Study of angiotensin converting enzyme and genotype among Egyptian preeclampsia patients

Abstract

Preeclampsia is a frequent disorder with reported incidence in pregnancies. In Egypt, it complicates 6%- 8% of pregnancies and reaches 15% in referral centers. The renin-angiotensin system activation during the early stages of Preeclampsia proved to be a direct cause. Women carrying the D allele of the ACE-I / D polymorphism have higher measures of uterine artery resistance, which is a marker for development of intrauterine growth retardation and preeclampsia. The maternal syndrome of preeclampsia (PE) during the latter half of pregnancy is believed to result from impaired placentation in early gestation and a failure to develop low resistance uteroplacental circulation. Aim: The aim of this study was to evaluate the association with angiotensin converting enzyme gene polymorphism and changes in its enzyme serum level in preeclamptic patients compared to non preeclamptic control group together with studying the changes in umbilical artery and uterine artery Doppler. Subjects: The study was conducted on 180 pregnant women allocated into two groups having the same inclusion and exclusion criteria except for hypertension and proteinuria; each group comprised of 90 pregnant women with matched age. Methods: Doppler study of umbilical and uterine arteries and the detection of Angiotensin converting gene polymorphism by PCR with Estimation of serum ACE in serum by ELISA technique. Results: The distribution of the ACE-I/D genotypes and allelic frequencies in the present study of polymorphism was 37.8% for the DD, 48.9% for the ID, 13.3% for the II in preeclampsia group while it was 33.3% for the DD, 46.7% for the ID, and 20% for the II in the control group. There was no significant difference between cases and controls regarding the cumulative D effect. Conclusions: No existence of a relation between preeclampsia and ACE gene polymorphism considering different modes of inheritance whether is dominance or recessiveness. No effect of ACE gene polymorphism is on ACE serum level. Positive correlation between ACE gene polymor phism and the uterine artery Doppler changes gives strong evidence that ACE gene may have a role in the histopathological changes taking place in these vessels, therefore affecting maternal prognosis. It is unclear to explain this mismatched ACE genetic influence on the incidence of preeclampsia, but the multifactorial pathogenesis of the development and complication in preeclampsia and also physician’s intervention may contribute to the pregnancy outcome. Recommenda tions : International collaborations, particularly among countries with a high incidence of preeclampsia, may help to include participants with different cultural and genetic backgrounds, which can provide further insight into the etiology of the disease both genetic and environmental.