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Aiello M, Fantin A, Longo C, Ferrarotti I, Bertorelli G, Chetta A. Clinical manifestations in patients with PI*MM Malton genotypes. A matter still unsolved in alpha-1 antitrypsin deficiency. Respirol Case Rep 2020; 8:e00528. [PMID: 32076552 PMCID: PMC7029433 DOI: 10.1002/rcr2.528] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/05/2019] [Accepted: 12/22/2019] [Indexed: 11/08/2022] Open
Abstract
We report the genetic variants associated with alpha-1 antitrypsin deficiency (AATD) in 117 patients admitted to our outpatient clinic and characterized by a serum concentration of AAT lower than 113 mg/dL. We focused on the M-like heterozygous variant of the SERPINA1 gene called PI*MMMalton, and describe three patients with this variant. While the role of homozygous AATD in liver and pulmonary disease is well established, the association between heterozygous AATD and chronic liver and pulmonary disease is still under investigation. The PI*MMMalton genotype was found in 5.8% of patients with a pathological genotype of AATD and in 14.3% of the subjects when considering only those with intermediate AATD. There were no liver or renal abnormalities in patients with the PI*MMMalton genotype. The PI*MMMalton patients included here showed a normal liver function, and none had renal function abnormalities or abdominal aortic aneurysm. Only a prevalence of lung disease was detected.
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Affiliation(s)
- Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaItaly
| | - Alberto Fantin
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaItaly
| | - Chiara Longo
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaItaly
| | - Ilaria Ferrarotti
- Center for the Diagnosis of Inherited Alpha1‐antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumology UnitUniversity of PaviaItaly
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaItaly
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaItaly
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2
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Abstract
Alpha-1 antitrypsin (AAT) deficiency is a common inherited metabolic disorder caused by a point mutation in the SERPIN1A gene. A small portion of homozygous PI*ZZ individuals develop severe liver disease that requires liver transplantation. Posttransplant survival is excellent. The largest burden of advanced liver disease lies within the adult population rather than children. Evaluation of lung function in adults before transplant is essential because of the underlying risk for chronic obstructive pulmonary disease. Post-liver transplantation lung function should also be monitored for decline. Although uncommon, cases of simultaneous lung and liver transplant for AAT deficiency have been reported.
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Affiliation(s)
- Virginia C Clark
- Division of Gastroenterology, Hepatology, and Nutrition, University of Florida, 1600 Southwest Archer Road, Room M440, Gainesville, FL 32601, USA.
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Figueira Gonçalves JM, Martínez Bugallo F, Díaz Pérez D, Martín Martínez MD, García-Talavera I. Alpha-1 Antitrypsin Deficiency Associated With the Mmalton Variant. Description of a Family. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.05.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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4
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Figueira Gonçalves JM, Martínez Bugallo F, Díaz Pérez D, Martín Martínez MD, García-Talavera I. Déficit de alfa-1-antitripsina asociado a la variante Mmalton. Descripción de una familia. Arch Bronconeumol 2016; 52:617-618. [DOI: 10.1016/j.arbres.2016.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
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Joly P, Guillaud O, Hervieu V, Francina A, Mornex JF, Chapuis-Cellier C. Clinical heterogeneity and potential high pathogenicity of the Mmalton Alpha 1 antitrypsin allele at the homozygous, compound heterozygous and heterozygous states. Orphanet J Rare Dis 2015; 10:130. [PMID: 26446624 PMCID: PMC4596512 DOI: 10.1186/s13023-015-0350-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/01/2015] [Indexed: 11/20/2022] Open
Abstract
Background Alpha 1 antitrypsin (A1AT) deficiency (A1ATD) is potentially associated with a high degree of liver and/or lung disease. Apart from the most frequent deficiency alleles, Pi S and Pi Z, some A1AT alleles of clinical significance may be easily misdiagnosed. This is typically the case of the Pi Mmalton variant which shares the same ‘gain-of-function’ liver toxicity than Pi Z and the same ‘loss of function’ lung disease as well. Methods The biological diagnosis of A1ATD typically relies on a low serum concentration associated with an abnormal isoelectric focusing (IEF) pattern of migration. However, Sanger direct DNA sequencing may be required for deficiency alleles without biochemical expression (Null alleles) or for A1AT variants whose IEF profiles resemble the wild-type and sub-types M allele but with a low concentration. Results We report four cases of A1ATD involving the deficient Pi Mmalton allele with very different clinical expressions: (i) one Mmalton/Mmalton with liver fibrosis and cirrhosis, (ii) two Mmalton/Z with chronic pulmonary obstructive disease in one case and (iii) one M/Mmalton without liver or lung disease. In both cases, the correct diagnosis has necessitated a genetic analysis. Conclusions Our study provides another example of Pi Mmalton homozygosity associated with a severe liver disease that emphasizes the necessity of a not delayed diagnosis. The great clinical heterogeneity of the other genotypes (which is in agreement with the literature data) questions about the role of environmental and other modifier genes in the pathogenicity of A1ATD.
