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Alpha1-antitrypsin deficiency: a clinical-genetic overview

Overview of attention for article published in The Application of Clinical Genetics, March 2011
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Title
Alpha1-antitrypsin deficiency: a clinical-genetic overview
Published in
The Application of Clinical Genetics, March 2011
DOI 10.2147/tacg.s10604
Pubmed ID
Authors

Raja Abboud, Nelson, Tanya, Benjamin Jung, Andre Mattman

Abstract

Severe α1-antitrypsin deficiency (AATD) is an inherited disorder, leading to development of emphysema in smokers at a relatively young age with disability in their forties or fifties. The emphysema results from excessive elastin degradation by neutrophil elastase as a result of the severe deficiency of its major inhibitor α1-antitrypsin (AAT). The AAT expression is determined by the SERPINA1 gene which expresses codominant alleles. The three most common alleles are the normal M, the S with plasma levels of 60% of normal, and the severely deficient Z with levels of about 15% of normal. Homozygosity for the Z mutant allele is associated with retention of abnormal AAT in the liver, which may lead to neonatal hepatitis, liver disease in children, and liver disease in adults. Regular intravenous infusions of purified human AAT (AAT augmentation therapy) have been used to partially correct the biochemical defect and protect the lung against further injury. Two randomized controlled trials showed a trend of slower progression of emphysema by chest computerized tomography. Integrated analysis of these two studies indicated significantly slower progression of emphysema. AAT is quantified by immunologic measurement of AAT in serum, the phenotype characterized by isoelectric focusing, the common genotypes by targeted DNA analysis, and by sequencing the coding region of the gene when the AAT abnormality remains undefined. AATD is often unrecognized, and diagnosis delayed. Testing for AATD is recommended in patients with chronic irreversible airflow obstruction, especially in those with early onset of disease or positive family history. Testing is also recommended for immediate family members of those with AATD, asthmatics with persistent airflow obstruction, and infants and older subjects with unexplained liver disease. There are over 100 different AAT gene variants; most are rare and only some are associated with clinical disease.

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Geographical breakdown

Country Count As %
Canada 1 2%
Unknown 47 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 9 19%
Researcher 8 17%
Other 7 15%
Student > Ph. D. Student 6 13%
Student > Bachelor 4 8%
Other 7 15%
Unknown 7 15%
Readers by discipline Count As %
Medicine and Dentistry 15 31%
Biochemistry, Genetics and Molecular Biology 7 15%
Agricultural and Biological Sciences 5 10%
Chemistry 3 6%
Nursing and Health Professions 2 4%
Other 5 10%
Unknown 11 23%