Abstract
Recent observations revealed a novel role of angiotensin-converting enzyme 2 and the angiotensin II type-1 receptor (AT1R) in lung injury, thereby extending knowledge about the functions of the angiotensin system. Angiotensin II, whose target is the AT1R, is a potent vasoconstrictor. Accordingly, an imbalance leading to enhanced activity of the angiotensin II-AT1R axis is postulated to contribute to both circulatory disturbances and lung injury. In this context, a functional single-nucleotide polymorphism, AT1R A1166C, which leads to enhanced responsiveness of the AT1R, has been postulated as a candidate susceptibility factor for ischemic stroke. The aim of our study was to investigate its occurrence in ischemic stroke and to analyze its possible synergistic associations with clinical risk factors. Genetic and clinical data on 308 consecutive patients with acutely developing ischemic stroke were analyzed. A total of 272 stroke and neuroimaging alteration-free subjects served as a control group. Univariate and logistic regression statistical approaches were used. Alone, the AT1R 1166C allele did not pose a risk of stroke. In hypertensive smokers, however, it was associated with an increased risk of ischemic stroke (OR 22.3, 95% CI 5.8–110.2, p<0.001). Further subgroup analysis revealed the same association for both small-vessel (OR 24.3, 95% CI 6.1–121.1, p<0.001) and large-vessel (OR 21.3, 95% CI 4.6–81.1, p<0.001) infarction. On a pathophysiological basis, our results suggest the possibility that the AT1R A1166C polymorphism might give rise to ischemic stroke indirectly via an unfavorable effect on the cardiorespiratory function.
Index Entries: AT1R A1166C polymorphism, stroke risk, genetic interaction
References
- Agachan B., Isbir T., Yilmaz H., Akoglu E. Angiotensin converting enzyme I/D, angiotensinogen T174M-M235T and angiotensin II type 1 receptor A1166C gene polymorphisms in Turkish hypertensive patients. Exp. Mol. Med. 2003;35:545–549. doi: 10.1038/emm.2003.71. [DOI] [PubMed] [Google Scholar]
- Cheng Z. J., Vapaatalo H., Mervaala E. Angiotensin II and vascular inflammation. Med. Sci. Monit. 2005;25:194–205. [PubMed] [Google Scholar]
- Ferreira A.J., Santos R.A.S. Cardiovascular action of angiotensin (1–7) Braz. J. Med. Biol. Res. 2005;38:499–507. doi: 10.1590/s0100-879x2005000400003. [DOI] [PubMed] [Google Scholar]
- Fukazawa R., Sonobe T., Hamamato K., Hamaoka K., Sakata K., Asano T., et al. Possible synergic effect of angiotensin-I converting enzyme insertion/deletion polymorphism and angiotensin-II type-1 receptor 1166A/C gene polymorphism on ischaemic heart disease in patients with Kawasaki disease. Pediatr. Res. 2004;56:597–601. doi: 10.1203/01.PDR.0000139426.16381.C8. [DOI] [PubMed] [Google Scholar]
- Henderson S.O., Haiman C.A., Mack W. Multiple polymorphisms in the renin-angiotensin-aldosterone system (ACE, CYP11B2, AGTR1) and their contribution to hypertension in African Americans and Latinos in the multiethnic cohort. Am. J. Med. Sci. 2004;328:266–273. doi: 10.1097/00000441-200411000-00006. [DOI] [PubMed] [Google Scholar]
- Hindorff L. A., Heckbert S. R., Tracy R., Tang Z., Psaty B. M., Edwards K. I., et al. Angiotensin II type 1 receptor polymorphisms in the cardiovascular health study: relation to blood pressure, ethnicity, and cardiovascular events. Am. J. Hypertens. 2002;15:1050–1056. doi: 10.1016/S0895-7061(02)03063-7. [DOI] [PubMed] [Google Scholar]
- Imai Y., Kuba K., Rao S., Huan Y., Guo F., Guan B., et al. Angiotensin-converting enzyme 2 protects from severe acute lung failure. Nature. 2005;436:112–116. doi: 10.1038/nature03712. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jones A., Dhamrait S. S., Payne J. R., Hawe E., Li P., Toor I.S., et al. Genetic variants of angiotensin II receptors and cardiovascular risk in hypertension. Hypertension. 2003;42:500–506. doi: 10.1161/01.HYP.0000088853.27673.D0. [DOI] [PubMed] [Google Scholar]
- Kobashi G., Hata A., Ohta K., Yamada H., Kato E. H., Minakami H., et al. A1166C variant of angiotensin II type 1 receptor gene is associated with severe hypertension in pregnancy independently of T235 variant of angiotensinogen gene. J. Hum. Genet. 2004;49:182–186. doi: 10.1007/s10038-004-0129-4. [DOI] [PubMed] [Google Scholar]