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Affiliation(s)
- Philippe Joly
- Unité de Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France. .,Centre de Recherche et d'Innovation sur le Sport (CRIS)-EA 647, Université Claude-Bernard Lyon 1, Villeurbanne, France. .,Labex GR-Ex, Institut Universitaire de France, Paris, France.
| | - Olivier Guillaud
- Service d'hépato-gastroentérologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Valérie Hervieu
- Service d'anatomie pathologique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Alain Francina
- Unité de Pathologie Moléculaire du Globule Rouge, Laboratoire de Biochimie et de Biologie Moléculaire, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.
| | - Jean-François Mornex
- Service de pneumologie, Groupement Hospitalier Est, Hospices Civils & Université Claude Bernard-Lyon 1, Bron, France.
| | - Colette Chapuis-Cellier
- Laboratoire d'Immunologie, Centre de Biologie Sud, Centre hospitalier Lyon-Sud, Hospices Civils & Université Claude Bernard-Lyon 1, Lyon, France.
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Nelson D, Teckman J, Di Bisceglie A, Brenner DA. Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency. Clin Gastroenterol Hepatol 2012; 10:575-80. [PMID: 22200689 PMCID: PMC3360829 DOI: 10.1016/j.cgh.2011.12.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 12/08/2011] [Accepted: 12/12/2011] [Indexed: 02/07/2023]
Abstract
Alpha(1)-antitrypsin (A1AT) deficiency is an autosomal codominant disease that can cause chronic liver disease, cirrhosis, and hepatocellular carcinoma in children and adults and increases risk for emphysema in adults. The development of symptomatic disease varies; some patients have life-threatening symptoms in childhood, whereas others remain asymptomatic and healthy into old age. As a result of this variability, patients present across multiple disciplines, including pediatrics, adult medicine, hepatology, genetics, and pulmonology. This can give physicians the mistaken impression that the condition is less common than it actually is and can lead to fragmented care that omits critical interventions commonly performed by other specialists. We sought to present a rational approach for hepatologists to manage adult patients with A1AT deficiency.
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Affiliation(s)
- David Nelson
- Department of Medicine, University of Florida, Gainesville, FL, 32611
| | - Jeffrey Teckman
- Department of Pediatrics, Saint Louis University, St. Louis, MO, 63104
| | - Adrian Di Bisceglie
- Department of Internal Medicine, Saint Louis University, St Louis, MO, 63104
| | - David A. Brenner
- Department of Medicine, University of California, San Diego, La Jolla, CA, 92093
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Francalanci P, Santorelli FM, Saccani S, Bonetti MF, Medicina D, Coni P, Faa G, Callea F. Z and Mmalton-1-antitrypsin deficiency-associated hepatocellular carcinoma: a genetic study. Liver Int 2009; 29:1593-6. [PMID: 19744266 DOI: 10.1111/j.1478-3231.2009.02091.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND The histological hallmark of alpha-1-antitrypsin deficiency (AATD) is the presence of periodic acid-Schiff diastase (PASD)-resistant positive globules in hepatocytes, with a heterogeneous distribution. It is noteworthy that hepatocellular carcinoma (HCC) arises specifically from the AAT-negative areas but the reason for this remains unclear. AIM To determine whether the different distribution of AAT globules within neoplastic and non-neoplastic hepatocytes is the result of a self-induced correction of the genetic defect. PATIENTS AND METHODS Two HCV-positive patients with AATD-associated HCC were studied. One patient harboured a compound heterozygous PiSZ genotype whereas the other showed the rarer PiMMmalton in heterozygosity. In both cases, neoplastic hepatocytes appeared globule devoid, while non-neoplastic hepatocytes showed intracytoplasmic accumulation of PASD-positive globules. Laser-assisted microdissection was used to assess a genotype/phenotype correlation in single liver cells from HCC and from non-neoplastic hepatocytes. RESULTS Direct sequencing of DNA purified from globule-devoid and globule-filled hepatocytes demonstrated that all liver cells carried the same mutant genetic background. CONCLUSION Our findings indicate that (i) both variants of HCC arising in AAT deficiency (Z and Mmalton) do not accumulate the mutant protein and (ii) the different phenotypic appearance of hepatocytes is not the result of a retromutation during neoplastic transformation, but other mechanisms should be investigated.
