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Angiotensin converting enzyme (ACE) gene polymorphism in vitiligo: protective and predispo-
sing effects of genotypes in disease susceptibility and progression
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European Journal of Dermatology, 2011, Volume 21, Num´ero 2
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2. © John Libbey Eurotext, 2011
doi:10.1684/ejd.2011.1279
EJD, vol. 21, n◦
2, March-April 2011 173
To cite this article: Tippisetty S, Ishaq M, Komaravalli PL, Jahan P. Angiotensin converting enzyme (ACE) gene polymorphism in vitiligo: protective and predisposing
effects of genotypes in disease susceptibility and progression. Eur J Dermatol 2011; 21(2): 173-7 doi:10.1684/ejd.2011.1279
Genes and skin Eur J Dermatol 2011; 21(2): 173-7
Surekha TIPPISETTY1
Mohammed ISHAQ1
Prasanna Latha KOMARAVALLI2
Parveen JAHAN1
1 Osmania University,
Dept. of Genetics,
Hyderabad,
Andhra Pradesh,
Hyd -12, India
2 Shadan Institute for PG studies,
Dept. of Genetics,
Hyd -04,
India
Reprints: P. Jahan
<parveenjahan_dr@yahoo.in>
Article accepted on 12/20/2010
Angiotensin converting enzyme (ACE) gene
polymorphism in vitiligo: protective and
predisposing effects of genotypes in disease
susceptibility and progression
Vitiligo is a depigmenting skin disorder with profound heterogenity in its
aetio-pathophysiology, and is associated with inter-individual variation
in progression of disease. Angiotensin converting enzyme (ACE) is a
regulator of renin angiotensin system (RAS) that plays an important
role in the physiology of the vasculature, blood pressure, inflammation,
adipocyte distribution of various diseases. The present study was carried
out in 243 vitiligo patients (132 males and 111 females), aged between
3-62 years with a mean age at onset of 21.6 ± 13.6 yrs, and in 205 healthy
controls of south Indian origin. The main objectives of the present study
were to evaluate the ACE I/D (insertion/deletion) polymorphism in the
patientandcontrolgroups.Further,I/Dgenotypeswerecomparedamong
the patients with and without the family history of vitiligo as well as the
progression of the disease, through polymerase chain reaction (PCR)
methods. The results revealed a highly significant association of DD
genotype with disease susceptibility (p < 0.01) in patients with a family
history of vitiligo (p < 0.05) in terms of early age at onset. Further, the
pre-dominance of ID genotype among patients revealed its association
with a slow progression of the disease (p < 0.05). The present study
is the first report to highlight the protective role of II genotype and
the significant association of ID genotype with slow progression of the
disease.
Key words: angiotensin converting enzyme, progression, protection,
susceptibility, vitiligo
V itiligo (leucoderma) is a common skin disorder in
which depigmented macules appear on the skin,
due to destruction of melanocytes. It is usually
bilateral, rarely unilateral, developing anywhere on the
body and may gradually enlarge. Irrespective of sex, race
and age, ∼1-2% of the world population suffer from this
disorder. It is reported that 18-20% of vitiligo probands
exhibit familial incidence of the disease [1, 2]. The aetiol-
ogy of vitiligo is multifactorial, involving both genetic and
the environmental triggers; however, it remains ambiguous
whether oxidative stress and autoimmunity are implicated
as important factors in the pathogenesis of this disease.
Genetic marker analysis has revealed a number of candi-
date genes such as AIRE, CTLA4, GCH1, VIT1, MHC,
CAT, COMT and SLEV1 in the susceptibility to vitiligo
[3-8]. However, heterogeneity is observed with respect to
loci in different ethnic groups.
Inter-individual variation is commonly observed with
respect to rate-of-progression and clinical variants of the
disease. Understanding the inter-individual variation in the
progression of the disease helps in predicting the vitiligo
from the very onset. Progression of the disease may be
defined as enlargement of the existing depigmented mac-
ules or appearance of new lesions over a period of time.
If the area of depigmentation is more than three quarters
of the total body surface area (TBSA) within one year of
disease onset, it is referred to as fast progression; on the
other hand, if the depigmented macules cover less than one
quarter of the total body surface area it is termed slow pro-
gression. The above classification is defined based on few
criteria laid down by some authors with slight modifications
[9-11].
