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Chan ED, King PT, Bai X, Schoffstall AM, Sandhaus RA, Buckle AM. The Inhibition of Serine Proteases by Serpins Is Augmented by Negatively Charged Heparin: A Concise Review of Some Clinically Relevant Interactions. Int J Mol Sci 2024; 25:1804. [PMID: 38339082 PMCID: PMC10855260 DOI: 10.3390/ijms25031804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024] Open
Abstract
Serine proteases are members of a large family of hydrolytic enzymes in which a particular serine residue in the active site performs an essential role as a nucleophile, which is required for their proteolytic cleavage function. The array of functions performed by serine proteases is vast and includes, among others, the following: (i) the ability to fight infections; (ii) the activation of blood coagulation or blood clot lysis systems; (iii) the activation of digestive enzymes; and (iv) reproduction. Serine protease activity is highly regulated by multiple families of protease inhibitors, known collectively as the SERine Protease INhibitor (SERPIN). The serpins use a conformational change mechanism to inhibit proteases in an irreversible way. The unusual conformational change required for serpin function provides an elegant opportunity for allosteric regulation by the binding of cofactors, of which the most well-studied is heparin. The goal of this review is to discuss some of the clinically relevant serine protease-serpin interactions that may be enhanced by heparin or other negatively charged polysaccharides. The paired serine protease-serpin in the framework of heparin that we review includes the following: thrombin-antithrombin III, plasmin-anti-plasmin, C1 esterase/kallikrein-C1 esterase inhibitor, and furin/TMPRSS2 (serine protease Transmembrane Protease 2)-alpha-1-antitrypsin, with the latter in the context of COVID-19 and prostate cancer.
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Affiliation(s)
- Edward D. Chan
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
- Department of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Paul T. King
- Medicine Monash Health, Monash University, Clayton, VIC 3800, Australia
| | - Xiyuan Bai
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO 80045, USA
- Department of Academic Affairs, National Jewish Health, Denver, CO 80206, USA
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO 80045, USA
| | - Allen M. Schoffstall
- Department of Chemistry and Biochemistry, University of Colorado, Colorado Springs, CO 80918, USA
| | | | - Ashley M. Buckle
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, VIC 3800, Australia;
- Replay, San Diego, CA 92121, USA
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Tural Onur S, Natoli A, Dreger B, Arınç S, Sarıoğlu N, Çörtük M, Karadoğan D, Şenyiğit A, Yıldız BP, Köktürk N, Argun Barıs S, Kodalak Cengiz S, Polatli M. An Alpha-1 Antitrypsin Deficiency Screening Study in Patients with Chronic Obstructive Pulmonary Disease, Bronchiectasis, or Asthma in Turkey. Int J Chron Obstruct Pulmon Dis 2023; 18:2785-2794. [PMID: 38046982 PMCID: PMC10693271 DOI: 10.2147/copd.s425835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/27/2023] [Indexed: 12/05/2023] Open
Abstract
Purpose Alpha-1 antitrypsin deficiency (AATD) is a rare hereditary condition characterized by decreased serum alpha-1 antitrypsin (AAT) levels. We aim to identify AATD in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, or asthma and to report the frequency of AAT variants in Turkey. Patients and Methods This non-interventional, multicenter, prospective study was conducted between October 2021 and June 2022. Adult patients with COPD, bronchiectasis, asthma, liver symptoms, or family members with AATD were included. Demographic and clinical characteristics, pulmonary diagnosis, respiratory symptoms, and AAT serum levels were assessed. Whole blood samples were collected as dried blood spots, and the most common AATD mutations were simultaneously tested by allele-specific genotyping. Results A total of 1088 patients, mainly diagnosed with COPD (92.7%) and shortness of breath (78.7%), were assessed. Fifty-one (5%) were found to have AATD mutations. Fifteen (29.4%) patients had Pi*S or Pi*Z mutations, whereas 36 (70.6%) patients carried rare alleles Pi*M malton (n=18, 35.3% of mutations), Pi*I (n=8, 16%), Pi*P lowell (n=7, 14%), Pi*M heerlen (n=2, 4%), and Pi*S iiyama (n=1, 2%). The most common heterozygous combinations were Pi*M/Z (n=12, 24%), and Pi*M/M malton (n=11, 22%). Ten patients with severe AATD due to two deficiency alleles were identified, two with the Pi*Z/Z genotype, four with the genotype Pi*M malton/M malton, three with Pi*Z/M malton, and one with Pi*Z/M heerlen. Conclusion Our results identified AATD mutations as a genetic-based contributor to lung disease in patients with COPD or bronchiectasis and assessed their frequency in a population of Turkish patients.
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Affiliation(s)
- Seda Tural Onur
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Antonino Natoli
- Scientific and Medical Affairs, Scientific Innovation Office, Grifols, Frankfurt, Deutschland
| | - Bettina Dreger
- Scientific and Medical Affairs, Scientific Innovation Office, Grifols, Frankfurt, Deutschland
| | - Sibel Arınç
- Clinic of Chest Diseases, University of Health Sciences Turkey, S.B.Ü. Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Türkiye
| | - Nurhan Sarıoğlu
- Department of Pulmonology, Balıkesir University Faculty of Medicine, Pulmonology Clinic, Balıkesir, Türkiye
| | - Mustafa Çörtük
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Dilek Karadoğan
- Department of Chest Diseases, Recep Tayyip Erdoğan University, School of Medicine, Rize, Türkiye
| | - Abdurrahman Şenyiğit
- Department of Chest Diseases, Dicle University Faculty of Medicine Hospital, Diyarbakır, Türkiye
| | - Birsen Pınar Yıldız
- Department of Pulmonology, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Nurdan Köktürk
- Department of Pulmonary Medicine, Gazi University, School of Medicine, Ankara, Türkiye
| | - Serap Argun Barıs
- Department of Pulmonary Diseases, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye
| | | | - Mehmet Polatli
- Faculty of Medicine, Aydin Adnan Menderes University, Aydin, Türkiye
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Abreu N, Pereira VM, Pestana M, Jasmins L. Future Perspectives in the Diagnosis and Treatment of Liver Disease Associated with Alpha-1 Antitrypsin Deficiency. GE Port J Gastroenterol 2023; 30:327-335. [PMID: 37868641 PMCID: PMC10586215 DOI: 10.1159/000528809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/15/2022] [Indexed: 10/24/2023]
Abstract
Alpha-1 antitrypsin deficiency (AATD) is one of the most common genetic diseases and is caused by mutations in the SERPINA1 gene. The homozygous Pi*Z variant is responsible for the majority of the classic severe form of alpha-1 antitrypsin deficiency, which is characterized by markedly decreased levels of serum alpha-1 antitrypsin (AAT) with a strong predisposition to lung and liver disease. The diagnosis and early treatment of AATD-associated liver disease are challenges in clinical practice. In this review, the authors aim to summarize the current evidence of the non-invasive methods in the assessment of liver fibrosis, as well as to elucidate the main therapeutic strategies under investigation that may emerge in the near future.
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Affiliation(s)
- Nélia Abreu
- Department of Gastroenterology, Hospital Central Do Funchal, Madeira, Portugal
| | - Vítor Magno Pereira
- Department of Gastroenterology, Hospital Central Do Funchal, Madeira, Portugal
| | - Madalena Pestana
- Department of Gastroenterology, Hospital Central Do Funchal, Madeira, Portugal
| | - Luís Jasmins
- Department of Gastroenterology, Hospital Central Do Funchal, Madeira, Portugal
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Reinoso-Arija R, Proaño C, Ruiz-Serrano R, Núñez Ollero D, Ruiz-Duque B, Ortega Ruiz F, Márquez Martín E, Carrasco Hernández L, López-Campos JL. [Results of the Implementation of a Case-Finding Program for Alpha-1 Antitrypsin Deficiency in COPD Patients]. Open Respir Arch 2023; 5:100251. [PMID: 37810428 PMCID: PMC10556779 DOI: 10.1016/j.opresp.2023.100251] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 05/12/2023] [Indexed: 10/10/2023] Open
Abstract
Objectives Currently, the identification of new cases of alpha-1 antitrypsin deficiency (AATD) continues to be one of the great challenges facing the disease. The present study aims to perform an analysis of the results of the implementation of a systematic case detection program of AATD for patients with chronic obstructive pulmonary disease. Material and methods Cross-sectional observational study in which the results of AAT screening until December 2022 were analyzed. The cases studied were divided into three periods: (1) no systematic case detection until 2013; (2) systematic case detection of S and Z alleles for cases with AAT < 90 mg/dL until 2018, and (3) systematic case detection of 14 mutations for cases with AAT < 120 mg/dL since 2018. Results A total of 471 cases were studied, of which 306 (65.0%) were carriers of some mutation related to HAD. The number of detected cases of all mutations with their percentage against those studied in each period was respectively: 6 (100%), 48 (88.8%) and 253 (61.5%). If we limit to severe mutations (AAT < 57.2 mg/dL), the distribution by periods was respectively: 3 (50.0), 10 (18.5%) and 17 (4.1%). Conclusions The present study describes the changes in the detection of patients carrying DAAT-related alleles with three different case identification policies. The data support the use of systematic case detection system in the COPD patient population.
