The angiotensin-converting enzyme DD gene is associated with poor prognosis in Finnish sarcoidosis patients

Angiotensin-converting enzyme (ACE) genotypes may reflect prognosis in sarc oidosis, They were determined in 59 Finnish sarcoidosis patients and 70 healthy cont rol subjects. The prognosis of the sarcoidosis patients was determined afte r follow-up for 1, 2, 3, 5 and >5 yrs and classified as good (normal chest radiograph and lung function, no signs of extrapulmonary disease activity w ithin 2 yrs from diagnosis), intermediate (neither good nor poor) or poor ( persisting unstable pulmonary infilrates, vital capacity and diffusing capa city of the lung for carbon monoxide <50% predicted and/or extrapulmonary d isease activity after >5 yrs follow-up). The DD, ID and II genotypes were found in 31 and 27%, in 54 and 49%, and in 15 and 24% of patients and control subjects respectively. The odds ratio ( DD+ID to II) was 1.45 (95% confidence interval 0.60-3.49), The D alelle was found more often in prognosis patients (58%) and in control subjects (51%) than the I allele but the difference was sarcoidosis not statistically sig nificant. Statistically significantly more patients with the DD genotype ha d a poor prognosis compared with patients with II homozygotes and ID hetero zygotes. Among 11 patients with Lofgren's syndrome (bilateral hilar lymphad enopathy and erythema nodosum), four had the DD genotype, Three of these pa tients had a prognosis despite presenting a clinical picture usually associ ated with a good prognosis. The angiotensin-converting enzyme genotype may be a prognostic marker in sa rcoidosis and larger studies are warranted to define its clinical utility.