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Affiliation(s)
- Paola Francalanci
- Department of Pathology, Bambino Gesù Children's Hospital, Rome, Italy.
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Gambarotti M, Medicina D, Baronchelli C, Bercich L, Bonetti F, Facchetti F. Alpha-1-Antitrypsin-Positive “Signet-Ring” Bile Duct Adenoma in a Patient With MMALTON Mutation. Int J Surg Pathol 2008; 16:218-21. [DOI: 10.1177/1066896907306968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 65-year-old man with a colonic adenocarcinoma and a single small liver nodule underwent surgery. The nodule showed the histological features of a bile duct adenoma. Large eosinophilic, periodic acid-Schiff—positive diastase-resistant intracytoplasmic globules conferred a signet-ring appearance to the cells. Similar globules were found in the biliary epithelium in perinodular portal tracts, whereas smaller globules were detected in periportal hepatocytes. All globules showed strong immunoreactivity for alpha-1-antitrypsin, and the sequence of the alpha-1-antitrypsin gene showed a heterozygous Mmalton genotype. The selective recurrence of large alpha-1-antitrypsin globules within the bile ducts may indicate a neoplastic rather than a reactive or hamartomatous nature of the nodule.
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Affiliation(s)
- Marco Gambarotti
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy,
| | - Daniela Medicina
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy
| | - Carla Baronchelli
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy
| | - Luisa Bercich
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy
| | - Fausta Bonetti
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy
| | - Fabio Facchetti
- 1st Department of Surgical Pathology, University of Brescia, Brescia, Italy
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9
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American Thoracic Society/European Respiratory Society statement: standards for the diagnosis and management of individuals with alpha-1 antitrypsin deficiency. Am J Respir Crit Care Med 2007; 168:818-900. [PMID: 14522813 DOI: 10.1164/rccm.168.7.818] [Citation(s) in RCA: 627] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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10
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Abstract
Alpha-1-antitrypsin (AT) deficiency was first described in the late 1960s in patients with severe pulmonary emphysema. The recognition of AT deficiency as a cause of emphysema then led to what is still the prevailing theory for the pathogenesis of emphysema, the protease-antiprotease theory. Soon it was found that AT deficiency accounted for a significant number of cases of neonatal liver disease that were previously categorized as idiopathic. We now know that AT deficiency is the most common genetic cause of neonatal liver disease and the most frequent diagnosis necessitating liver transplantation. It has also been shown to cause chronic liver disease, cryptogenic cirrhosis, and hepatocellular carcinoma in adults never previously known to have liver disease in infancy or childhood. Observations indicate that genetic traits unlinked to the AT gene or environmental factors predispose to or protect AT-deficient individuals from liver disease.
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12
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Bailey MA, Brunt EM. Hepatocellular carcinoma: predisposing conditions and precursor lesions. Gastroenterol Clin North Am 2002; 31:641-62. [PMID: 12134622 DOI: 10.1016/s0889-8553(02)00017-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The global incidence of HCC is rising; in the United States, its rise is in parallel to that of cirrhosis due to the HCV and obesity epidemics. The lack of adequate treatment for advanced HCC mandates both prevention and early detection of these lesions. The limitations of currently available histopathologic evaluations, serologic markers, and radiographic imaging modalities in detecting HCC and its precursors have been outlined in this review. Refinements of all of these may lead to better HCC detection, earlier intervention, and successful treatment. Randomized controlled trials are necessary to evaluate the most efficacious and cost-effective approach to screening.
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Affiliation(s)
- Marie Ann Bailey
- Division of Gastroenterology, Hospital of the Medical College of Philadelphia, 7th Floor, 3300 Henry Avenue, Philadelphia, PA 19129, USA.