Angiotensin converting enzyme (ACE) is a regulator of the
renin- angiotensin system that plays an important role in
the physiology of the vasculature, blood pressure, inflam-
mation and adipocyte distribution of various diseases, of
which vitiligo is one of them [12]. An insertion/deletion
(I/D)polymorphismofa287bprepetitivesequenceinintron
16 of the ACE gene gives two co-dominant alleles. The
gene product is a monomeric, membrane-bound, zinc and
chloride dependent peptidyl dipeptidase that catalyzes the
conversion of angiotensin I to angiotensin II, by removing a
carboxy terminal dipeptide. The gene codes for this enzyme
is located on chromosome 17q23. The expression and activ-
ity of ACE in blood and tissue depends on insertion and
deletionpolymorphism[13,14].TheDD(deletionhomozy-
gote) genotype exhibits two fold higher plasma and tissue
levels than the II (insertion homozygote) genotype and with
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3. © John Libbey Eurotext, 2011
174 EJD, vol. 21, n◦
2, March-April 2011
ID (insertion/deletion heterozygote) having intermediate
levels of the enzyme [14, 15]. It has been reported that
these genotypes exhibit variations with respect to oxida-
tive stress, angiogenesis, vasoconstriction and distribution
of subcutaneous fat [16, 17].
In view of existing literature on ACE insertion/deletion
polymorphism, it was felt that ACE was a relevant poly-
morphic marker for oxidative stress and angiogenesis as
well as body fat distribution. We aimed to investigate the
role of ACE insertion/deletion polymorphism not only in
susceptibility to vitiligo but also in the progression of the
depigmentation process, a novel aspect which has not been
dealt in other studies.
Materials and method
Our study enrolled 243 vitiligo cases from South India,
which were examined in the vitiligo unit at the Central
Research Institute of Unani Medicine (CRIUM, Hyder-
abad, India). These cases were not suffering from any
other skin or autoimmune disorder. As a control group,
205 healthy age and sex matched volunteers without any
clinical evidence of vitiligo or other skin disorders were
recruited. This study was approved by the ethical com-
mittee of CRIUM and Department of genetics, Osmania
University (Hyderabad). All subjects were included only
after informed consent for clinical and demographical data
was obtained. Based on the progression of the depigmenta-
tion, patients were categorized as fast or slow progressive
types. If the patients showed depigmentation of more than
three quarters of the total body surface area within one year
of the disease manifestation, they were categorized as fast
progressive type and if it was less than one quarter of the
total body surface area they were categorized as slow pro-
gressive type. As there is no standard classification of the
rate of progression of disease, our categorization is based
on the long term observation of CRIUM dermatologists
(unpublished) and from studies on treatment response in
vitiligo [9-11].
ACE gene polymorphism
Blood samples were collected from patients and controls
and were subjected to DNA isolation by standard pro-
cedure. ACE genotyping was carried out by polymerase
chain reaction using oligonucleotide sense primer 5 -CTG
GAG ACC ACT CCC ATC CTT TCT-3 , and the antisense
primer 5 -GAT GTG GCC ATC ACA TTC GTC AGA T-3 .
DNA samples (100 ng) were subjected to 35 cycles of
PCR amplification in eppendorf thermocycler under the
following conditions; initial denaturation 94 ◦C for 5 min,
denaturation 94 ◦C for 45 sec; annealing 58 ◦C for 1 min;
extension 72 ◦C for 45 sec and final extension of 72 ◦C for
7 min. PCR products were analyzed with 2% agarose gel
electrophoresis and ethidium bromide staining in order to
identify three patterns: II (a 490 bp fragment), DD (a 190
bp fragment) and ID (both 490 and190 bp fragments).
Statistical analyses
Statistical analysis for relative risk was done by Odds ratio
with 95% confidence interval. ANOVA was carried out for
association of ACE insertion/deletion polymorphism and
age at onset in relation to familial history. The statistical
package for social sciences (SPSS, 15th version) was used
to perform the analysis. Hardy-Weinberg equilibrium was
evaluated by ␹2 test for genotypic and allelic frequencies in
the patient and control groups.
