Investigation of the relationship between ace i/d gen polymorphism and the degree of liver fibrosis due to various underlying etiologies, bülent ecevit university

Background and aim: Angiotensin II, an important by product of renin angiotensin system can lead to increased extracellular matrix formation and fibrosis via enhanced TGF β-1 production in many organ systems including liver. Angiotensin converting enzyme (ACE) coding gen polymorphisms can lead to different degree of ACE expressions and hence, various angiotensin II tissue levels. ACE gen polymorphisms have been reported as ACE I/D. Especially, ACE gen D homozygotic patients produce more tissue levels of ACE and this may be a potential hazard for many organ systems. We aimed to investigate if there is any role of ACE I/D gen polymorphism in the degree of liver fibrosis due to various etiologies. Methods: We enrolled 420 patients with a histopathological diagnosis of liver fibrosis. There were 242 patients with the diagnosis of mild and moderate fibrosis (Ishak's stage; 1-3) and the rest, 178 patients had advanced liver fibrosis (Ishak's stage; 4-6). Polymerase chain reaction was used to determine the type of ACE I/D gen polymorphisms. We also studied serum ACE levels with enzymatic kinetic testing method on spectrometry. Results: There were 211 male and 209 female subjects with a mean age of 51.4±13.6 years, (range; 19-83 years). Within the mild and moderate liver fibrosis group, the etiologies were chronic viral hepatitis B in 128, chronic viral hepatitis C in 59, non-alcoholic steatohepatitis in 50, autoimmune hepatitis in 1 and primary biliary cirrhosis in 4 patients. Within the advanced liver fibrosis group, the etiologies were chronic viral hepatitis B in 72, chronic viral hepatitis C in 62, non-alcoholic steatohepatitis in 26, alcoholic liver disease in 13, autoimmune hepatitis in 4 and primary biliary cirrhosis in 1 patients. On statistical analysis, there was no difference between the two groups with regard to ACE genotypes. Moreover, we could not find any significant difference between the groups regarding serum levels of angiotensin converting enzyme. Conclusion: The ACE I/D gen polymorphism do not seem to contribute as a significant risk factor for advanced liver fibrosis.