Editing Angiotensin-converting enzyme (section)

== Influence on athletic performance ==

The angiotensin converting enzyme gene has more than 160 polymorphisms described as of 2018.<ref name="pmid30570054">{{cite journal | vauthors = Cintra MT, Balarin MA, Tanaka SC, Silva VI, Marqui AB, Resende EA, Lima MF, Gomes MK | display-authors = 6 | title = Polycystic ovarian syndrome: rs1799752 polymorphism of ACE gene | journal = Revista da Associação Médica Brasileira | volume = 64 | issue = 11 | pages = 1017–1022 | date = November 2018 | pmid = 30570054 | doi = 10.1590/1806-9282.64.11.1017 | doi-access = free }}</ref>

Studies have shown that different genotypes of angiotensin converting enzyme can lead to varying influence on athletic performance.<ref name="pmid31139091">{{cite journal | vauthors = Flück M, Kramer M, Fitze DP, Kasper S, Franchi MV, Valdivieso P | title = Cellular Aspects of Muscle Specialization Demonstrate Genotype - Phenotype Interaction Effects in Athletes | journal = Frontiers in Physiology | volume = 10 | pages = 526 | date = 8 May 2019 | pmid = 31139091 | pmc = 6518954 | doi = 10.3389/fphys.2019.00526 | doi-access = free }}</ref><ref name="pmid19026021">{{cite journal | vauthors = Wang P, Fedoruk MN, Rupert JL | title = Keeping pace with ACE: are ACE inhibitors and angiotensin II type 1 receptor antagonists potential doping agents? | journal = Sports Medicine | volume = 38 | issue = 12 | pages = 1065–1079 | year = 2008 | pmid = 19026021 | doi = 10.2165/00007256-200838120-00008 | s2cid = 7614657 }}</ref> However, these data should be interpreted with caution due to the relatively small size of the investigated groups.

The rs1799752 I/D polymorphism (aka rs4340, rs13447447, rs4646994) consists of either an insertion (I) or deletion (D) of a 287 base pair sequence in intron 16 of the gene.<ref name="pmid30570054"/> The DD genotype is associated with higher plasma levels of the ACE protein, the DI genotype with intermediate levels, and II with lower levels.<ref name="pmid30570054"/> During physical exercise, due to higher levels of the ACE for D-allele carriers, hence higher capacity to produce angiotensin II, the blood pressure will increase sooner than for I-allele carriers. This results in a lower maximal heart rate and lower maximum oxygen uptake (VO<sub>2max</sub>). Therefore, D-allele carriers have a 10% increased risk of cardiovascular diseases. Furthermore, the D-allele is associated with a greater increase in left ventricular growth in response to training compared to the I-allele.<ref name = "Montgomery_1997">{{cite journal | vauthors = Montgomery HE, Clarkson P, Dollery CM, Prasad K, Losi MA, Hemingway H, Statters D, Jubb M, Girvain M, Varnava A, World M, Deanfield J, Talmud P, McEwan JR, McKenna WJ, Humphries S | display-authors = 6 | title = Association of angiotensin-converting enzyme gene I/D polymorphism with change in left ventricular mass in response to physical training | journal = Circulation | volume = 96 | issue = 3 | pages = 741–747 | date = August 1997 | pmid = 9264477 | doi = 10.1161/01.CIR.96.3.741 }}</ref> On the other hand, I-allele carriers usually show an increased maximal heart rate due to lower ACE levels, higher maximum oxygen uptake and therefore show an enhanced endurance performance.<ref name = "Montgomery_1997"/> The I allele is found with increased frequency in elite distance runners, rowers and cyclists. Short distance swimmers show an increased frequency of the D-allele, since their discipline relies more on strength than endurance.<ref>{{cite journal | url = http://www.zeitschrift-sportmedizin.de/fileadmin/content/archiv2001/heft03/a01_0301.pdf | title = Kardiale Anpassung an Körperliches Training | trans-title = The cardiac response to physical training | vauthors = Sanders J, Montgomery H, Woods D | journal = Deutsche Zeitschrift für Sportmednizin | language = de | volume = 52 | issue = 3 | pages = 86–92 | year = 2001 | access-date = 1 March 2016 | archive-date = 8 March 2016 | archive-url = https://web.archive.org/web/20160308040320/http://www.zeitschrift-sportmedizin.de/fileadmin/content/archiv2001/heft03/a01_0301.pdf | url-status = live }}</ref><ref name="pmid19458960">{{cite journal | vauthors = Costa AM, Silva AJ, Garrido ND, Louro H, de Oliveira RJ, Breitenfeld L | title = Association between ACE D allele and elite short distance swimming | journal = European Journal of Applied Physiology | volume = 106 | issue = 6 | pages = 785–790 | date = August 2009 | pmid = 19458960 | doi = 10.1007/s00421-009-1080-z | hdl-access = free | s2cid = 21167767 | hdl = 10400.15/3565 }}</ref>