Imbalanced plasma ACE and ACE2 level in the uremic patients with cardiovascular diseases and its change during a single hemodialysis session

Chung-Wei Yang; Li-Che Lu; Chia-Chu Chang; Ching-Chang Cho; Wen-Yeh Hsieh; Chin-Hung Tsai; Yi-Chang Lin; Chih-Sheng Lin

doi:10.1080/0886022X.2017.1398665

Imbalanced plasma ACE and ACE2 level in the uremic patients with cardiovascular diseases and its change during a single hemodialysis session

Ren Fail. 2017 Nov;39(1):719-728. doi: 10.1080/0886022X.2017.1398665.

Authors

Chung-Wei Yang^{1

2}, Li-Che Lu³, Chia-Chu Chang^{4

5}, Ching-Chang Cho¹, Wen-Yeh Hsieh^{6

7}, Chin-Hung Tsai¹, Yi-Chang Lin¹, Chih-Sheng Lin¹

Affiliations

¹ a Department of Biological Science and Technology , National Chiao Tung University , Hsinchu , Taiwan.
² b Division of Nephrology, Department of Internal Medicine , National Taiwan University Hospital Hsinchu Branch , Hsinchu , Taiwan.
³ c Division of Nephrology, Department of Internal Medicine , Shin Kong Wu Ho-Su Memorial Hospital , Taipei , Taiwan.
⁴ d Division of Nephrology, Department of Internal Medicine , Changhua Christian Hospital , Changhua , Taiwan.
⁵ e School of Medicine , Chung-Shan Medical University , Taichung , Taiwan.
⁶ f Division of Chest Medicine, Department of Internal Medicine , Hsinchu Mackay Memorial Hospital , Hsinchu , Taiwan.
⁷ g Department of Senior Citizen Service Management , Minghsin University of Science and Technology , Hsinchu , Taiwan.

Abstract

Background: The renin-angiotensin system (RAS) has significant influences on heart and renal disease progression. Angiotensin converting enzyme (ACE) and angiotensin converting enzyme II (ACE2) are major peptidases of RAS components and play counteracting functions through angiotensin II (Ang II)/ATIR and angiotensin-(1-7) (Ang-(1-7))/Mas axis, respectively.

Methods: There were 360 uremic patients on regular hemodialysis (HD) treatment (inclusive of 119 HD patients with cardiovascular diseases (CVD) and 241 HD patients without CVD and 50 healthy subjects were enrolled in this study. Plasma ACE, ACE2, Ang II and Ang-(1-7) levels of the HD patients were determined.

Results: We compared pre-HD levels of plasma ACE, ACE2, Ang II and Ang-(1-7) in the HD patients with and without CVD to those of the controls. The HD patients, particularly those with CVD, showed a significant increase in the levels of ACE and Ang II, whereas ACE2 and Ang-(1-7) levels were lower than those in the healthy controls. Therefore, imbalanced ACE/ACE2 was observed in the HD patients with CVD. In the course of a single HD session, the plasma ACE, ACE/ACE2 and Ang II levels in the HD patients with CVD were increased from pre-HD to post-HD. On the contrary, ACE2 levels were decreased after the HD session. These changes were not detected in the HD patients without CVD.

Conclusions: Pathogenically imbalanced circulating ACE/ACE2 was detected in the HD patients, particularly those with CVD. HD session could increase ACE/Ang II/AT1R axis and decrease ACE2/Ang-(1-7)/Mas axis activity in the circulation of HD patients with CVD.

Keywords: Angiotensin converting enzyme; angiotensin converting enzyme II; cardiovascular diseases; hemodialysis; renin-angiotensin system; uremic patient.

MeSH terms

Aged
Aged, 80 and over
Angiotensin-Converting Enzyme 2
Cardiovascular Diseases / blood*
Cardiovascular Diseases / complications
Female
Humans
Kidney Failure, Chronic / blood*
Kidney Failure, Chronic / complications
Kidney Failure, Chronic / therapy
Male
Middle Aged
Peptidyl-Dipeptidase A / blood*
Prospective Studies
Uremia / blood*
Uremia / complications

Substances

Peptidyl-Dipeptidase A
ACE2 protein, human
Angiotensin-Converting Enzyme 2

Grants and funding

This work was supported by the grant of MOST 104-2313-B-009-001-MY3 from the Ministry of Science and Technology (MOST), Taiwan. This work is also supported by the grands of MMH-CT-10503 and MMH-HB-10507 from the Hsinchu Mackay Memorial Hospital, Taiwan.