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Affiliation(s)
- Rocío Reinoso-Arija
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Carmen Proaño
- Departamento de Medicina, Universidad de Sevilla, Sevilla, España
| | - Rosario Ruiz-Serrano
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Dolores Núñez Ollero
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Borja Ruiz-Duque
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
| | - Francisco Ortega Ruiz
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Eduardo Márquez Martín
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - Laura Carrasco Hernández
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
| | - José Luis López-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España
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Bai X, Schountz T, Buckle AM, Talbert JL, Sandhaus RA, Chan ED. Alpha-1-antitrypsin antagonizes COVID-19: a review of the epidemiology, molecular mechanisms, and clinical evidence. Biochem Soc Trans 2023; 51:1361-1375. [PMID: 37294003 PMCID: PMC10317171 DOI: 10.1042/bst20230078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/25/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
Alpha-1-antitrypsin (AAT), a serine protease inhibitor (serpin), is increasingly recognized to inhibit SARS-CoV-2 infection and counter many of the pathogenic mechanisms of COVID-19. Herein, we reviewed the epidemiologic evidence, the molecular mechanisms, and the clinical evidence that support this paradigm. As background to our discussion, we first examined the basic mechanism of SARS-CoV-2 infection and contend that despite the availability of vaccines and anti-viral agents, COVID-19 remains problematic due to viral evolution. We next underscored that measures to prevent severe COVID-19 currently exists but teeters on a balance and that current treatment for severe COVID-19 remains grossly suboptimal. We then reviewed the epidemiologic and clinical evidence that AAT deficiency increases risk of COVID-19 infection and of more severe disease, and the experimental evidence that AAT inhibits cell surface transmembrane protease 2 (TMPRSS2) - a host serine protease required for SARS-CoV-2 entry into cells - and that this inhibition may be augmented by heparin. We also elaborated on the panoply of other activities of AAT (and heparin) that could mitigate severity of COVID-19. Finally, we evaluated the available clinical evidence for AAT treatment of COVID-19.
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Affiliation(s)
- Xiyuan Bai
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, U.S.A
- Department of Academic Affairs, National Jewish Health, Denver, CO, U.S.A
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, U.S.A
| | - Tony Schountz
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, CO, U.S.A
| | - Ashley M. Buckle
- Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
- PTNG Bio, Melbourne, Australia
| | - Janet L. Talbert
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, U.S.A
| | | | - Edward D. Chan
- Department of Medicine, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, U.S.A
- Department of Academic Affairs, National Jewish Health, Denver, CO, U.S.A
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado School of Medicine, Aurora, CO, U.S.A
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Kamp JC, Kappe NN, Moro CF, Fuge J, Kuehnel MP, Wrenger S, Welte T, Hoek BV, Jonigk DD, Khedoe PPSJ, Strnad P, Björnstedt M, Stolk J, Janciauskiene S, Nemeth A. Fibrosis-Related Gene Profiling in Liver Biopsies of PiZZ α1-Antitrypsin Children with Different Clinical Courses. Int J Mol Sci 2023; 24. [PMID: 36768808 DOI: 10.3390/ijms24032485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 02/03/2023] Open
Abstract
PiZZ (Glu342Lys) α1-antitrypsin deficiency (AATD) is characterized by intrahepatic AAT polymerization and is a risk factor for liver disease development in children. The majority of PiZZ children are disease free, hence this mutation alone is not sufficient to cause the disease. We investigated Z-AAT polymers and the expression of fibrosis-related genes in liver tissues of PiZZ children with different clinical courses. Liver biopsies obtained during 1979-2010 at the Department of Paediatrics, Karolinska University Hospital, Sweden, were subjected to histological re-evaluation, immunohistochemistry and NanoString-based transcriptome profiling using a panel of 760 fibrosis plus 8 bile acid-related genes. Subjects were divided into three groups based on clinical outcomes: NCH (neonatal cholestasis, favourable outcome, n = 5), NCC (neonatal cholestasis, early cirrhosis and liver transplantation, n = 4), and NNCH (no neonatal cholestasis, favourable outcome, n = 5, six biopsies). Hepatocytes containing Z-AAT polymers were abundant in all groups whereas NCC showed higher expression of genes related to liver fibrosis/cirrhosis and lower expression of genes related to lipid, aldehyde/ketone, and bile acid metabolism. Z-AAT accumulation per se cannot explain the clinical outcomes of PiZZ children; however, changes in the expression of specific genes and pathways involved in lipid, fatty acid, and steroid metabolism appear to reflect the degree of liver injury.
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Amati F, Gramegna A, Contarini M, Stainer A, Curcio C, Aliberti S, Corsico AG, Blasi F. Genetic and Serum Screening for Alpha-1-Antitrypsin Deficiency in Adult Patients with Cystic Fibrosis: A Single-Center Experience. Biomedicines 2022; 10. [PMID: 36552004 DOI: 10.3390/biomedicines10123248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/04/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
Cystic fibrosis (CF) and alpha-1 antitrypsin (AAT) deficiency are two of the commonest genetic diseases affecting the Caucasian population. Neutrophil-mediated inflammation due to protease-antiprotease imbalance leads to progressive pulmonary involvement in both diseases. The aim of this study was to investigate the prevalence of AAT deficiency in CF adults. A prospective study enrolling CF adults was conducted at the Adult CF Center based in Milan from January 2018 to March 2019. Patients were tested for AAT serum protein quantification and expanded genotyping characterization of SERPINA1 during clinical stability. Genotyping characterization of SERPIN1 was compared to a control population of 2848 Caucasian individuals with the same geographical origin and similar demographic characteristics. Among 173 patients included in the study, the prevalence of AAT deficiency was 0. Genotype analysis was piMM in 166 (94.9%) patients and piMS in 9 patients (5.1%), respectively. No differences in terms of genotype characterization were found between the CF population and the control population. These data show that AAT deficiency is not common among adults with CF.
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Serban KA, Pratte KA, Strange C, Sandhaus RA, Turner AM, Beiko T, Spittle DA, Maier L, Hamzeh N, Silverman EK, Hobbs BD, Hersh CP, DeMeo DL, Cho MH, Bowler RP. Unique and shared systemic biomarkers for emphysema in Alpha-1 Antitrypsin deficiency and chronic obstructive pulmonary disease. EBioMedicine 2022; 84:104262. [PMID: 36155958 PMCID: PMC9507992 DOI: 10.1016/j.ebiom.2022.104262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/02/2022] [Accepted: 08/23/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Alpha-1 Antitrypsin (AAT) deficiency (AATD), the most common genetic cause of emphysema presents with unexplained phenotypic heterogeneity in affected subjects. Our objectives to identify unique and shared AATD plasma biomarkers with chronic obstructive pulmonary disease (COPD) may explain AATD phenotypic heterogeneity. METHODS The plasma or serum of 5,924 subjects from four AATD and COPD cohorts were analyzed on SomaScan V4.0 platform. Using multivariable linear regression, inverse variance random-effects meta-analysis, and Least Absolute Shrinkage and Selection Operator (LASSO) regression we tested the association between 4,720 individual proteins or combined in a protein score with emphysema measured by 15th percentile lung density (PD15) or diffusion capacity (DLCO) in distinct AATD genotypes (Pi*ZZ, Pi*SZ, Pi*MZ) and non-AATD, PiMM COPD subjects. AAT SOMAmer accuracy for identifying AATD was tested using receiver operating characteristic curve analysis. FINDINGS In PiZZ AATD subjects, 2 unique proteins were associated with PD15 and 98 proteins with DLCO. Of those, 68 were also associated with DLCO in COPD also and enriched for three cellular component pathways: insulin-like growth factor, lipid droplet, and myosin complex. PiMZ AATD subjects shared similar proteins associated with DLCO as COPD subjects. Our emphysema protein score included 262 SOMAmers and predicted emphysema in AATD and COPD subjects. SOMAmer AAT level <7.99 relative fluorescence unit (RFU) had 100% sensitivity and specificity for identifying Pi*ZZ, but it was lower for other AATD genotypes. INTERPRETATION Using SomaScan, we identified unique and shared plasma biomarkers between AATD and COPD subjects and generated a protein score that strongly associates with emphysema in COPD and AATD. Furthermore, we discovered unique biomarkers associated with DLCO and emphysema in PiZZ AATD. FUNDING This work was supported by a grant from the Alpha-1 Foundation to RPB. COPDGene was supported by Award U01 HL089897 and U01 HL089856 from the National Heart, Lung, and Blood Institute. Proteomics for COPDGene was supported by NIH 1R01HL137995. GRADS was supported by Award U01HL112707, U01 HL112695 from the National Heart, Lung, and Blood Institute, and UL1TRR002535 to CCTSI; QUANTUM-1 was supported by the National Heart Lung and Blood Institute, the Office of Rare Diseases through the Rare Lung Disease Clinical Research Network (1 U54 RR019498-01, Trapnell PI), and the Alpha-1 Foundation. COPDGene is also supported by the COPD Foundation through contributions made to an Industry Advisory Board that has included AstraZeneca, Bayer Pharmaceuticals, Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, and Sunovion.
