To the Editor:

In their article in the September 2009 issue of HEPATOLOGY, Österreicher et al. conclude with a protective role for angiotensin-converting enzyme 2 (ACE2) on liver injury.1 ACE2 acts to counterbalance up-regulation of the renin-angiotensin system (RAS) through degradation of angiotensin II to angiotensin 1-7. Based on previous reports on other disease models of RAS overactivity, we would like to highlight another potential anti-RAS mechanism. In these models, immunoassay studies have identified the presence of circulating antibodies against ACE and angiotensin II considered to exert a neutralizing effect.2, 3 Currently, no studies evaluating the levels of serum/tissue anti-RAS antibodies in chronic liver disease models are reported in the literature. It is possible that standardization of their titers could prove to be of prognostic significance.


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  • 1
    Österreicher CH, Taura K, De Minicis S, Seki E, Penz-Österreicher M, Kodama Y, et al. Angiotensin-converting-enzyme 2 inhibits liver fibrosis in mice. HEPATOLOGY 2009; 50: 929938.
  • 2
    Kostrikin DS, Panchenko ON, Miagkova MA, Stanislav ML, Kost OA, Nikol'skaia II, et al. Diagnostic implications of detecting antibodies to angiotensin-converting enzyme and its substrates [in Russian]. Klin Med (Mosk) 2003; 81: 3134.
  • 3
    Stanislav ML, Balabanova RM, Alekperov RT, Miagkova MA, Abramenko TV, Kiselev IP, et al. Autoantibodies to vasoactive peptides and angiotensin converting enzyme in patients with systemic diseases of the connective tissue. Ter Arkh 2001; 73: 2025.

Michael G. Lenos M.D.*, Sofia-Maria Tsaniklidou M.D.†, * Department of Pathology, General Hospital of Athens ‘HIPPOCRATION’, Athens, Greece, † Department of Microbiology, General Hospital of Athens ‘GENNIMATAS’, Athens, Greece.