The angiotensin-converting enzyme insertion/deletion polymorphysm modifies the clinical outcome in patients with Pompe disease.

Purpose: The insertion/deletion polymorphism of angiotensin-converting enzyme may influence muscle properties. We examined whether Pompe disease clinical manifestations, which are known to be highly variable among late-onset patients, may be modulated by angiotensinconverting enzyme polymorphism. Methods: We included 38 patients with late-onset Pompe disease, aged 44.6 _ 19.8 years. We compared the distribution of angiotensin-converting enzyme polymorphism according to demographic and disease parameters. Results: The distribution of angiotensin-converting enzyme polymorphism was in line with the general population, with 16% of patients carrying the II genotype, 37% carrying the DD genotype, and the remaining patients with the ID genotype. The three groups did not differ in mean age, disease duration, Walton score, and other scores used to measure disease severity. The DD polymorphism was associated with earlier onset of disease (P _ 0.041), higher creatine kinase levels at diagnosis (P _ 0.024), presence of muscle pain (P _ 0.014), and more severe rate of disease progression (P _ 0.037, analysis of variance test for interaction). Discussion: These findings suggest a potential role of angiotensin-converting enzyme polymorphism in modulating Pompe disease phenotype and prognosis.