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Affiliation(s)
- K A Serban
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, United States; Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States.
| | - K A Pratte
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, United States
| | - C Strange
- Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - R A Sandhaus
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, United States
| | - A M Turner
- Institute for Applied Health Research, University of Birmingham, Birmingham, UK
| | - T Beiko
- Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - D A Spittle
- Institute of Inflammation and Aging, University of Birmingham, UK
| | - L Maier
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, United States; Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States
| | - N Hamzeh
- Pulmonary, Critical Care, Allergy and Sleep Medicine, University of Iowa, Iowa City, IA, United States
| | - E K Silverman
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - B D Hobbs
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - C P Hersh
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - D L DeMeo
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - M H Cho
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States
| | - R P Bowler
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, National Jewish Health, Denver, CO, United States; Department of Medicine, Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado, Aurora, CO, United States.
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9
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Mornex JF, Balduyck M, Bouchecareilh M, Cuvelier A, Epaud R, Kerjouan M, Le Rouzic O, Pison C, Plantier L, Pujazon MC, Reynaud-Gaubert M, Toutain A, Trumbic B, Willemin MC, Zysman M, Brun O, Campana M, Chabot F, Chamouard V, Dechomet M, Fauve J, Girerd B, Gnakamene C, Lefrançois S, Lombard JN, Maitre B, Maynié-François C, Moerman A, Payancé A, Reix P, Revel D, Revel MP, Schuers M, Terrioux P, Theron D, Willersinn F, Cottin V, Mal H. [French clinical practice guidelines for the diagnosis and management of lung disease with alpha 1-antitrypsin deficiency]. Rev Mal Respir 2022; 39:633-656. [PMID: 35906149 DOI: 10.1016/j.rmr.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 11/18/2022]
Affiliation(s)
- J-F Mornex
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France.
| | - M Balduyck
- CHU de Lille, centre de biologie pathologie, laboratoire de biochimie et biologie moléculaire HMNO, faculté de pharmacie, EA 7364 RADEME, université de Lille, service de biochimie et biologie moléculaire, Lille, France
| | - M Bouchecareilh
- Université de Bordeaux, CNRS, Inserm U1053 BaRITon, Bordeaux, France
| | - A Cuvelier
- Service de pneumologie, oncologie thoracique et soins intensifs respiratoires, CHU de Rouen, Rouen, France; Groupe de recherche sur le handicap ventilatoire et neurologique (GRHVN), université Normandie Rouen, Rouen, France
| | - R Epaud
- Centre de références des maladies respiratoires rares, site de Créteil, Créteil, France
| | - M Kerjouan
- Service de pneumologie, CHU Pontchaillou, Rennes, France
| | - O Le Rouzic
- CHU Lille, service de pneumologie et immuno-allergologie, Lille, France; Université de Lille, CNRS, Inserm, institut Pasteur de Lille, U1019, UMR 9017, CIIL, OpInfIELD team, Lille, France
| | - C Pison
- Service de pneumologie physiologie, pôle thorax et vaisseaux, CHU de Grenoble, Grenoble, France; Université Grenoble Alpes, Saint-Martin-d'Hères, France
| | - L Plantier
- Service de pneumologie et explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Université de Tours, CEPR, Inserm UMR1100, Tours, France
| | - M-C Pujazon
- Service de pneumologie et allergologie, pôle clinique des voies respiratoires, hôpital Larrey, Toulouse, France
| | - M Reynaud-Gaubert
- Service de pneumologie, centre de compétence pour les maladies pulmonaires rares, AP-HM, CHU Nord, Marseille, France; Aix-Marseille université, IHU-Méditerranée infection, Marseille, France
| | - A Toutain
- Service de génétique, CHU de Tours, Tours, France; UMR 1253, iBrain, université de Tours, Inserm, Tours, France
| | | | - M-C Willemin
- Service de pneumologie et oncologie thoracique, CHU d'Angers, hôpital Larrey, Angers, France
| | - M Zysman
- Service de pneumologie, CHU Haut-Lévèque, Bordeaux, France; Université de Bordeaux, centre de recherche cardiothoracique, Inserm U1045, CIC 1401, Pessac, France
| | - O Brun
- Centre de pneumologie et d'allergologie respiratoire, Perpignan, France
| | - M Campana
- Service de pneumologie, CHR d'Orléans, Orléans, France
| | - F Chabot
- Département de pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France; Inserm U1116, université de Lorraine, Vandœuvre-lès-Nancy, France
| | - V Chamouard
- Service pharmaceutique, hôpital cardiologique, GHE, HCL, Bron, France
| | - M Dechomet
- Service d'immunologie biologique, centre de biologie sud, centre hospitalier Lyon Sud, HCL, Pierre-Bénite, France
| | - J Fauve
- Cabinet médical, Bollène, France
| | - B Girerd
- Université Paris-Saclay, faculté de médecine, Le Kremlin-Bicêtre, France; AP-HP, centre de référence de l'hypertension pulmonaire, service de pneumologie et soins intensifs respiratoires, hôpital Bicêtre, Le Kremlin-Bicêtre, France; Inserm UMR_S 999, hôpital Marie-Lannelongue, Le Plessis-Robinson, France
| | - C Gnakamene
- Service de pneumologie, CH de Montélimar, GH Portes de Provence, Montélimar, France
| | | | | | - B Maitre
- Service de pneumologie, centre hospitalier intercommunal, Créteil, France; Inserm U952, UFR de santé, université Paris-Est Créteil, Créteil, France
| | - C Maynié-François
- Université de Lyon, collège universitaire de médecine générale, Lyon, France; Université Claude-Bernard Lyon 1, laboratoire de biométrie et biologie évolutive, UMR5558, Villeurbanne, France
| | - A Moerman
- CHRU de Lille, hôpital Jeanne-de-Flandre, Lille, France; Cabinet de médecine générale, Lille, France
| | - A Payancé
- Service d'hépatologie, CHU Beaujon, AP-HP, Clichy, France; Filière de santé maladies rares du foie de l'adulte et de l'enfant (FilFoie), CHU Saint-Antoine, Paris, France
| | - P Reix
- Service de pneumologie pédiatrique, allergologie, mucoviscidose, hôpital Femme-Mère-Enfant, HCL, Bron, France; UMR 5558 CNRS équipe EMET, université Claude-Bernard Lyon 1, Villeurbanne, France
| | - D Revel
- Université Claude-Bernard Lyon 1, Lyon, France; Hospices civils de Lyon, Lyon, France
| | - M-P Revel
- Université Paris Descartes, Paris, France; Service de radiologie, hôpital Cochin, AP-HP, Paris, France
| | - M Schuers
- Université de Rouen Normandie, département de médecine générale, Rouen, France; Sorbonne université, LIMICS U1142, Paris, France
| | | | - D Theron
- Asten santé, Isneauville, France
| | | | - V Cottin
- Université de Lyon, université Lyon 1, INRAE, EPHE, UMR754, IVPC, 69007 Lyon, France; Centre de référence coordonnateur des maladies pulmonaires rares, hospices civils de Lyon, hôpital Louis-Pradel, service de pneumologie, 69500 Bron, France
| | - H Mal
- Service de pneumologie B, hôpital Bichat-Claude-Bernard, AP-HP, Paris, France; Inserm U1152, université Paris Diderot, site Xavier Bichat, Paris, France
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Sotnikova EA, Kiseleva AV, Kutsenko VA, Zharikova AA, Ramensky VE, Divashuk MG, Vyatkin YV, Klimushina MV, Ershova AI, Revazyan KZ, Skirko OP, Zaicenoka M, Efimova IA, Pokrovskaya MS, Kopylova OV, Glechan AM, Shalnova SA, Meshkov AN, Drapkina OM. Identification of Pathogenic Variant Burden and Selection of Optimal Diagnostic Method Is a Way to Improve Carrier Screening for Autosomal Recessive Diseases. J Pers Med 2022; 12:jpm12071132. [PMID: 35887629 PMCID: PMC9322704 DOI: 10.3390/jpm12071132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/16/2022] Open
Abstract
Cystic fibrosis, phenylketonuria, alpha-1 antitrypsin deficiency, and sensorineural hearing loss are among the most common autosomal recessive diseases, which require carrier screening. The evaluation of population allele frequencies (AF) of pathogenic variants in genes associated with these conditions and the choice of the best genotyping method are the necessary steps toward development and practical implementation of carrier-screening programs. We performed custom panel genotyping of 3821 unrelated participants from two Russian population representative samples and three patient groups using real-time polymerase chain reaction (PCR) and next generation sequencing (NGS). The custom panel included 115 known pathogenic variants in the CFTR, PAH, SERPINA1, and GJB2 genes. Overall, 38 variants were detected. The comparison of genotyping platforms revealed the following advantages of real-time PCR: relatively low cost, simple genotyping data analysis, and easier detection of large indels, while NGS showed better accuracy of variants identification and capability for detection of additional pathogenic variants in adjacent regions. A total of 23 variants had significant differences in estimated AF comparing with non-Finnish Europeans from gnomAD. This study provides new AF data for variants associated with the studied disorders and the comparison of genotyping methods for carrier screening.