Results and discussion
WeanalyzedthepolymorphismofACEgenein243patients
and 205 healthy volunteers. Based on CRIUM observation
(unpublished) 50 (20.6%) patients were categorized as fast
progressive and the remaining 193 (79.4%) as slow pro-
gressive types. The age at onset was 1-59 yrs of the patients
and it was lower in the fast progressive (1-49yrs) compared
to the slow progressive group (1-59yrs). The overall mean
age at onset was 21.6 ± 13.6 yrs. However, it was found to
be 22.3 ± 14.7 yrs and 21.4 ± 13.3 yrs in the fast progres-
sive and slow progressive types, respectively. Of the 243
vitiligo patients, 54 (22.2%) individuals showed a family
history of the disease.
ACE I/D polymorphism in disease susceptibility
The frequencies of ACE I/D genotypes in vitiligo patients
and controls are given in table 1 and figure 1. Analysis
of genotype frequencies revealed an over-representation of
DD and ID among patients, compared to that of the con-
trol group (p < 0.05). This observation indicates increased
susceptibility of the DD genotype to vitiligo. However, the
apparent difference of the ID genotype between patients
and controls was not significant.
ACE, being a pleiotropic gene, may be involved in sus-
ceptibility to vitiligo, due to its multiple effects. The role
of the ACE gene is implicated in oxidative stress, angio-
genesis and the distribution of body fat. Earlier reports on
ACE insertion/deletion polymorphism in disease associa-
tion have suggested the role of angiogenesis in vitiligo,
while in some other diseases its role is suggested in
enhanced reactive oxygen species (ROS) and fat distribu-
tion [16, 17]. Of the 3 ACE I/D genotypes, DD is considered
to be associated with relatively enhanced ROS generation
mediated by angiotensin II, compared to other genotypes
[17].Moreover,individualswiththishomozygousgenotype
DD have also been reported to have greater accumulated
visceral fat, which may be contributing to the disease mani-
festations associated with high oxidative stress like diabetes
and cardiovascular disease [18-21]. These adverse patho-
physiological effects of the DD genotype, along with other
susceptible genes, may predispose individuals to a derma-
tological condition like vitiligo. The aetiopathogenesis of
vitiligo involves not only oxidative stress but also angiogen-
esis, which may facilitate the access of cells of the immune
system and of auto-antibodies to the site of melanocyte
destruction.
Analysis of the II genotype frequency revealed an almost
50% reduction in the frequency of this genotype among
the patients compared to controls. It suggests a protective
role of the II homozygous condition against the develop-
ment of vitiligo, as the II genotype is suggested to be less
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4. © John Libbey Eurotext, 2011
EJD, vol. 21, n◦
2, March-April 2011 175
Table 1. Distribution of ACE I/D genotypes in vitiligo patients and controls.
Allele frequency
Groups II (%) ID (%) DD (%) ␹2 (p value) I D ␹2 (p value)
Patients 54 (22.3) 115 (47.3) 74 (30.4) 18.2 (0.000) 0.45 0.55 4.51 (0.03)
Controls 83 (40.5) 80 (39) 42 (20.5) 0.60 0.40
OR (95% CI) p value
II vs DD 0.369 (0.227-0.644) 0.000
ID vs DD 0.816 (0.509-1.309) NS
DD vs II 2.708 (1.627-4.506) 0.000
I vs D 0.545 (0.312-0.955) 0.04
Note: NS is not significant.
ROS-generating compared to other genotypes. Hence, the
suggestive protective role of II in susceptibility to vitiligo.
A few reports on vitiligo dealing with ACE I/D geno-
types have emphasized the predisposing effects of the DD
genotype. Our results go in accordance with a Korean and
another Indian study [12, 19, 22] were generalized and
localized vitiligo patients were included. However, in con-
trast to Akhtar et al and Dwivedi et al restricted their studies
to generalized vitiligo [23, 24]. The present study revealed
not only the predisposition of DD individuals to vitiligo
but also reported a considerable protection conferred by
the II genotype against this depigmenting condition. The
current study appears to be the first report highlighting the
protective role of II genotypes.