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Canva V, Piotte S, Aubert JP, Porchet N, Lecomte-Houcke M, Huet G, Zenjari T, Roumilhac D, Pruvot FR, Degand P, Paris JC, Balduyck M. Heterozygous M3Mmalton α1-Antitrypsin Deficiency Associated with End-Stage Liver Disease: Case Report and Review. Clin Chem 2001. [DOI: 10.1093/clinchem/47.8.1490] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstractα1-Antitrypsin (α1AT) deficiency is an autosomal recessive disorder that can cause pulmonary emphysema and liver disease. We report here the case of a 59-year-old woman who was admitted to hospital for evaluation of jaundice. She had no history of hepatitis or childhood liver disease. She had never received a blood transfusion, nor had she abused drugs or alcohol. Transjugular liver biopsy was then performed and revealed a micronodular cirrhosis. Ten months later, because of persistent liver cell failure and ascites, she underwent an orthotopic liver transplantation. Investigation of α1AT system in the proband revealed a substantial decrease in serum α1AT associated with a low elastase inhibitory capacity. The Pi phenotype revealed a PiM-like profile. Sequencing of exons 1–5 demonstrated the presence of the M3 allele. Moreover, a triple nucleotide deletion was detected in exon 2 of one allele. This caused an “in-phase” frameshift, coding for a protein deficient in a single Phe residue, which corresponded to the Mmalton variant. After liver biopsy, periodic acid-Schiff-positive acidophilic bodies resistant to diastase digestion were observed in the cytoplasm of hepatocytes. These results demonstrated that our patient had a heterozygous M3Mmalton α1AT genotype related to a deficiency phenotype. This observation is the first of a patient with heterozygous Mmalton genotype associated with an α1AT deficiency that induced severe liver disease requiring orthotopic liver transplantation.
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Affiliation(s)
| | | | - Jean-Pierre Aubert
- Biochemistry, and
- Unité INSERM 377, Place de Verdun, 59037 Lille Cedex, France
| | - Nicole Porchet
- Biochemistry, and
- Unité INSERM 377, Place de Verdun, 59037 Lille Cedex, France
| | | | - Guillemette Huet
- Biochemistry, and
- Unité INSERM 377, Place de Verdun, 59037 Lille Cedex, France
| | | | - Didier Roumilhac
- Department of Liver Transplantation, Hôpital A. Calmette, CHRU-Lille, 59037 Lille Cedex, France
| | - François-René Pruvot
- Department of Liver Transplantation, Hôpital A. Calmette, CHRU-Lille, 59037 Lille Cedex, France
| | - Pierre Degand
- Biochemistry, and
- Unité INSERM 377, Place de Verdun, 59037 Lille Cedex, France
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14
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Abstract
Alpha 1-antitrypsin deficiency is the most common genetic cause of liver disease in children. It is also associated with chronic liver disease, hepatocellular carcinoma, and pulmonary emphysema in adults. Liver injury is caused by hepatotoxic effects of retention of the mutant alpha 1-antitrypsin molecule within the endoplasmic reticulum of liver cells, and emphysema is caused by uninhibited proteolytic damage to elastic tissue in the lung parenchyma. Recent studies of the biochemistry and cell biology of the mutant alpha 1-antitrypsin molecule have led to advances in understanding susceptibility to liver injury and in developing new strategies for prevention of both liver and lung disease.
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Affiliation(s)
- D H Perlmutter
- Departments of Pediatrics, Biology, and Physiology, Washington University School of Medicine, St. Louis, Missouri, USA.
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15
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Norman MR, Mowat AP, Hutchison DC. Molecular basis, clinical consequences and diagnosis of alpha-1 antitrypsin deficiency. Ann Clin Biochem 1997; 34 ( Pt 3):230-46. [PMID: 9158819 DOI: 10.1177/000456329703400303] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
(1) Deficiency of alpha AT is one of the most common hereditary diseases affecting Caucasians in Europe. The alpha 1AT protein is extremely pleomorphic, and around 90 variants due to mutations have been recognized. The prime functions of alpha 1AT is to inhibit neutrophil elastase, and a proportion of individuals who are deficient in alpha 1AT develop emphysema. The most common deficiency variant (Z) is also associated with liver disease. The main site of alpha 1AT synthesis is in the liver. Not all deficient individuals are affected by lung or liver disease, however, so that other factors (genetic and environmental) are clearly important. (2) Investigation of alpha 1AT status is essential in any child or adult presenting with chronic liver disease. The genetic cause cannot be identified clinically or by any other laboratory investigation. The diagnosis carries important prognostic consequences and is important for other family members. Patients with emphysema should have their Pi type determined, especially if they are under the age of 50, have never smoked or there is a suggestive family history. Asymptomatic individuals who are homozygous type Z should be referred to a chest physician for a clinical and radiological assessment together with lung function tests. (3) Several laboratory tests are available to detect alpha 1AT deficiency, and the choice of test(s) will depend on circumstances. Quantitation of the serum protein is simple and cheap. Because alpha 1AT is an acute phase protein, however, quantitation used in isolation may give false negative results which are clearly unacceptable, particularly in association with paediatric liver disease. Phenotyping by isoelectric focusing requires some experience in distinguishing SZ and ZZ phenotypes, and phenotyping should ideally be used in conjunction with quantitation because heterozygous null phenotypes may appear identical to homozygous normal phenotypes. (4) Prenatal diagnosis is usually performed by DNA analysis of CVS samples obtained at 11-13 weeks. Because of the risk that CVS samples might be contaminated by maternal tissue, assays which are less likely to detect minor contaminants are preferable. At present, use of DNA tests is confined to prenatal diagnosis, but the availability of simple tests and the possibility of unequivocal identification of S and Z alleles means that these tests are likely to find greater use in the near future.