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Affiliation(s)
- Evgeniia A. Sotnikova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Anna V. Kiseleva
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- Correspondence:
| | - Vladimir A. Kutsenko
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- Faculty of Mechanics and Mathematics, Lomonosov Moscow State University, 1-73, Leninskie Gory, 119991 Moscow, Russia
| | - Anastasia A. Zharikova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 1-73, Leninskie Gory, 119991 Moscow, Russia
| | - Vasily E. Ramensky
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- Faculty of Bioengineering and Bioinformatics, Lomonosov Moscow State University, 1-73, Leninskie Gory, 119991 Moscow, Russia
| | - Mikhail G. Divashuk
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- All-Russia Research Institute of Agricultural Biotechnology, Timiryazevskaya Street, 42, 127550 Moscow, Russia
| | - Yuri V. Vyatkin
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
- Novosibirsk State University, 1, Pirogova Str., 630090 Novosibirsk, Russia
| | - Marina V. Klimushina
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Alexandra I. Ershova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Karina Z. Revazyan
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Olga P. Skirko
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Marija Zaicenoka
- Moscow Institute of Physics and Technology, Dolgoprudny, Institutskiy per.9, 141701 Dolgoprudny, Russia;
| | - Irina A. Efimova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Maria S. Pokrovskaya
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Oksana V. Kopylova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Anush M. Glechan
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Svetlana A. Shalnova
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Alexey N. Meshkov
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
| | - Oxana M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine, Ministry of Healthcare of the Russian Federation, Petroverigsky per.10, Bld. 3, 101000 Moscow, Russia; (E.A.S.); (V.A.K.); (A.A.Z.); (V.E.R.); (M.G.D.); (Y.V.V.); (M.V.K.); (A.I.E.); (K.Z.R.); (O.P.S.); (I.A.E.); (M.S.P.); (O.V.K.); (A.M.G.); (S.A.S.); (A.N.M.); (O.M.D.)
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11
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Nygren D, Mölstad U, Thulesius H, Hillman M, Broman LM, Tanash H, Landin-Olsson M, Rasmussen M, Thunander M. Low Prevalence of Mild Alpha-1-Antitrypsin Deficiency in Hospitalized COVID-19-Patients. Int J Gen Med 2022; 15:5843-5848. [PMID: 35789772 PMCID: PMC9250346 DOI: 10.2147/ijgm.s370434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/31/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction Alpha-1-antitrypsin (AAT) has been shown to inhibit SARS-CoV-2 cell entry and suggested as a therapeutic agent for COVID-19. Furthermore, epidemiological association of high prevalence of Alpha-1-antitrypsin deficiency (AATD) and regional severity of COVID-19-impact has been hypothesized. In our study setting, the estimated prevalence rates of mild (PI*MZ, PI*SS or PI*MS) and moderate-to-severe AATD (PI*ZZ or PI*SZ) are high, 9% and 0.2%, respectively. Our primary aim was to examine the prevalence rate of AATD among hospitalized COVID-19-patients. Methods In this prospective observational study, enrollment occurred from December 2020 to January 2021 in two COVID-19-units at Skåne University Hospital, Lund, Sweden. Case definition was a patient hospitalized due to COVID-19. Patients were screened for AATD with PI-typing and if results were inconclusive, PCR for the S- and Z-genes were performed. Patients were categorized as severe or moderate COVID-19 and 30-day-mortality data were collected. The primary outcome was prevalence rate of AATD. The secondary outcome investigated association between presence of mild AATD and severe COVID-19. Results We enrolled 61 patients with COVID-19. Two patients out of 61 (3%) had mild AATD (PI*MZ) and none had moderate-to-severe AATD. 30/61 (49%) had severe COVID-19. Both patients with mild AATD developed severe COVID-19. Yet, presence of AATD was not significantly associated with severe COVID-19 (p=0.24). Conclusion Mild AATD (PI*MS or PI*MZ) was rare in a small cohort of hospitalized patients with COVID-19 in a study setting with a high background prevalence of AATD.
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Affiliation(s)
- David Nygren
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden,Correspondence: David Nygren, Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden, Tel +4646171192, Fax +4646176002, Email
| | - Ulrica Mölstad
- Department of Research and Development, Health Care Region Kronoberg, Växjö, Sweden
| | - Hans Thulesius
- Department of Research and Development, Health Care Region Kronoberg, Växjö, Sweden,Department of Medicine and Optometry, Linnaeus University, Växjö, Sweden,Department of Clinical Sciences, Family Medicine, Lund University, Malmö, Sweden
| | - Magnus Hillman
- Diabetes Research Laboratory, Biomedical Center, Lund University, Lund, Sweden,Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Hanan Tanash
- Department of Clinical Sciences, Respiratory Medicine, Lund University, Malmö, Sweden,Department of Respiratory Medicine, Skåne University Hospital, Malmö, Sweden
| | - Mona Landin-Olsson
- Diabetes Research Laboratory, Biomedical Center, Lund University, Lund, Sweden,Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden
| | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Maria Thunander
- Department of Research and Development, Health Care Region Kronoberg, Växjö, Sweden,Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden,Department of Internal Medicine, Endocrinology, Växjö Central Hospital, Växjö, Sweden
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12
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Torres-Durán M, López-Campos JL, Rodríguez-Hermosa JL, Esquinas C, Martínez-González C, Hernández-Pérez JM, Rodríguez C, Bustamante A, Casas-Maldonado F, Barrecheguren M, González C, Miravitlles M. Demographic and clinical characteristics of patients with alpha-1 antitrypsin deficiency genotypes PI*ZZ and PI*SZ in the Spanish registry of EARCO. ERJ Open Res 2022; 8:00213-2022. [PMID: 36171983 PMCID: PMC9511153 DOI: 10.1183/23120541.00213-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background The Spanish registry of α1-antitrypsin deficiency (AATD) integrated in the European Alpha-1 Research Collaboration (EARCO) provides information about the characteristics of patients, in particular those with the PI*SZ genotype, which is frequent in Spain. Method Individuals with severe AATD defined as proteinase inhibitor (PI) genotypes PI*ZZ, PI*SZ and other rare deficient variants were included from February 1, 2020, to February 1, 2022. The analysis focused on a comparison of the characteristics of PI*ZZ and PI*SZ patients. Results 409 patients were included (53.8% men) with a mean±sd age of 53.5±15.9 years. Genotypes were PI*ZZ in 181 (44.7%), PI*SZ in 163 (40.2%), PI*SS in 29 (7.2%) and other in 32 (7.9%). 271 (67.4%) had lung disease: 175 chronic obstructive pulmonary disease (43.5%), 163 emphysema (40.5%) and 83 bronchiectasis (20.6%). Patients with the PI*SZ genotype were younger, more frequently non-index cases and had a lower frequency of respiratory diseases except asthma compared with PI*ZZ patients. Among patients with respiratory diseases, PI*SZ individuals were significantly older both at onset of symptoms and at diagnosis; only asthma was more frequent in PI*SZ than in PI*ZZ individuals. Twelve PI*SZ patients (15.4%) received augmentation therapy compared with 94 PI*ZZ patients (66.2%; p<0.001). Conclusions There is a high prevalence of PI*SZ in Spain. Patients with the PI*SZ genotype were older at symptom onset and diagnosis and had less severe lung disease compared with PI*ZZ patients. The prevalence of asthma was higher in PI*SZ, and up to 15% of PI*SZ patients received augmentation therapy. Patients with the PI*ZZ genotype have more severe pulmonary disease than those with the PI*SZ genotype. However, asthma is as frequent in PI*SZ as in PI*ZZ.https://bit.ly/3m10MNN
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Lopez-Campos JL, Osaba L, Czischke K, Jardim JR, Fernandez Acquier M, Ali A, Günen H, Rapun N, Drobnic E, Miravitlles M. Feasibility of a genotyping system for the diagnosis of alpha1 antitrypsin deficiency: a multinational cross-sectional analysis. Respir Res 2022; 23:152. [PMID: 35689213 PMCID: PMC9184812 DOI: 10.1186/s12931-022-02074-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/29/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction Currently, strategies for improving alpha1 antitrypsin deficiency (AATD) diagnosis are needed. Here we report the performance of a multinational multiplex-based genotyping test on dried blood spots and buccal swabs sent by post or courier and with web registration for subjects with suspected AATD in Argentina, Brazil, Chile, Colombia, Spain, and Turkey.
