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Effects of Angiotensin-Converting Enzyme Polymorphism on Soluble Receptor for Advanced Glycation End-Products in Maintenance Hemodialysis Patients

유지혈액투석 환자에서 안지오텐신 전환효소 유전자 다형성에 따른 sRAGE의 변화

  • Lee, Kang Won (Department of Internal Medicine, Wonkwang University College of Medicine) ;
  • Cha, Jeong Min (Department of Internal Medicine, Wonkwang University College of Medicine) ;
  • Lee, Yu Min (Department of Internal Medicine, Wonkwang University College of Medicine) ;
  • Park, Seok Don (Genome Research Center for Immune Disorder, Wonkwang University College of Medicine) ;
  • Song, Ju Hung (Department of Internal Medicine, Wonkwang University College of Medicine) ;
  • Ahn, Seon Ho (Department of Internal Medicine, Wonkwang University College of Medicine)
  • 이강원 (원광대학교 의과대학 내과학교실) ;
  • 차정민 (원광대학교 의과대학 내과학교실) ;
  • 이유민 (원광대학교 의과대학 내과학교실) ;
  • 박석돈 (원광대학교 의과대학 면역질환유전체 연구소) ;
  • 송주흥 (원광대학교 의과대학 내과학교실) ;
  • 안선호 (원광대학교 의과대학 내과학교실)
  • Received : 2012.05.04
  • Accepted : 2013.04.10
  • Published : 2013.11.01

Abstract

Background/Aims: Advanced glycation end-products (AGEs) exert various toxic effects through the receptor for AGEs (RAGE). Soluble RAGE (sRAGE) is a naturally occurring inhibitor of AGE-RAGE. Recent studies have suggested that inhibition of angiotensin-converting enzyme (ACE) reduces the accumulation of AGEs in diabetes partly by increasing the production and secretion of sRAGE into the plasma. This report describes the relationship between sRAGE and ACE polymorphism in maintenance hemodialysis patients. Methods: The levels of sRAGE and advanced oxidation protein products (AOPPs) were assessed by enzyme-linked immunosorbent assay (ELISA), and ACE polymorphism was detected by PCR amplification. Results: The distributions of ACE genotypes in 105 hemodialysis patients were as follows: II, 56 (35.9%); ID, 29 (18.6%); and DD, 20 (12.8%). According to the ACE genotypes, the study group consisted of II (n = 56) and ID + DD group (n = 49). sRAGE was correlated with age (r = -0.24; p = 0.013). There were significant differences in sRAGE, AOPP, age, duration of dialysis, C-reactive protein, or 24-h urine volume between two genotype groups. There were no significant differences in sRAGE levels, even though the effect of age was treated as a covariate. Conclusions: Our findings suggested that sRAGE may be affected only by age, and not by ACE polymorphism in maintenance hemodialysis patients.

목적: 당화산물(AGE)은 당화산물 수용체(RAGE)에 작용하여 다양한 독성 효과를 일으키는데 일부 혈청에 순환하는 가용성 당화산물 수용체(sRAGE)는 체내에서 생기는 당화산물과 그 수용체 간의 작용을 억제하는 기능을 가지고 있다. 최근 안지오텐신 전환효소억제제(ACEI)가 당뇨 환자에서 당화산물 축적을 감소시키면서 혈청 sRAGE 농도를 증가시키는 것으로 보고되고 있어 저자들은 유지혈액투석 중인 환자에서 ACE 유전자 다형성에 따른 sRAGE의 변화를 알아보고자 본 연구를 시행하였다. 방법: 유지혈액투석 중인 105명의 환자를 대상으로 혈청 sRAGE와 여러 생화학적 지표들을 ACE 유전자형에 따라 비교 분석하였다. 결과: 대상 환자는 105명이었다(남자 55, 여자 50명, 평균 연령 $58.77{\pm}1.68$세, 당뇨 환자 46명, 비당뇨 환자 59명). 투석 기간 $62.39{\pm}9.5$개월, ACE 유전자형의 분포는 II형 56명(35.9%), ID형 29명(18.6%), DD형 20명(12.8%)이었다. 전체 혈액투석 환자에서 연령이 증가함에 따라 sRAGE 감소하였다(r = -0.24; p = 0.013). 투석 기간, CRP 및 24시간 소변량과 sRAGE는 상관성이 없었다. 연령, 투석 기간, 24시간 소변량을 공변량으로 처리한 후 유전자형에 따른 sRAGE를 분석하였다. 전체 대상 환자에서 sRAGE는 연령에 따라 영향을 받고 있지만(F = 5.38; p = 0.02), ACE 유전자형에 따라서는 유의한 차이가 없었다($3,872.80{\pm}237.11$ vs. $4,224.17{\pm}255.60pg/mL$; F = 0.53; p = 0.47). RAS 억제제를 사용하고 있는 당뇨 환자는 37명이었고 ACE 유전자 II형 18명, ID+DD형 19명이었다. 공분산분석을 시행한 결과, sRAGE 농도 차이는 연령에 따라 영향을 받고 있지만(F = 6.10; p = 0.02), ACE 유전자형에 따라서는 차이가 없었다(sRAGE $3,874.01{\pm}472.98$ vs. $4,114.69{\pm}429.26pg/mL$; F = 0.06; p = 0.80). 결론: 혈액투석 중인 환자에서 sRAGE 농도는 ACE 유전자 다형성에 따라서는 차이가 없었고 연령이 증가함에 따라 감소하였다.

Keywords

Acknowledgement

Supported by : Ministry of Health and Welfare

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