ACE Insertion/Deletion Polymorphism and Diabetic Nephropathy: Clinical Implications of Genetic Information

• Published in: Journal of Diabetes Research Vol. 2014; no. 2014; pp. 1 - 8
• Main Author: Ha, S. K.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Publishing Corporation 01.01.2014; John Wiley & Sons, Inc; Hindawi Limited
• Subjects: Angiotensin converting enzyme; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Animals; Asian people; Chronic kidney failure; Diabetes; Diabetes therapy; Diabetic nephropathies; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - enzymology; Diabetic Nephropathies - genetics; Diabetic nephropathy; Diabetics; Disease Progression; Enzymes; Genes; Genetic aspects; Genetic polymorphisms; Genetic Predisposition to Disease; Genetic research; Genotype & phenotype; Health aspects; Health care; Humans; Hypertension; Kidney diseases; Kidney Failure, Chronic - drug therapy; Kidney Failure, Chronic - enzymology; Kidney Failure, Chronic - genetics; Medical research; Medicine, Experimental; Meta-analysis; Pathogenesis; Peptidyl-Dipeptidase A - genetics; Phenotype; Plasma; Polymorphism; Polymorphism, Genetic; Proteinuria - drug therapy; Proteinuria - enzymology; Proteinuria - genetics; Renin-Angiotensin System - drug effects; Renin-Angiotensin System - genetics; Review; Risk Factors; Smooth muscle; Treatment Outcome; Type 2 diabetes
• ISSN: 2314-6745; 2314-6753
• DOI: 10.1155/2014/846068

Approximately 20–40% of diabetic patients develop nephropathy which is the leading cause of ESRD in developed countries. The ACE I/D polymorphism is thought to be a marker for functional polymorphism which regulates circulating and tissue ACE activity. While the initial study found a protective effect of the II genotype on the development of nephropathy in IDDM patients, subsequent studies have addressed the role of ACE I/D polymorphism in the development and progression of diabetic nephropathy. RAAS blockers are the first line drugs for the treatment hypertension associated with diabetes and have been widely used in everyday clinical practice for the purpose of reducing proteinuria in patients with various renal diseases. However, the antiproteinuric effect of RAAS blockers is variable and the percentage of reducing proteinuria is in the range of 20–80%. The antiproteinuric effect of RAAS blockers may be related to a number of factors: the type or the dose of RAAS blockers, the duration of therapy, the level of sodium intake, and the type of patient’s ACE I/D genotype. Besides the nongenetic factors, drug responses, can be influenced by ACE gene polymorphism. In this review, we discuss the relationship between ACE I/D polymorphism and diabetic nephropathy and therapeutic response of RAAS blockers.