Methods This was an observational, cross-sectional analysis of samples from patients with suspected AATD from March 2018 to January 2022. Samples were coded on a web platform and sent by post or courier to the central laboratory in Northern Spain. Allele-specific genotyping for the 14 most common mutations was carried out with the A1AT Genotyping Test (Progenika-Grifols, Spain). SERPINA1 gene sequencing was performed if none of the mutations were found or one variant was detected in heterozygous status and the AAT serum level was < 60 mg/dl, or if requested by the clinician in charge. Results The study included 30,827 samples: 30,458 (94.7%) with final results after direct genotyping and 369 (1.1%) with additional gene sequencing. Only 0.3% of the samples were not processed due to their poor quality. The prevalence of the most frequent allele combinations was MS 14.7%, MZ 8.6%, SS 1.9%, SZ 1.9%, and ZZ 0.9%. Additionally, 70 cases with new mutations were identified. Family screening was conducted in 2.5% of the samples. Samples from patients with respiratory diseases other than COPD, including poorly controlled asthma or bronchiectasis, also presented AATD mutations. Conclusions Our results confirm the viability of this diagnostic system for genotyping AATD conducted simultaneously in different countries. The system has proved satisfactory and can improve the timely diagnosis of AATD. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-022-02074-x.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Avda. Manuel Siurot, s/n, 41013, Seville, Spain. .,CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
| | - Lourdes Osaba
- Progenika Biopharma, a Grifols Company, Derio, Vizcaya, Spain
| | - Karen Czischke
- Departamento de Neumología, Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - José R Jardim
- Centro de Reabilitação Pulmonar da Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM/Unifesp), São Paulo, Brazil
| | | | - Abraham Ali
- Departamento Médico, Fundación Neumológica Colombiana, Bogotá, D.C., Colombia
| | - Hakan Günen
- Süreyyapaşa Research and Training Center for Chest Diseases and Thoracic Surgery, University of Health Sciences, Istanbul, Turkey
| | - Noelia Rapun
- Progenika Biopharma, a Grifols Company, Derio, Vizcaya, Spain
| | | | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.,Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
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14
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Hernández-Pérez JM, Ramos-Díaz R, Vaquerizo-Pollino C, Pérez JA. Frequency of alleles and genotypes associated with alpha-1 antitrypsin deficiency in clinical and general populations: Revelations about underdiagnosis. Pulmonology 2022:S2531-0437(22)00030-7. [PMID: 35346640 DOI: 10.1016/j.pulmoe.2022.01.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Alpha-1 antitrypsin deficiency (AATD) is an underdiagnosed hereditary condition that promotes the development of lung and liver diseases, and the most common potentially life-threatening genetic condition in Caucasian adults. In this study, the clinical and genetic profile of pulmonary patients from a single center in La Palma Island (Canary Islands, Spain) was assessed to predict how to increase AATD diagnosis. METHODS AATD was tested in 1,493 pulmonary outpatients without regard to respiratory symptoms and 465 newborns. Variants of the SERPINA1 gene were characterised by real-time PCR, DNA sequencing, molecular haplotyping and phenotyping (AAT isoelectric focusing). Different respiratory pathologies were diagnosed in patients and their levels of serum AAT were measured by nephelometry. RESULTS The prevalence of pneumological patients with AATD alleles was 30.5%, including PI*S, PI*Z and 6 rare genetic variants. Certain deficiency genotypes were unevenly distributed among patients diagnosed with respiratory diseases: PI*ZZ (71.4%) and PI*SS (34.8%) genotypes were more represented in patients with chronic obstructive pulmonary disease (COPD), whereas PI*MZ (27.7%) and PI*SZ (34.5%) genotypes were more abundant in patients with bronchial asthma. The estimated frequency of PI*S and PI*Z alleles in the general population was 8.2% and 2.1%, respectively. A very significant enrichment (p< 0.01) of PI*S allele, independent of the PI*Z allele, was detected in the clinical population. CONCLUSIONS AATD diagnosis would improve if both the COPD and the asthmatic patients were included to screening programs. The prevalence of PI*ZZ genotype in La Palma (1/2,162) was relatively high within Spain (average 1/3,344).
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15
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Mariam SH. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Pandemic: Are Africa's Prevalence and Mortality Rates Relatively Low? Adv Virol 2022; 2022:3387784. [PMID: 35256885 PMCID: PMC8898136 DOI: 10.1155/2022/3387784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/14/2022] [Accepted: 01/28/2022] [Indexed: 12/13/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the cause of coronavirus disease 19 (COVID-19), has been rapidly spreading since December 2019, and within a few months, it turned out to be a global pandemic. The disease affects primarily the lungs, but its pathogenesis spreads to other organs as well. However, its mortality rates vary, and in the majority of infected people, there are no serious consequences. Many factors including advanced age, preexisting health conditions, and genetic predispositions are believed to exacerbate outcomes of COVID-19. The virus contains several structural proteins including the spike (S) protein with subunits for binding, fusion, and internalization into host cells following interaction with host cell receptors and proteases (ACE2 and TMPRSS2, respectively) to cause the subsequent pathology. Although the pandemic has spread into all countries, most of Africa is thought of as having relatively less prevalence and mortality. Several hypotheses have been forwarded as reasons for this and include warmer weather conditions, vaccination with BCG (i.e., trained immunity), and previous malaria infection. From genetics or metabolic points of view, it has been proposed that most African populations could be protected to some degree because they lack some genetic susceptibility risk factors or have low-level expression of allelic variants, such as ACE2 and TMPRSS2 that are thought to be involved in increased infection risk or disease severity. The frequency of occurrence of α-1 antitrypsin (an inhibitor of a tissue-degrading protease, thereby protecting target host tissues including the lung) deficiency is also reported to be low in most African populations. More recently, infections in Africa appear to be on the rise. In general, there are few studies on the epidemiology and pathogenesis of the disease in African contexts, and the overall costs and human life losses due to the pandemic in Africa will be determined by all factors and conditions interacting in complex ways.