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Affiliation(s)
- M R Norman
- Department of Medicine, University of Bristol, Bristol Royal Infirmary, UK
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16
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Abstract
alpha 1-Antitrypsin (alpha 1-AT) deficiency is the most common genetic cause of liver disease in children and genetic disease for which children undergo liver transplantation. It also causes cirrhosis and hepatocellular carcinoma in adults. Studies by Sveger in Sweden have shown that only a subgroup of the population with homozygous PiZZ alpha 1-AT deficiency develop clinically significant liver injury. Other studies have shown that the mutant alpha 1-AT Z molecule undergoes polymerization in the endoplasmic reticulum and that a subpopulation of alpha 1-AT-deficient individuals may be susceptible to liver injury because they also have a trait that reduces the efficiency by which the mutant alpha 1-AT Z molecule is degraded in the endoplasmic reticulum.
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Affiliation(s)
- D Qu
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri 63110, USA
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17
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Abstract
Alpha-1-antitrypsin (alpha 1-AT) deficiency is a well known cause of emphysema in adults. A subgroup of deficient individuals develops liver injury during infancy and childhood. In fact, it is the most common genetic cause of liver disease in children. Although lung injury is due to the decrease in alpha 1-AT function in the lung, allowing uninhibited elastolytic destruction of its connective tissue integrity, liver injury is probably due to retention of the mutant alpha 1-AT molecule in the endoplasmic reticulum (ER) of liver cells. Recent studies have shown that the mutant alpha 1-AT molecule polymerizes in the ER by a novel loop-sheet insertion mechanism. Other recent studies show that the subgroup of deficient individuals is susceptible to liver injury by virtue of unlinked genetic traits and/or environmental factors which interfere with degradation of the mutant alpha 1-AT molecules within the ER.
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Affiliation(s)
- D H Perlmutter
- Department of Pediatrics, Cell Biology and Physiology, Washington University, School of Medicine, St. Louis Children's Hospital, MO 63110, USA
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18
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Vennarecci G, Gunson BK, Ismail T, Hübscher SG, Kelly DA, McMaster P, Elias E. Transplantation for end stage liver disease related to alpha 1 antitrypsin. Transplantation 1996; 61:1488-95. [PMID: 8633377 DOI: 10.1097/00007890-199605270-00014] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Alpha 1 antitrypsin deficiency (AT) is an autosomal recessive disease associated with chronic liver disease in adults and children and emphysema in adults. The disease is one of the most common inherited disorders of the Caucasian population of North Europe and North America and is the most common genetic reason for pediatric orthotopic liver transplantation (OLTx), although it is a rare indication in adults. The natural history of the disease is unpredictable and the pathogenesis of the liver injury unclear. Thirty-five patients with histologically apparent alpha 1 AT accumulation in the liver (22 adults, 13 children) have been transplanted in this center. Clinical features were correlated with the pretransplant phenotype, serum alpha 1 antitrypsin levels and potential precipitating factors. All children were PiZZ homozygotes, most of whom had presented with neonatal hepatitis. The majority of adult patients were heterozygotes presenting with portal hypertension and liver cirrhosis. Current one-year posttransplant survival figures are 73% for adults and 87.5% for children. Replacement of the cirrhotic liver results in acquisition of the donor phenotype, a rise in serum levels of alpha 1 antitrypsin, and apparent prevention of associated disease.
