ACE variants interact with the RAS pathway to confer risk and protection against type 2 diabetic nephropathy

Tarunveer Singh Ahluwalia, Monica Ahuja, Taranjit Singh Rai, Harbir Singh Kohli, Anil Bhansali, Kamal Sud, Madhu Khullar

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Abstract

Genetic predisposition has been proposed to be a major determinant in the development of renal complications of diabetes. Among candidate genes examined for susceptibility to diabetic nephropathy, angiotensin-converting enzyme (ACE) gene has been found to be associated with pathogenesis and progression of diabetic nephropathy. However, the role of other renin-angiotensin system (RAS) polymorphisms and their possible interactions with different ACE I/D genotypes are less clearly defined. Recent studies also show that ACE haplotypes may be better predictors to disease susceptibility. Thus, in the present study, we evaluated the association of ACE haplotypes and the interactions of ACE, angiotensinogen (AGT), and angiotensin II receptor type I (AGTR1) gene polymorphisms with DNP in Asian Indians. We genotyped seven variants of the RAS pathway genes (ACE, AGT, and AGTR1) in type 2 diabetic cohorts without nephropathy (DM) and with nephropathy (DNP), using allele-specific oligonucleotide-PCR, and PCR-restriction fragment length polymorphism assays. We studied the interaction of these variants with each other and ACE I/D polymorphism. Frequency of ACE D allele and DD genotype (ACE I/D) was significantly higher in DNP (p < 0.005) and was associated with increased risk of nephropathy. The frequency of T allele, MT/TT genotypes (AGT: M235T), and C allele 1166CC genotype (AGTR1: A1166C) was higher and associated with increased risk of DNP (235T, p < 0.0001; 235TT/MT, p < 0.01; 1166C, p < 0.007; 1166CC, p < 0.0001). The ACE locus revealed a near doubling in the prevalence of T-D-G risk haplotype (odds ratio, 1.76) in DNP (0.13) compared to DM (0.08; p < 0.02). ACE haplotypes carrying the I allele were associated with a lower risk of DNP (C-I-A, p < 0.04; C-I-G, p < 0.008). ACE ID/DD genotypes in combination with ACE rs4311, rs4343, and AGT rs699 mutant genotypes increased the risk of DNP development fourfold (p < 0.01). This study provides the first evidence for a disease haplotype for DNP at the ACE locus in Asian Indians. The study further indicates that ACE D allele individually and in interaction with other RAS single-nucleotide polymorphisms significantly increases the risk of nephropathy in type 2 diabetic patients of Asian Indian origin.

LanguageEnglish
Pages141-150
Number of pages10
JournalDNA and Cell Biology
Volume28
Issue number3
DOIs
Publication statusPublished - 1 Mar 2009

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Diabetic Nephropathies
Peptidyl-Dipeptidase A
Renin-Angiotensin System
Angiotensinogen
Haplotypes
Genotype
Alleles
Genes
Polymerase Chain Reaction
Angiotensin Receptors
Disease Susceptibility
Diabetes Complications
Genetic Predisposition to Disease
Gene Frequency
Oligonucleotides
Restriction Fragment Length Polymorphisms
Single Nucleotide Polymorphism

Cite this

Ahluwalia, Tarunveer Singh ; Ahuja, Monica ; Rai, Taranjit Singh ; Kohli, Harbir Singh ; Bhansali, Anil ; Sud, Kamal ; Khullar, Madhu. / ACE variants interact with the RAS pathway to confer risk and protection against type 2 diabetic nephropathy. In: DNA and Cell Biology. 2009 ; Vol. 28, No. 3. pp. 141-150.
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ACE variants interact with the RAS pathway to confer risk and protection against type 2 diabetic nephropathy. / Ahluwalia, Tarunveer Singh; Ahuja, Monica; Rai, Taranjit Singh; Kohli, Harbir Singh; Bhansali, Anil; Sud, Kamal; Khullar, Madhu.

In: DNA and Cell Biology, Vol. 28, No. 3, 01.03.2009, p. 141-150.

Research output: Contribution to journalArticle

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AU - Ahluwalia, Tarunveer Singh

AU - Ahuja, Monica

AU - Rai, Taranjit Singh

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AU - Bhansali, Anil

AU - Sud, Kamal

AU - Khullar, Madhu

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AB - Genetic predisposition has been proposed to be a major determinant in the development of renal complications of diabetes. Among candidate genes examined for susceptibility to diabetic nephropathy, angiotensin-converting enzyme (ACE) gene has been found to be associated with pathogenesis and progression of diabetic nephropathy. However, the role of other renin-angiotensin system (RAS) polymorphisms and their possible interactions with different ACE I/D genotypes are less clearly defined. Recent studies also show that ACE haplotypes may be better predictors to disease susceptibility. Thus, in the present study, we evaluated the association of ACE haplotypes and the interactions of ACE, angiotensinogen (AGT), and angiotensin II receptor type I (AGTR1) gene polymorphisms with DNP in Asian Indians. We genotyped seven variants of the RAS pathway genes (ACE, AGT, and AGTR1) in type 2 diabetic cohorts without nephropathy (DM) and with nephropathy (DNP), using allele-specific oligonucleotide-PCR, and PCR-restriction fragment length polymorphism assays. We studied the interaction of these variants with each other and ACE I/D polymorphism. Frequency of ACE D allele and DD genotype (ACE I/D) was significantly higher in DNP (p < 0.005) and was associated with increased risk of nephropathy. The frequency of T allele, MT/TT genotypes (AGT: M235T), and C allele 1166CC genotype (AGTR1: A1166C) was higher and associated with increased risk of DNP (235T, p < 0.0001; 235TT/MT, p < 0.01; 1166C, p < 0.007; 1166CC, p < 0.0001). The ACE locus revealed a near doubling in the prevalence of T-D-G risk haplotype (odds ratio, 1.76) in DNP (0.13) compared to DM (0.08; p < 0.02). ACE haplotypes carrying the I allele were associated with a lower risk of DNP (C-I-A, p < 0.04; C-I-G, p < 0.008). ACE ID/DD genotypes in combination with ACE rs4311, rs4343, and AGT rs699 mutant genotypes increased the risk of DNP development fourfold (p < 0.01). This study provides the first evidence for a disease haplotype for DNP at the ACE locus in Asian Indians. The study further indicates that ACE D allele individually and in interaction with other RAS single-nucleotide polymorphisms significantly increases the risk of nephropathy in type 2 diabetic patients of Asian Indian origin.

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