 6-week periods on placebo, 1.25 mg/day ramipril, and 5 mg/day ramipril in a double-blind, cross-over study. During normoglycemia, the hemodynamic changes induced by ramipril were similar in both genotypes. During hyperglycemia, the changes induced by ramipril were accentuated in the II genotype group and attenuated dose dependently in the D allele group (treatment-genotype interaction P values for ERPF, 0.018; MAP, 0.018; and total renal resistances, 0.055). These results provide a basis to different renal responses to ACE inhibition according to ACE genotype in type 1 diabetes.
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Affiliation(s)
- Laurent Weekers
- Department of Medicine, Centre Hospitalier Universitaire du Sart Tilman, Liege, Belgium
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Salinas I, Romero R. Hipercolesterolemia y nefropatía diabética, una asociación multifactorial. Med Clin (Barc) 2005; 125:415-6. [PMID: 16216187 DOI: 10.1157/13079392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Jacobsen PK. Preventing end stage renal disease in diabetic patients--genetic aspect (part I). J Renin Angiotensin Aldosterone Syst 2005; 6:1-14. [PMID: 16088846 DOI: 10.3317/jraas.2005.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Diabetic nephropathy is a major cause of diabetes- related morbidity and mortality; however the clinical course of the disease and the renal prognosis is highly variable among individuals. The current review will discuss the genetic influence on the development of end stage renal disease (ESRD) in diabetic patients and potential improvements to the current treatment strategy to slow the loss of kidney function in these patients. In this first part, the growing evidence that glucose-induced activation of the intra-renal and systemic renin-angiotensin systems plays an essential role in processes leading to destruction of renal function is summarised. Genetic variations, especially the angiotensin-converting enzyme (ACE)/ID polymorphisms in the gene coding for ACE, are involved in activation of the renin-angiotensin system and seem to influence the clinical course of diabetic nephropathy during treatment with ACE inhibitors. In addition, this polymorphism may interact with other polymorphisms within the renin-angiotensin system, leading to high risk of ESRD. As new genetic approaches and methods develop, further understanding of diabetic nephropathy will evolve and genotyping will help prevent ESRD in diabetic patients.
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Barkai L, Soós A, Vámosi I. Association of angiotensin-converting enzyme DD genotype with 24-h blood pressure abnormalities in normoalbuminuric children and adolescents with Type 1 diabetes. Diabet Med 2005; 22:1054-9. [PMID: 16026372 DOI: 10.1111/j.1464-5491.2005.01601.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To assess the distribution of the insertion/deletion (I/D) polymorphism of the angiotensin-converting enzyme (ACE) gene in children and adolescents with Type 1 diabetes and to evaluate the association between ACE genotype and blood pressure (BP). METHODS ACE genotypes were assessed in 124 normoalbuminuric, clinically normotensive Type 1 diabetic children and adolescents and 120 non-diabetic controls using polymerase chain reaction. Twenty-four-hour ambulatory BP monitoring was undertaken in all patients. RESULTS ACE genotypes distributed in patients as follows: 34 (27%) DD, 57 (46%) ID, 33 (27%) II. The distribution was similar in the control group: DD in 28% (33), ID in 45% (54), and II in 27% (33). Patients with DD genotype had higher mean 24-h diastolic BP (73.8 +/- 6.2 vs. 70.2 +/- 5.0 and 69.7 +/- 6.3 mmHg; P = 0.005) and lower diurnal variation in BP (11.8 +/- 4.6 vs. 14.2 +/- 4.2 and 14.8 +/- 4.3%; P = 0.011) compared with ID and II groups. Four patients in the DD group proved to be non-dipper compared with one in the ID and none in the II group (P = 0.026). Twenty-four-hour diastolic blood pressure was independently predictive for AER as dependent variable in the DD genotype patient group (r(2) = 0.12, P = 0.03). CONCLUSIONS Children and adolescents with Type 1 diabetes do not differ from the non-diabetic population regarding the I/D polymorphism of the ACE gene. ACE gene polymorphism is associated with BP abnormalities in normotensive and normoalbuminuric children and adolescents with Type 1 diabetes.
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Affiliation(s)
- L Barkai
- Institute of Child Health, Borsod County University Hospital and Postgraduate Institute of Pediatrics, University of Debrecen, Miskolc, Hungary.
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Hadjadj S, Aubert R, Fumeron F, Pean F, Tichet J, Roussel R, Marre M. Increased plasma adiponectin concentrations are associated with microangiopathy in type 1 diabetic subjects. Diabetologia 2005; 48:1088-92. [PMID: 15875155 DOI: 10.1007/s00125-005-1747-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2004] [Accepted: 01/27/2005] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS Insulin resistance is related to an increased risk of diabetic retinopathy and nephropathy in type 1 diabetes. Patients with insulin resistance and/or macrovascular disease have abnormally low levels of adiponectin. The aim of this study was to investigate the relationships between adiponectin and renal and retinal diabetic complications in type 1 diabetic patients. METHODS In this 6-year prospective follow-up observational study, we evaluated the severity of retinopathy at baseline and determined the incident risk of microalbuminuria in 126 normoalbuminuric patients with type 1 diabetes. Each patient was age- and sex-matched to two non-diabetic control subjects. RESULTS Plasma adiponectin concentrations were significantly higher in diabetic subjects than in control subjects (p < 0.0001). The adiponectin concentration was significantly higher in patients with severe diabetic retinopathy than in those without (39.1+/-14.0 vs 29.0+/-13.0 microg/ml, p = 0.0005). The 18 patients who developed persistent microalbuminuria had higher adiponectin concentrations than the other patients (35.8+/-14.5 vs 30.6+/-13.7 microg/ml). Increased adiponectin concentrations were independently associated with the occurrence of microalbuminuria (p = 0.0158) after adjustment for baseline urinary albumin concentration (p = 0.004), sex (p = 0.0054), blood pressure (NS) and metabolic control (NS). CONCLUSIONS/INTERPRETATION The elevated adiponectin concentrations observed in subjects with microvascular disease may indicate an altered regulation of this adipocytokine in patients with complications associated with type 1 diabetes.
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Affiliation(s)
- S Hadjadj
- Department of Endocrinology and Diabetology, University Hospital, BP 577, 86021, Poitiers Cedex, France.
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