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Affiliation(s)
- G Vennarecci
- The Liver Unit, The Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom
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19
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Poley JR. Malignant liver disease in alpha 1-antitrypsin deficiency. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1994; 393:27-32. [PMID: 8032114 DOI: 10.1111/j.1651-2227.1994.tb13204.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J R Poley
- Children's Hospital of the King's Daughters, Department of Pediatrics, Eastern Virginia Medical School, Medical College of Hampton Roads, Norfolk
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20
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Hepatocarcinogenesis is the sequel to hepatitis in Z#2 α1-antitrypsin transgenic mice: Histopathological and DNA ploidy studies. Hepatology 1994. [DOI: 10.1002/hep.1840190218] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
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Affiliation(s)
- W S Robinson
- Standard University School of Medicine, Stanford, California
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22
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Frazier GC, Siewertsen MA, Hofker MH, Brubacher MG, Cox DW. A null deficiency allele of alpha 1-antitrypsin, QOludwigshafen, with altered tertiary structure. J Clin Invest 1990; 86:1878-84. [PMID: 2254451 PMCID: PMC329821 DOI: 10.1172/jci114919] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The most common deficiency allele of the plasma protease inhibitor alpha 1-antitrypsin (alpha 1AT) is PI*Z. Some rare deficiency alleles of alpha 1AT produce low but detectable amounts of plasma alpha 1AT (1-20% of normal), which can be differentiated by isoelectric focusing. Others, designated null (QO) alleles, produce no alpha 1AT detectable by routine quantitative methods. We have previously described a method using DNA polymorphisms, haplotypes, and polyacrylamide isoelectric focusing gels, to differentiate various deficiency alleles. Based on haplotypes, we previously identified, in eight patients, five different null alleles, four of which had been previously sequenced. We have now analyzed all 12 null alleles in these eight patients, using allele-specific oligonucleotide probes, and have identified six different null alleles. We have cloned and sequenced one of these, PI*QOludwigshafen, which has a base substitution in exon II, replacing isoleucine 92 in the normal sequence with an asparagine. This substitution of a polar for a nonpolar amino acid occurs in one of the alpha-helices and is predicted to disrupt the tertiary structure. A total of 13 different alpha 1AT deficiency alleles, 6 of them null alleles, have been sequenced to date.
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Affiliation(s)
- G C Frazier
- Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
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23
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Geller SA, Nichols WS, Dycaico MJ, Felts KA, Sorge JA. Histopathology of alpha 1-antitrypsin liver disease in a transgenic mouse model. Hepatology 1990; 12:40-7. [PMID: 1695605 DOI: 10.1002/hep.1840120108] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transgenic mice were constructed using human alpha 1-antitrypsin M and Z genomic clones. Livers of the M lineage mice showed slight cellular pleomorphism and immunohistochemically demonstrable finely granular alpha 1-antitrypsin material in hepatocytes. Z lineage mice with five gene copies per haploid mouse genome (Z#1) demonstrated fine granular alpha 1-antitrypsin material and a few large globules. In contrast, Z lineage mice with 12 gene copies per haploid mouse genome (Z#2) demonstrated hepatocytes filled with homogeneous, eosinophilic globules that were strongly reactive with diastase and periodic acid-Schiff and antibody to alpha 1-antitrypsin. Scattered microscopic polymorphonuclear leukocyte accumulations were seen that contained extracellular alpha 1-antitrypsin material, but there was neither histological nor serological evidence of mouse infectious hepatitis. In young animals, small clusters of hepatocytes lacking alpha 1-antitrypsin material were seen. These cells were the dominant population in older animals and formed nodular arrangements. Fibrosis was not demonstrable in neonatal and young animals or in any of the controls, but perisinusoidal fibrosis was seen in older Z#2 mice. Groups of hepatocytes without alpha 1-antitrypsin material showed dysplastic changes. We conclude that the transgenic mouse is a reliable and useful model in which to study the effects of alpha 1-antitrypsin in the liver because it demonstrates changes similar to those in the human disease.
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Affiliation(s)
- S A Geller
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California 90048
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Curiel DT, Holmes MD, Okayama H, Brantly ML, Vogelmeier C, Travis WD, Stier LE, Perks WH, Crystal RG. Molecular Basis of the Liver and Lung Disease Associated with the α1-Antitrypsin Deficiency Allele Mmalton. J Biol Chem 1989. [DOI: 10.1016/s0021-9258(18)80090-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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