ACE I/D genotypes in relation to family history of
vitiligo and influence on age at onset of the disease
Of the total 243 patients, 22.2% (n = 54) show a positive
family history of vitiligo, whereas 77.8% (n = 189) were
without family history of vitiligo. When the ACE I/D poly-
morphism was analyzed, 16.7%, 46.3% and 37% of the
familial cases showed II, ID and DD genotypes respec-
tively. However, 23.8%, 47.6% and 28.6% of non-familial
cases revealed the above genotypes. When genotype vs fam-
ily history of vitiligo with age at onset was analyzed by
Percentageofindividuals
0
5
10
15
20
25
30
35
40
45
50
ACE genotypes
II ID DD
Patients
Controls
Figure 1. Distribution of percentage of ACE II, ID and DD
genotypes in patients and control group.
ANOVA, it was observed that the individuals with a family
history and the DD genotype had an early age at onset of the
disease, indicating that the DD genotype may be contribut-
ing to early age at onset of vitiligo (Fisher’s value 32.95,
p < 0.01).
ACE I/D polymorphism in disease progression
In addition to disease susceptibility, another important fac-
tor to be noted is disease progression, which is defined
as enlargement of the existing depigmented lesions and/or
appearance of new depigmented areas. Inter-individual
variations in disease progression among patients are fre-
quently observed, warranting genetic marker association
analysis that may help to predict disease progression in
patients. In view of this variation, we analyzed ACE I/D
polymorphism in two groups of patients, namely fast pro-
gression and slow progression types of the disease.
Out of 50 cases observed in the fast progressive group, 13
(26%) showed II genotype and 18 (36%) had ID genotypes.
The DD genotype was observed in 19 (38%) cases. In the
slow progressive group, which comprised of 193 patients,
41(21.2%) individuals were of II genotype, 97(50.2%) indi-
viduals with ID genotype and the remaining 55(28.4%)
were of DD genotype.
Analysis of the proportion of II and DD homozygotes in the
fast progressive and slow progressive groups revealed no
significant differences. However, there was an about 9.6%
increase in the frequency of the DD genotype among the fast
progressive group compared to the slow progressive group.
Further, it was observed that the percentage of individuals
with an ID genotype was significantly reduced in the fast
progressive compared to the slow progressive group (36%
vs 50.2%) (table 2, figure 2).
Basedonourresults,itislikelythatdiseaseprogressionmay
be more due to an angiogenic effect as it facilitates access
of cells of the immune system, as well as auto-antibodies, to
the site of melanocyte destruction. The observations made
in the present study, like the substantial increase in the fre-
quency of the DD genotype in the fast progressive group
(9.6%) compared to the slow progressive group, are sugges-
tive of angiogenic effects of the D allele in a homozygous
condition. This assumption is supported by reports of a DD
homozygote association with diabetic nephropathy, which
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5. © John Libbey Eurotext, 2011
176 EJD, vol. 21, n◦
2, March-April 2011
Table 2. Distribution of ACE I/D genotypes in vitiligo patients with fast progressive and slow progressive type.
Allele frequency
Groups II (%) ID (%) DD (%) I D
Fast progressive 13 (26) 18 (36) 19 (38) 0.44 0.56
Slow progressive 41 (21.2) 97 (50.2) 55 (28.4) 0.46 0.54
OR (95% CI) p value
DD vs other 1.538 (0.807-2.933) NS
ID vs DD 0.537 (0.281-1.100) 0.05
ID vs others 0.558 (0.317-0.981) 0.05
I vs D 0.92 (0.11-1.60) NS
Note: NS is not significant.
is explained on the basis of enhanced neovascularization
in the kidney [25, 26], progression of sarcoidosis [27] and
severity of systemic lupus erythematosus [28]. Moreover,
metastasis is observed in cancers more frequently in DD
individuals, which is mainly attributed to angiogenic effects
[29-31].
The patterns of genotype association with vitiligo suscepti-
bility and progression are different. The DD genotype is
observed to be associated with a significantly increased
susceptibility (p - 0.000). Contrary to this, in disease pro-
gression we observed a 14% decrease in the frequency of ID
in fast progression, indicating that a heterozygous condition
slows down the disease progression. As vitiligo pathogen-
esis involves both oxidative stress and autoimmunity, it
appears that autoimmune mechanism(s) have a decisive
role in progression, while in disease susceptibility oxidative
stress mechanisms play a relatively more important role.
