Angiotensin-converting enzyme activity and the ACE Alu polymorphism in autosomal dominant polycystic kidney disease

Background. Previous studies concerning Alu I/D polymorphism in the ACE gene and ADPKD severity have used the Alu genotypes as a representative of the true biological variable, namely ACE activity. However, wide individual and ethnic differences in the proportion of variance in ACE activity explained by the I/D genotype may have confounded these studies. This investigation examines the association between ADPKD severity and ACE in terms of plasma enzyme activity and I/D genotypes in individuals from three different countries. Methods. Blood samples were collected from 307 ADPKD patients (116 Australian. 124 Bulgarian and 67 Polish) for determination of ACE activity levels and I/D genotypes. Chronic renal failure (CRF) was present in 117 patients and end-stage renal failure (ESRF) in 68 patients. Results. ACE activity was related to the I/D genotype, showing a dosage effect of the D allele (P = 0.006). The proportion of variance due to the Alu polymorphism was 14%. No difference in ACE activity and I/D genotype distribution was found between patients with CRF versus normal renal function (P = 0.494; P = 0.576) or between those with ESRF versus those without ESRF (P = 0.872. P = 0.825). No effect of the I/D genotype on age at development and progression to renal failure (CRF: ESRF) was detected in the overall group, and in subgroups based on ethnic origin, linkage status and sex. Conclusion. ACE is not likely to play a role as a determinant of ADPKD phenotype severity.