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Affiliation(s)
- Solomon H. Mariam
- Infectious Diseases Program, Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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16
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Stirpe E, Bardaro F. Alpha1-antitrypsin deficiency and asthma. Monaldi Arch Chest Dis 2022; 92. [DOI: 10.4081/monaldi.2022.2179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
α1-antitrypsin deficiency (AATD) is a genetically inherited autosomal-codominant disease with a variable clinical spectrum of lung-related diseases. Pulmonary involvement of α1-antitrypsin deficiency may also include emphysema with variable functional and radiological abnormalities, asthma, and bronchiectasis. Asthma and AATD are mutually exclusive disease entities, but the commonality of neutrophil inflammation across the diseases might suggest common underlying mechanisms of effect. The diseases share many clinical and functional features: patients with AATD commonly first present with asthma-like symptoms; functional alterations may be common to both, such as bronchial hyperresponsiveness or fixed obstruction after bronchial remodeling. It has been recognized that allergy and asthma often coexist with AATD, but the relationship between allergy, asthma and AATD is not clear. Distinguishing AATD from asthma based on presentation and clinical evaluation is not possible. The clinician must assess each of the elements in the context of the whole patient, any patient with difficult-to-manage asthma should be screened for AATD. From the clinician’s point of view, improving diagnosis in this population is fundamental to optimize clinical management. Genetic studies will probably be needed in the future to unequivocally establish the causal link between AATD and asthma.
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17
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Ghosh AJ, Hobbs BD. Recent advancements in understanding the genetic involvement of alpha-1 antitrypsin deficiency associated lung disease: a look at future precision medicine approaches. Expert Rev Respir Med 2022; 16:173-182. [PMID: 35025710 PMCID: PMC8983484 DOI: 10.1080/17476348.2022.2027755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Alpha-1 antitrypsin deficiency occurs in individuals with deleterious genetic mutations on both chromosomes (maternal and paternal) in SERPINA1, the gene encoding the alpha-1 antitrypsin protein. There has been substantial progress in understanding the genetic variation that underlies the heterogeneous penetrance of lung disease in alpha-1 antitrypsin deficiency. AREAS COVERED This review will cover SERPINA1 gene structure and genetic variation, population genetics, genome-wide genetic modifiers of lung disease, alternative mechanisms of disease, and emerging therapeutics - including gene and cell therapy - related to alpha-1 antitrypsin deficiency-associated lung disease. EXPERT OPINION There remains ample opportunity to employ precision medicine in the diagnosis, prognosis, and therapy of alpha-1 antitrypsin deficiency-associated lung disease. In particular, a genome-wide association study and subsequent polygenic risk score is an important first step in identifying genome-wide genetic modifiers contributing to the variability of lung disease in severe alpha-1 antitrypsin deficiency.
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Affiliation(s)
- Auyon J. Ghosh
- Assistant Professor of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, SUNY Upstate Medical University, 750 E. Adams St, Syracuse, NY, 13210
| | - Brian D. Hobbs
- Assistant Professor of Medicine, Channing Division of Network Medicine, Brigham and Women’s Hospital, 181 Longwood Ave, Boston, MA, 02115,Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital,Harvard Medical School
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18
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Remih K, Amzou S, Strnad P. Alpha1-antitrypsin deficiency: New therapies on the horizon. Curr Opin Pharmacol 2021; 59:149-156. [PMID: 34256305 DOI: 10.1016/j.coph.2021.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
Alpha1-antitrypsin deficiency (AATD) is caused by mutations in the SERPINA1 gene, coding for alpha1-antitrypsin (AAT). AAT is synthesised mainly in the liver and is released into bloodstream to protect tissues (particularly lung) with its antiprotease activity. The homozygous Pi∗Z mutation (Pi∗ZZ genotype) is the predominant cause of severe AATD. It interferes with AAT secretion thereby leading to AAT accumulation in the liver and lack of AAT in the circulation and the lung. Accordingly, Pi∗ZZ individuals are strongly predisposed to lung and liver injury. The former is treated by a weekly AAT augmentation therapy, but not medicinal products exist for the liver. Our review summarises the current approaches silencing AAT production, improving protein folding and secretion or promoting AAT degradation.
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Affiliation(s)
- Katharina Remih
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Samira Amzou
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany
| | - Pavel Strnad
- Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany; Coordinating Centre for Alpha1-Antitrypsin Deficiency-related Liver Disease of the European Reference Network (ERN) "Rare Liver" and The European Association for the Study of the Liver (EASL) Registry Group "Alpha1-Liver", Germany.
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19
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Faria N, Inês Costa M, Gomes J, Sucena M. Alpha-1 antitrypsin deficiency severity and the risk of COVID-19: A Portuguese cohort. Respir Med 2021; 181:106387. [PMID: 33848921 PMCID: PMC8016729 DOI: 10.1016/j.rmed.2021.106387] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | - Maria Inês Costa
- Department of Pulmonology, Centro Hospitalar e Universitário Do Porto, Portugal
| | - Joana Gomes
- Department of Pulmonology, Centro Hospitalar e Universitário Do Porto, Portugal
| | - Maria Sucena
- Department of Pulmonology, Centro Hospitalar e Universitário Do Porto, Portugal
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20
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Guillaud O, Jacquemin E, Couchonnal E, Vanlemmens C, Francoz C, Chouik Y, Conti F, Duvoux C, Hilleret MN, Kamar N, Houssel-Debry P, Neau-Cransac M, Pageaux GP, Gonzales E, Ackermann O, Gugenheim J, Lachaux A, Ruiz M, Radenne S, Debray D, Lacaille F, McLin V, Duclos-Vallée JC, Samuel D, Coilly A, Dumortier J. Long term results of liver transplantation for alpha-1 antitrypsin deficiency. Dig Liver Dis 2021; 53:606-611. [PMID: 33139195 DOI: 10.1016/j.dld.2020.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Liver transplantation (LT) is the therapeutic option for end-stage liver disease associated with alpha1 antitrypsin (A1AT) deficiency. The aim of the present retrospective study was to report on long-term outcomes following LT for A1AT deficiency. METHODS The medical records of 90 pediatric and adult patients transplanted between 1982 and 2017 in France and Geneva (Switzerland) were reviewed. RESULTS The study population consisted of 32 adults and 58 children; median age at transplant was 13.0 years (range: 0.2-65.1), and 65 were male (72.2%). Eighty-two patients (94.8% of children and 84.4% of adults) had the PI*ZZ genotype/phenotype and eight patients (8.9%) had the Pi*SZ genotype/phenotype. Eighty-four patients (93.3%) were transplanted for end-stage liver disease and six (all Pi*ZZ adults) for HCC. Median follow-up after LT was 13.6 years (0.1-31.7). The overall cumulative patient survival rates post-transplant were 97.8% at 1 year, and 95.5%, 95.5%, 92.0%, 89.1% at 5, 10, 15, 20 years respectively. The overall cumulative graft survival rates were 92.2% at 1 year, and 89.9%, 89.9%, 84.4%, 81.5% at 5, 10, 15 and 20 years, respectively. CONCLUSIONS In a representative cohort of patients having presented with end-stage-liver disease or HCC secondary to A1AT, liver transplantation offered very good patient and graft survival rates.
