Exome Sequencing Reveals Common and Rare Variants in F5 Associated With ACE Inhibitor and Angiotensin Receptor Blocker–Induced Angioedema

Cyrielle Maroteau (Lead / Corresponding author), Moneeza Kalhan Siddiqui, Abirami Veluchamy, Fiona Carr, Myra White, Andrew J. Cassidy, Eva R. Rasmussen, Ekaterina V. Baranova, Niclas Eriksson, Katarzyna M. Bloch, Nancy J. Brown, Anette Bygum, Pär Hallberg, Malgorzata Karawajczyk, Patrik K. E. Magnusson, Qun-Ying Yue, Ann-Christine Syvänen, Christian von Buchwald, Ana Alfirevic, Anke Hilse Maitland-van der ZeeMia Wadelius, Colin N. A. Palmer, PREDICTION-ADR Consortium

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)
63 Downloads (Pure)


Angioedema occurring in the head and neck region is a rare and sometimes life-threatening adverse reaction to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). Few studies have investigated the association of common variants with this extreme reaction, but none have explored the combined influence of rare variants yet. Adjudicated cases of ACEI-induced angioedema (ACEI-AE) or ARB-induced angioedema (ARB-AE) and controls were recruited at five different centers. Sequencing of 1,066 samples (408 ACEI-AE, ARB-AE, and 658 controls) was performed using exome-enriched sequence data. A common variant of the F5 gene that causes an increase in blood clotting (rs6025, p.Arg506Gln, also called factor V Leiden), was significantly associated with both ACEI-AE and ARB-AE (odds ratio: 2.85, 95% confidence interval (CI), 1.89–4.25). A burden test analysis of five rare missense variants in F5 was also found to be associated with ACEI-AE or ARB-AE, P = 2.09 × 10 −3. A combined gene risk score of these variants, and the common variants rs6025 and rs6020, showed that individuals carrying at least one variant had 2.21 (95% CI, 1.49–3.27, P = 6.30 × 10 −9) times the odds of having ACEI-AE or ARB-AE. The increased risk due to the common Leiden allele was confirmed in a genome-wide association study from the United States. A high risk of angioedema was also observed for the rs6020 variant that is the main coagulation defect-causing variant in black African and Asian populations. We found that deleterious missense variants in F5 are associated with an increased risk of ACEI-AE or ARB-AE.

Original languageEnglish
Pages (from-to)1195-1202
Number of pages8
JournalClinical Pharmacology & Therapeutics
Issue number6
Early online date4 Jun 2020
Publication statusPublished - Dec 2020


  • ACE inhibitors
  • ARB
  • Angioedema
  • Adverse drug reactions
  • Next generation sequencing
  • Hypertension


Dive into the research topics of 'Exome Sequencing Reveals Common and Rare Variants in F5 Associated With ACE Inhibitor and Angiotensin Receptor Blocker–Induced Angioedema'. Together they form a unique fingerprint.

Cite this