The Association of Angiotensin-1 Converting Enzyme (ACE) Serum Level and (I/D) Polymorphism in Egyptian Preeclamptic Women

Preeclampsia (PE) a major cause of maternal and neonatal mortality and morbidity worldwide in which hypertensive disorders during pregnancy account for 25.7% of maternal deaths. Both maternal and fetal genetic factors may predispose towards pre-eclamptic pregnancy, especially severe forms. However, preeclampsia is thought to be the result of the interplay between important genetic components and environmental influences; still, factors and mechanisms that lead to preeclampsia remain mysterious. Insertion/deletion (I/D) polymorphism of of ACE gene has attracted significant attention and has been extensively investigated with its serum activity in a spectrum of cardiovascular phenotypes. Aim to study the potential association of I/D polymorphism of ACE gene in PE Egyptian women that gets us closer to understanding the disease. Patients and Methods: One hundred hypertensive and age-matched normotensive primigravidae were recruited from Menoufiya university Hospital. Routine investigations were done for PE diagnosis. DNA was extracted from whole blood of patients and healthy controls. All samples were genotyped for ACE I/D polymorphism according to Rigat et al. using amplification and PCR of known allelic variants. ACE genotype was identified and followed by serum concentration of ACE activity for both groups. Results: ACE DD genotype was found in 60% of PE patients while 34% of normotensive subjects (P≤ 0.005). The odds ratio (95% CI) for developing hypertension in cases with DD genotype was 2.91 (1.29-6.57), while with II genotype was 0.18 (0.02-1.63). DD genotype revealed significantly more prevalent among cases than controls (P≤ 0.005), where it was 2.9 folds higher among cases than controls. The incidence of D allele of ACE gene was higher in hypertensive (0.98) than in normotensive (0.90, P > 0.05), although D allele was higher among cases than controls, but it did not show significance (P > 0.05). High significance was revealed when comparing the mean total ACE activity in the hypertensive patients (32.74 IU/l) and normotensive subjects (28.06 IU/l) (P <0.001). The ACE activity in cases and controls carrying DD allele differed significantly (P<0.001). In contrast the other ACE genotype ID and II did not show significance between cases and controls. Conclusion: These findings might bear implications for precise management of pregnancy in high-risk DD genotype women. Further large scale evaluation was required to provide added marker for risk assessment for PE patients.