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Affiliation(s)
- Olivier Guillaud
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des spécialités digestives, Lyon, France; Ramsay Générale de Santé, Clinique de la Sauvegarde, Lyon, France
| | - Emmanuel Jacquemin
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Hépatologie et Transplantation Hépatique Pédiatriques, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Université Paris Saclay, Le Kremlin-Bicêtre, France; Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France
| | - Eduardo Couchonnal
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'Hépato-gastroentérologie et Nutrition Pédiatrique, Bron, France
| | | | - Claire Francoz
- Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service d'Hépatologie, Clichy, France
| | - Yasmina Chouik
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des spécialités digestives, Lyon, France
| | - Filomena Conti
- Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpétrière, Service d'Hépato-gastroentérolgie, Paris, France
| | - Christophe Duvoux
- Assistance Publique-Hôpitaux de Paris, Hôpital Henri Mondor, Service d'Hépatologie, Créteil, France
| | - Marie-Noëlle Hilleret
- CHU de Grenoble, Hôpital Michalon, Service d'Hépato-Gastroentérologie, La Tronche, France
| | - Nassim Kamar
- CHU de Toulouse, Hôpital Rangueil, Service de Néphrologie-Hypertension artérielle-Dialyse-Transplantation, Toulouse, France
| | | | - Martine Neau-Cransac
- CHU de Bordeaux, Hôpital Haut Lévêque, Service de Chirurgie Hépatobiliaire et de Transplantation Hépatique, Bordeaux, France
| | - Georges-Philippe Pageaux
- CHU de Montpellier, Hôpital Saint-Eloi, Fédération Médico-Chirurgicale des Maladies de l'Appareil Digestif, Montpellier, France
| | - Emmanuel Gonzales
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Hépatologie et Transplantation Hépatique Pédiatriques, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Université Paris Saclay, Le Kremlin-Bicêtre, France; Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France
| | - Oanez Ackermann
- Assistance Publique-Hôpitaux de Paris, Hôpital Bicêtre, Hépatologie et Transplantation Hépatique Pédiatriques, Centre National de Référence de l'Atrésie des Voies Biliaires et des Cholestases Génétiques, Université Paris Saclay, Le Kremlin-Bicêtre, France; Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France
| | - Jean Gugenheim
- CHU de Nice, Hôpital L'Archet 2, Service de Chirurgie Digestive, Nice, France
| | - Alain Lachaux
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'Hépato-gastroentérologie et Nutrition Pédiatrique, Bron, France; Université de Lyon, Lyon, France
| | - Mathias Ruiz
- Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service d'Hépato-gastroentérologie et Nutrition Pédiatrique, Bron, France
| | - Sylvie Radenne
- Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Service d'Hépatologie, Lyon, France
| | - Dominique Debray
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants malades, Unité d'Hépatologie pédiatrique, Centre de référence de l'Atrèsie des voies biliaires et cholestases génétiques, filière de santé Filfoie, Paris, France
| | - Florence Lacaille
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants malades, Unité d'Hépatologie pédiatrique, Centre de référence de l'Atrèsie des voies biliaires et cholestases génétiques, filière de santé Filfoie, Paris, France
| | - Valérie McLin
- Centre Suisse du Foie de l'Enfant, Hôpitaux Universitaires de Genève, Département de Pédiatrie, Gynécologie et Obstétrique, Genève, Suisse
| | - Jean-Charles Duclos-Vallée
- Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France; Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Didier Samuel
- Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France; Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Audrey Coilly
- Inserm U1193, Hepatinov, Université Paris Saclay, Orsay, France; Assistance Publique-Hôpitaux de Paris, Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
| | - Jérôme Dumortier
- Hospices Civils de Lyon, Hôpital Edouard Herriot, Fédération des spécialités digestives, Lyon, France; Université de Lyon, Lyon, France.
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21
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Murgia N, Corsico AG, D'Amato G, Maesano CN, Tozzi A, Annesi-Maesano I. Do gene-environment interactions play a role in COVID-19 distribution? The case of Alpha-1 Antitrypsin, air pollution and COVID-19. Multidiscip Respir Med 2021; 16:741. [PMID: 34012547 PMCID: PMC8114100 DOI: 10.4081/mrm.2021.741] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 12/13/2022] Open
Abstract
Background Gene-environment interactions are relevant for several respiratory diseases. This communication raises the hypothesis that the severity of COVID-19, a complex disease where the individual response to the infection may play a significant role, could partly result from a gene-environment interaction between air-pollution and Alpha-1 Antitrypsin (AAT) genes. Methods To evaluate the impact of the AAT and air pollution interaction on COVID-19, we introduced an AAT*air pollution global risk score summing together, in each country, an air pollution score (ozone, nitrogen dioxide and fine particulate matter) and an AAT score (which sums the ranked frequency of MZ, SZ, MS). We compared this global score with the ranking of European countries in terms of death number per million persons. Results The ranking of the AAT*air pollution global risk score matched the ranking of the countries in terms of the observed COVID-19 deaths per 1M inhabitants, namely in the case of the first European countries: Belgium, UK, Spain, Italy, Sweden, France. We observed parallelism between the number of COVID deaths and the AAT*air pollution global risk in Europe. AAT anti-protease, immune-modulating and coagulation-modulating activities may explain this finding, although very speculatively. Conclusions Even if further studies taking into account genetic background, population density, temporal dynamics of individual epidemics, access to healthcare, social disparities and immunological response to SARS-CoV2 are needed, our preliminary observation urges to open a discussion on gene-environment interactions in COVID-19.
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Affiliation(s)
- Nicola Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Italy
| | - Angelo Guido Corsico
- Center for Diagnosis of Inherited α1-Antitrypsin Deficiency, Department of Internal Medicine and Therapeutics, Pneumology Unit, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Italy
| | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty A. Cardarelli Hospital, and Medical School of Specialization in Respiratory Diseases, Federico II University of Naples, Italy
| | - Cara Nichole Maesano
- INSERM and Sorbonne University, Epidemiology of Allergic and Respiratory Diseases Department, IPLESP, Paris, France
| | - Arturo Tozzi
- Center for Nonlinear Science, Department of Physics, University of North Texas, Denton TX, USA
| | - Isabella Annesi-Maesano
- INSERM and Sorbonne University, Epidemiology of Allergic and Respiratory Diseases Department, IPLESP, Paris, France.,Desbrest Institute of Epidemiology and Public Health, INSERM and Montpellier University, Montpellier, France
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22
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Yang C, Chapman KR, Wong A, Liu M. α1-Antitrypsin deficiency and the risk of COVID-19: an urgent call to action. Lancet Respir Med 2021; 9:337-339. [PMID: 33485406 PMCID: PMC7826115 DOI: 10.1016/s2213-2600(21)00018-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Chengliang Yang
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Kenneth R Chapman
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Division of Respiratory Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Aaron Wong
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada
| | - Mingyao Liu
- Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Division of Respiratory Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Department of Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada; Department of Physiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5G 1L7, Canada.
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23
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Seixas S, Marques PI. Known Mutations at the Cause of Alpha-1 Antitrypsin Deficiency an Updated Overview of SERPINA1 Variation Spectrum. Appl Clin Genet 2021; 14:173-194. [PMID: 33790624 PMCID: PMC7997584 DOI: 10.2147/tacg.s257511] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022]
Abstract
Alpha-1-Antitrypsin deficiency (AATD), caused by SERPINA1 mutations, is one of the most prevalent Mendelian disorders among individuals of European descend. However, this condition, which is characterized by reduced serum levels of alpha-1-antitrypsin (AAT) and associated with increased risks of pulmonary emphysema and liver disease in both children and adults, remains frequently underdiagnosed. AATD clinical manifestations are often correlated with two pathogenic variants, the Z allele (p.Glu342Lys) and the S allele (p.Glu264Val), which can be combined in severe ZZ or moderate SZ risk genotypes. Yet, screenings of AATD cases and large sequencing efforts carried out in both control and disease populations are disclosing outstanding numbers of rare SERPINA1 variants (>500), including many pathogenic and other likely deleterious mutations. Generally speaking, pathogenic variants can be subdivided into either loss- or gain-of-function according to their pathophysiological effects. In AATD, the loss-of-function is correlated with an uncontrolled activity of elastase by its natural inhibitor, the AAT. This phenomenon can result from the absence of circulating AAT (null alleles), poor AAT secretion from hepatocytes (deficiency alleles) or even from a modified inhibitory activity (dysfunctional alleles). On the other hand, the gain-of-function is connected with the formation of AAT polymers and their switching on of cellular stress and inflammatory responses (deficiency alleles). Less frequently, the gain-of-function is related to a modified protease affinity (dysfunctional alleles). Here, we revisit SERPINA1 mutation spectrum, its origins and population history with a greater emphasis on variants fitting the aforementioned processes of AATD pathogenesis. Those were selected based on their clinical significance and wider geographic distribution. Moreover, we also provide some directions for future studies of AATD clinically heterogeneity and comprehensive diagnosis.
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Affiliation(s)
- Susana Seixas
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - Patricia Isabel Marques
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
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Abstract
Clinical heterogeneity has been demonstrated in alpha-1 antitrypsin deficiency (AATD), such that clinical suspicion plays an important role in its diagnosis. The PiZZ genotype is the most common severe deficiency genotype and so tends to result in the worst clinical presentation, hence it has been the major focus of research. However, milder genotypes, especially PiSZ and PiMZ, are also linked to the development of lung and liver disease, mainly when unhealthy behaviors are present, such as smoking and alcohol use. Monitoring and managing AATD patients remains an area of active research. Lung function tests or computed tomography (CT) densitometry may allow physicians to identify progressive disease during follow up of patients, with a view to decision making about AATD-specific therapy, like augmentation therapy, or eventually surgical procedures such as lung volume reduction or transplant. Different types of biological markers have been suggested for disease monitoring and therapy selection, although most need further investigation. Intravenous augmentation therapy reduces the progression of emphysema in PiZZ patients and is available in many European countries, but its effect in milder deficiency is less certain. AATD has also been suggested to represent a risk factor and trigger for pulmonary infections, like those induced by mycobacteria. We summarize the last 5-10 years' key findings in AATD diagnosis, assessment, and management, with a focus on milder deficiency variants.