- Kuba K., Imai Y., Rao S., Gao H., Guo F., Guan B., et al. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat. Med. 2005;11:875–879. doi: 10.1038/nm1267. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller J. A., Scholey J. W. The impact of reninangiotensin system polymorphisms on physiological and pathophysiological processes in humans. Curr. Opin. Nephrol. Hypertens. 2004;13:101–106. doi: 10.1097/00041552-200401000-00014. [DOI] [PubMed] [Google Scholar]
- Miller S.A., Dykes D.D., Polesky H.F. A simple salting out procedure for extracting DNA from human nucleated cells. Nucleic Acids Res. 1988;16:1215–1218. doi: 10.1093/nar/16.3.1215. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Munzel T., Daiber A., Ullrich V., Mulsch A. Vascular consequences of endothelial nitric oxide synthase uncoupling for the activity and expression of the soluble guanylyl cyclase and the cGMP-dependent protein kinase. Arterioscler. Thromb. Vasc. Biol. 2005;25:1551–1557. doi: 10.1161/01.ATV.0000168896.64927.bb. [DOI] [PubMed] [Google Scholar]
- Nicholls J., Peiris M. Good ACE, bad ACE do battle in lung injury, SARS. Nat. Med. 2005;11:821–822. doi: 10.1038/nm0805-821. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rubattu S., DiAngelantonio E., Stanzione R., Zanda B., Evangelista A., Pirisi A., et al. Gene polymorphisms of the renin-angiotensin-aldosterone system and the risk of ischemic stroke: a role of the A1166C/AT1 gene variant. J. Hypertens. 2004;22:2129–2134. doi: 10.1097/00004872-200411000-00015. [DOI] [PubMed] [Google Scholar]
- Sainani G. S., Maru V. G. Role of endothelial cell dysfunction in essential hypertension. J. Assoc. Physicians India. 2004;52:966–969. [PubMed] [Google Scholar]
- Schmieder R. E. Mechanisms for the clinical benefits of angiotensin II receptor blockers. Am. J. Hypertens. 2005;18:720–730. doi: 10.1016/j.amjhyper.2004.11.032. [DOI] [PubMed] [Google Scholar]
- Schram M. T., Stehouwer C. D. Endothelial dysfunction, cellular adhesion molecules and the metabolic syndrome. Horm. Metab. Res. 2005;37:49–55. doi: 10.1055/s-2005-861363. [DOI] [PubMed] [Google Scholar]
- Sugimoto K., Katsuya T., Ohkubo T., Hozawa A., Yamamoto K., Matsuo A., et al. Association between angiotensin II type 1 receptor gene polymorphism and essential hypertension: the Ohasama Study. Hypertens. Res. 2004;27:551–556. doi: 10.1291/hypres.27.551. [DOI] [PubMed] [Google Scholar]
- Szolnoki Z., Somogyvari F., Kondacs A., Szabo M., Fodor L. Evaluation of the interactions of common genetic mutations in stroke subtypes. J. Neurol. 2002;249:1391–1397. doi: 10.1007/s00415-002-0848-4. [DOI] [PubMed] [Google Scholar]
- Szolnoki Z., Somogyvari F., Kondacs A., Szabo M., Fodor L., Bene J., Melegh B. Evaluation of the modifying effects of unfavourable genotypes on classical clinical risk factors for ischaemic stroke. J. Neurol. Neurosurg. Psychiatry. 2003;74:1615–1620. doi: 10.1136/jnnp.74.12.1615. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Treszl A., Szabo M., Dunai G., Nobilis A., Kocsis I., Machay T., et al. Angiotensin II type 1 receptor, a 1166C polymorphism and prophylactic indomethacin treatment induced ductus arterious closure in very low birth weight neonates. Pediatr. Res. 2003;54:753–755. doi: 10.1203/01.PDR.0000088016.67117.39. [DOI] [PubMed] [Google Scholar]
- Um J. Y., Moon K. S., Lee K. M., Cho K. H., Heo Y., Moon B. S., Kim H. M. Polymorphism of angiotensin-converting enzyme, angiotensinogen, and apolipoprotein E genes in Korean patients with cerebral infaction. J. Mol. Neurosci. 2003;21:23–28. doi: 10.1385/JMN:21:1:23. [DOI] [PubMed] [Google Scholar]
- van Geel P.P., Pinto Y.M., Voors A.A., Buikema H., Oosterga M., Crijns H.J.G.M., van Gilst W. H. Angiotenin II type 1 receptor A1166C gene polymorphism is associated with an increased response to angiotensin II in human arteries. Hypertension. 2000;35:717–721. doi: 10.1161/01.hyp.35.3.717. [DOI] [PubMed] [Google Scholar]
- World Health Organization (1985) Report on diabetes mellitus. World Health Organ. Tech. Rep. Ser. 727. [PubMed]