Converse to our expectation, the ID genotype was associ-
ated with a reduced risk of disease progression compared
to the other two genotypes (p < 0.05). It appears that an
as yet not understood mechanism of allelic interaction is
associated with this pleiotropic gene; the oxidative stress-
inducing role of D allele predominates in the susceptibility
and the angiogenic role in disease progression. However,
ACE genotypes
Percentageofindividuals
II
60
50
40
30
20
10
0
ID
p - 0.05
DD
Progressive
Non-progressive
Figure 2. Distribution of percentage of ACE II, ID and DD
genotypes with fast progressive and slow progressive vitiligo.
II in the homozygous condition is more prominent in a
protective role. Though these two alleles are co-dominant
in their expression, their product interaction seems to be
complex. It is suggested that, in order to understand the
role of ACE (a pleiotropic marker on susceptibility and
progression of disease), certain markers of angiogenicity
and adipocyte distribution could be studied with respect to
vitiligo in different populations.
Disclosure. Acknowledgements: We thank all the vitiligo
subjects for their co-operation in giving consent for blood
samples and the clinical information. And we would also
like to thank Dr. M.A. Waheed, Deputy Director of Central
Research Institute for Unani Medicine, Hyderabad, for his
extendedhelpinunderstandingthediseaseofvitiligoandits
progression. Financial support: none. Conflict of interest:
none.
References
1. Surekha T, Ishaq M, Latha KP, Rao PH, Jahan P. Do clinical variants
of vitiligo involve X-chromosomal gene(s) too?. J Med Sci 2008; 8: 728-
33.
2. Nordlund JJ, Ortonne JP. Vitiligo vulgaris. In: Nordlund JJ, editor.
The Pigmentary System. Physiology and Pathophysiology. New
York: Oxford University Press, 1998, p. 513-51.
3. Pamela RF, Katherine G, Gregory SL, et al. A genomewide screen
for generalised vitiligo: Conformation of AIS1 on chromosome 1p31
and evidence for additional susceptibility loci. Am J Hum Genet
2003; 72: 1560-4.
4. Richard AS, Katherine G, Dorothy CB, Pamela RF. Novel vitiligo
susceptibility loci on chromosome 7(AIS2) and 8 (AIS3), conformation
of SLEV1 on chromosome 17 and their roles in autoimmune diathesis.
Am J Hum Genet 2004; 74: 188-91.
5. Jian JC, Wei H, Jin PG, et al. A novel linkage to generalised vitiligo
on 4q13-q21 identified in genomewide linkage analysis of Chinese
families. Am J Hum Genet 2005; 76: 1057-65.
6. Pehlivan S, Ozkinay F, Alper S, et al. Association Between
Il4 (-590), Ace (I)/(D), Ccr5 (Delta32), Ctla4 (+49) And Il1-Rn
(Vntr In Intron 2) Gene Polymorphisms And Vitiligo. Eur J Dermatol
2009; 19: 126-8.
Author
offprint

6. © John Libbey Eurotext, 2011
EJD, vol. 21, n◦
2, March-April 2011 177
7. Aksoy Sn, Erbagci Z, Saygili Ei, Sever T, Erbagci Ab, Pehlivan
S. Analysis Of Myeloperoxidase Promotor Polymorphism And Enzyme
Activity In Turkish Patients With Vitiligo. Eur J Dermatol 2009; 19:
576-80.
8. Kim Hj, Uhm Yk, Yun Jy, et al. Association Between Polymor-
phisms Of Discoidin Domain Receptor Tyrosine Kinase 1 (Ddr1) And
Non-Segmental Vitiligo In The Korean Population. Eur J Dermatol
2010; 20: 231-2.
9. Dammak I, Boudaya S, Ben Abdallah F, Turki H, Attia H, Hentati
B. Antioxidant enzymes and lipid peroxidation at the tissue level in
patients with stable and active vitiligo. Int J Dermatol 2009; 48: 476-
80.
10. Thappa DM. Vitiligo. Indian J Dermatol Venereol Leprol
2002; 68: 227-8.
11. Warwick L. Morison-Laser therapy, Puva therapy. http://www.
lightandlaser.com/vitiligo.html.
12. Jin SY, Park HH, Li GZ, et al. Association of Angiotensin Convert-
ing Enzyme gene I/D polymorphism of Vitiligo In korean population.
Pigment Cell Research 2004; 17: 84-6.
13. Koh WP, Yuan JM, Sun CL, et al. Angiotensin I-converting enzyme
(ACE) gene polymorphism and breast cancer risk among Chinese
women in Singapore. Cancer Res 2003; 63: 573-8.
