From the Guidelines
There is no direct evidence to suggest that Lyme disease or Epstein-Barr virus (EBV) infection increases Angiotensin-Converting Enzyme (ACE) levels. The provided evidence focuses on the management of heart failure with reduced ejection fraction (HFrEF) using ACE inhibitors, angiotensin receptor blockers (ARBs), and angiotensin receptor-neprilysin inhibitors (ARNIs) 1. While ACE levels are crucial in the context of heart failure management, the relationship between Lyme disease, EBV infection, and ACE levels is not explicitly addressed in the given studies. However, it is known that inflammatory responses, such as those caused by infections, can affect various physiological pathways, potentially influencing ACE levels indirectly. Given the lack of direct evidence, it is essential to consider other clinical findings and laboratory results when interpreting ACE levels in patients with suspected Lyme disease or EBV infection. If you suspect Lyme disease or EBV infection, consult a healthcare provider for appropriate testing and treatment, as proper diagnosis and management are critical for patient outcomes 1. Key points to consider include:
- The use of ACE inhibitors, ARBs, and ARNIs in managing HFrEF to reduce morbidity and mortality 1.
- The importance of cautious use of these medications in patients with certain conditions, such as low systemic blood pressure, renal insufficiency, or elevated serum potassium 1.
- The need for comprehensive patient evaluation and monitoring when initiating or adjusting treatments that affect the renin-angiotensin system 1.
From the Research
Angiotensin-Converting Enzyme (ACE) Levels
- ACE levels are considered a serological marker of sarcoidosis, but elevated levels can also be encountered in other medical conditions 2
- A study found that elevated ACE levels were most commonly encountered among patients with sarcoidosis, non-Hodgkin's lymphoma, cirrhosis, and interstitial lung disease 2
- However, there is no direct evidence to suggest that Lyme disease or Epstein-Barr virus (EBV) infection increases ACE levels
Genetic Causes of Elevated ACE Levels
- A novel Trp1197Stop mutation in the ACE gene was found to result in a dramatic elevation of serum ACE levels 3
- This mutation leads to the production of a truncated ACE protein that is directly secreted out of cells, resulting in high serum ACE levels 3
- Another study found that a Pro1199Leu substitution in the ACE gene enhanced the cleavage-secretion process, leading to elevated ACE levels 3
ACE Phenotyping
- ACE phenotyping is a novel approach that characterizes serum ACE in patients and establishes normal values for ACE levels 4
- This approach includes determination of ACE activity, calculation of a ratio for hydrolysis of substrates, and quantification of ACE immunoreactive protein levels and ACE conformation 4, 5
- ACE phenotyping can identify patients with various mutations in ACE and may help to identify unknown ACE secretase or other mechanistic details of precise regulation of ACE expression 4, 5
Clinical Significance of ACE Levels
- Elevated ACE levels are associated with an increased risk of cardiovascular diseases and are a marker for granulomatous diseases 2, 6
- Decreased blood ACE activity is becoming a new risk factor for Alzheimer's disease 5
- ACE levels may be useful in the diagnosis and monitoring of diseases associated with ACE, and ACE inhibitors and Angiotensin Receptor Blockers may be used in the management of these diseases 6