14. Rigat B, Hubert C, Alhenc-Gelas F, Cambien F, Corvol P, Soubrier
F. An Insertion/deletion polymorphism in the angiotensin I-converting
enzyme gene accounting for half the variance of serum enzyme levels.
J Clin Invest 1990; 86: 1343-6.
15. Hubert C, Houot AM, Corvol P, Soubrier F. Structure of
angiotensin I converting enzyme gene: two alternate promoters cor-
responds to evolutionary steps of a duplicated gene. J Biol Chem
1991; 266: 15377-83.
16. The Skinny-Fat Ectomorph - Part I- Kelly Baggett. http://www.
mindandmuscle.net/node/226?page=all.
17. Jian MY, Woon PK, Can LS, Hin PL, Mimi CY. Green tea intake.
ACE gene polymorphism and breast cancer risk among Chinese
women in Singapore. Carcinogenesis 2005; 26: 1389-94.
18. Molnar GA, Wagner Z, Wagner L, et al. Effect of ACE
gene polymorphism on carbohydrate metabolism, on oxidative stress
and on end-organ damage in type-2 diabetes mellitus. Orv Hetil
2004; 145: 855-9.
19. Nicholls MG, Richards AM, Agarwal M. The importance of the
renin-angiotensin system in cardiovascular disease. J Hum Hypertens
1998; 12: 295-9.
20. Mykkanen L, Kuusisto J, Pyorala K, Laakso M. Cardiovascular dis-
ease risk factors as predictors of type 2 (noninsulin-dependent) diabetes
mellitus in elderly subjects. Diabetologia 1993; 36: 553-9.
21. Haffner SM, Valdez RA, Hazuda HP, Mitchell BD, Morales PA,
Stern MP. Prospective analysis of the insulin resistance syndrome (Syn-
drome X). Diabetes 1992; 41: 715-22.
22. Deeba F, Jamil k F, Syed R, Waheed MA, Rao PH. Association of
angiotensin converting enzyme gene I/D polymorphism with vitiligo in
South Indian population. Int J Med Med Sci 2009; 1: 009-12.
23. Akhtar S, Gavalas NG, Gawkrodger DJ, et al. An inser-
tion/deletion polymorphism in the gene encoding angiotensin
converting enzyme is not associated with generalised vitiligo in an
English Population. Arch Dermatol Res 2005; 297: 94-8.
24. Dwivedi M, Naresh CL, Shajil EM, Shah BJ, Begum R. The ACE
gene I/D polymorphism is not associated with generalized vitiligo sus-
ceptibility in Gujarat population. Pigment Cell & Melanoma Research
2008; 21: 407-8.
25. Groop L. Genetics of the metabolic syndrome. Br J Nutri 2000;
83 (Suppl. 1): S39-84.
26. Matsusaka T, Hymes J, Ichikawa I. Angiotensin in progressive
renal disease: theory and practice. J Am Soc Nephrol 1996; 7: 2025-
43.
27. Pietinalho A, Furuya K, Yamaguchi E, Kawakami K, Selroos O.
The angiotensin - converting enzyme DD gene is associated with poor
prognosis in Finnish Sarcoidosis patients. Eur Respir J 1999; 13: 723-
6.
28. Malik AR, Saeed MM, Sabeen FM, Philippe MF. Association
of Angiotensin-Converting enzyme gene dimorphisms with sever-
ity of Lupus disease. Saudi J Kidney Dis Transplant 2008; 19:
761-6.
29. Rocken C, Lendeckel U, Dierkes J, et al. The number of lymph
node metastases in gastric cancer correlates with the angiotensin
I-converting enzyme gene insertion/deletion polymorphism. Clin Can-
cer Res 2005; 11: 2526-30.
30. Medeiros R, Vasconcelos A, Costa S, et al. Linkage of angiotensin
I-converting enzyme gene insertion/deletion polymorphism to the
progression of human prostate cancer. J Pathol 2004; 202:
330-5.
31. Haiman CA, Henderson SO, Bretsky P, Kolonel LN, Hender-
son BE. Genetic variation in angiotensin I-converting enzyme (ACE)
and breast cancer risk: the multiethnic cohort. Cancer Res 2003; 63:
6984-7.
Author
offprint