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Affiliation(s)
- Gabriela Santos
- Pneumology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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McCarthy C, Bugnet E, Benattia A, Keane MP, Vedie B, Lorillon G, Tazi A. Clarifying the relationship between pulmonary langerhans cell histiocytosis and Alpha 1 antitrypsin deficiency. Orphanet J Rare Dis 2021; 16:72. [PMID: 33563302 PMCID: PMC7871552 DOI: 10.1186/s13023-021-01720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 02/01/2021] [Indexed: 11/26/2022] Open
Abstract
Pulmonary Langerhans cell histiocytosis (PLCH) is a rare, smoking related, progressive diffuse cystic lung disease that occurs primarily in smokers. The aim of this study was to determine if there was an increase in alpha-1 antitrypsin deficient alleles or phenotypes in a large series of PLCH patients and whether serum alpha-1 antitrypsin levels correlated with markers of disease severity. Fifty PLCH patients, 24 with a diffuse cystic lung pattern and 26 with a typical nodulo-cystic pattern on imaging were included. The mean alpha-1 antitrypsin levels were in normal range for both the population with diffuse cystic lung pattern population (1.39 g/L ± 0.37) and the nodulo-cystic pattern group (1.41 g/L ± 0.21). Deficiency alleles PiZ and PiS were 1% and 2% respectively in the entire study population of 50 patients, demonstrating no increased incidence of alpha-1 antitrypsin deficiency in PLCH. Alpha-1 antitrypsin levels showed no correlation with lung function parameters or extent of cystic lesions on lung computed tomography.
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Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Emmanuelle Bugnet
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Amira Benattia
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin 4, Ireland.,School of Medicine, University College Dublin, Dublin 4, Ireland
| | - Benoit Vedie
- Hôpital Européen Georges Pompidou, Service de Biochimie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gwenaël Lorillon
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Abdellatif Tazi
- Hôpital Saint-Louis, Centre National de Référence des Histiocytoses, Service de Pneumologie, Assistance Publique-Hôpitaux de Paris, Paris, France. .,Université de Paris, INSERM U976, Institut de Recherche Saint-Louis, 75006, Paris, France. .,Centre National de Référence des Histiocytoses, Service de Pneumologie, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75475, Paris Cedex 10, France.
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Abstract
PURPOSE OF REVIEW The aim of the article is to highlight the association between α1-antitrypsin deficiency (AATD) and asthma. RECENT FINDINGS AATD is one of the most common and underrecognized autosomal disorders associated with an increased risk of developing liver and lung diseases. An association between α1-antitrypsin and asthma has been suggested, especially with severe forms of this disease. Many studies have shown an increased prevalence of asthma in the α1-antitrypsin-deficient population overtime (4-38%). The biological mechanism underlying these two conditions and able to bind them has not yet been well investigated. As α1-antitrypsin is the main inhibitor of the serine proteinase and it is an important anti-inflammatory protein with pronounced immunomodulatory activities, it can be hypothesized that the link between AATD and asthma might be represented by the elastase/antielastase imbalance and the proinflammatory effect that occurs because of the reduction of this protein. SUMMARY There is a strong need for further researches to better understand the molecular mechanisms binding AATD and asthma. It is also recommendable to screen for AATD, late-onset asthma patients, and/or those with not fully reversible airways obstruction.
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Affiliation(s)
- Laura Pini
- Respiratory Medicine Unit, Spedali Civili
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Giovanni Paoletti
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Claudio Tantucci
- Respiratory Medicine Unit, Spedali Civili
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
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Matamala N, Gomez-Mariano G, Perez JA, Baladrón B, Torres-Durán M, Michel FJ, Saez R, Hernández-Pérez JM, Belmonte I, Rodriguez-Frias F, Blanco I, Strnad P, Janciauskiene S, Martinez-Delgado B. New cis-Acting Variants in PI*S Background Produce Null Phenotypes Causing Alpha-1 Antitrypsin Deficiency. Am J Respir Cell Mol Biol 2020; 63:444-451. [PMID: 32515985 DOI: 10.1165/rcmb.2020-0021oc] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Alpha-1 antitrypsin deficiency (AATD) is an inherited condition characterized by reduced levels of serum AAT due to mutations in the SERPINA1 (Serpin family A member 1) gene. The Pi*S (Glu264Val) is one of the most frequent deficient alleles of AATD, showing high incidence in the Iberian Peninsula. Herein, we describe two new alleles carrying an S mutation but producing a null phenotype: QOVigo and QOAachen. The new alleles were identified by sequencing the SERPINA1 gene in three patients who had lower AAT serum levels than expected for the initial genotype. These alleles are the result of combined mutations in cis in a PI*S allele. Sequencing detected the S mutation in cis with Tyr138Cys (S+Tyr138Cys) in two patients, whereas a third one had the S mutation in cis with Pro391Thr variant (S+Pro391Thr). When expressed in a cellular model, these variants caused strong AAT polymerization and very low AAT secretion to almost undetectable levels. The isoelectric focusing method for plasma AAT phenotyping did not show AAT protein encoded by the novel mutant alleles, behaving as null. We called these alleles PI*S-plus because the S variant was phased with another variant conferring more aggressive characteristics to the allele. The current data demonstrate that the clinical variability observed in AATD can be explained by additional genetic variation, such as dual cis-acting variants in the SERPINA1 gene. The possible existence of other unrevealed variants combined in the PI*S alleles should be considered to improve the genetic diagnosis of the patients.
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Affiliation(s)
- Nerea Matamala
- Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Gema Gomez-Mariano
- Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - Jose Antonio Perez
- Área de Genética, Instituto Universitario de Enfermedades Tropicales y Salud Pública de Canarias, Universidad de La Laguna, Tenerife, Spain
| | - Beatriz Baladrón
- Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - María Torres-Durán
- Servicio de Neumología, Hospital Álvaro Cunqueiro, Estructura Organizativa de Xestión Integrada Vigo, Pneumovigo I + i, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Spain
| | | | - Raquel Saez
- Genetica e Inmunología, Hospital Universitario Donostia, País Vasco, Spain
| | | | - Irene Belmonte
- Biochemistry Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Ignacio Blanco
- Registro Español de Pacientes con Déficit de Alfa-1 Antitripsina, Fundación Española, de Pulmón, Respira, Sociedad Española de Neumología y Cirugía Torácica, Barcelona, Spain
| | - Pavel Strnad
- Department of Internal Medicine III, University Hospital Aachen, Aachen, Germany
| | - Sabina Janciauskiene
- Department of Respiratory Medicine, Biomedical Research in Endstage and Obstructive Lung Disease Hannover, Member of the German Center for Lung Research, Hannover Medical School, Hannover, Germany; and
| | - Beatriz Martinez-Delgado
- Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras, Madrid, Spain
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Lopez-Campos JL, Casas-Maldonado F, Torres-Duran M, Medina-Gonzálvez A, Rodriguez-Fidalgo ML, Carrascosa I, Calle M, Osaba L, Rapun N, Drobnic E, Miravitlles M. Results of a Diagnostic Procedure Based on Multiplex Technology on Dried Blood Spots and Buccal Swabs for Subjects With Suspected Alpha1 Antitrypsin Deficiency. Arch Bronconeumol 2020; 57:42-50. [PMID: 32680720 DOI: 10.1016/j.arbres.2020.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The objective of this analysis was the evaluation of a new national circuit used for diagnosing alpha1 antitrypsin deficiency (AATD) based on multiplex technology using online registration and mail posted samples from dried blood spots (DBS) and buccal swabs. METHODS This is an observational, ongoing study conducted in Spain since March 2018. Samples are coded on a web platform and sent by postal mail to the central laboratory. Allele-specific genotyping for the 14 most common mutations was done with the Luminex 200 Instrument System. Gene sequencing was done if none of the mutations were found and the AAT serum level was <60mg/dl, or by request from the clinician in charge. RESULTS At the time of the present report, 5803 (92.9%) samples were processed, 4984 (85.9%) from buccal swab and 819 (14.1%) from DBS. The prevalence of the frequent allele combinations were: MS 19.0%, MZ 14.4%, SS 2.9%, SZ 3.7%, and ZZ: 1.4%. Globally, Z carriers represented 20.0% and S carriers 26.6% of this population, with differences seen between regions. 209 (3.6%) were identified carrying rare alleles, 12 (0.2%) carrying null alleles and 14 (0.3%) new mutations were described. Respiratory diseases other than COPD, including poorly controlled asthma or bronchiectasis, also presented AATD mutations. CONCLUSIONS The availability of a diagnostic system based on the simultaneous testing of 14 genetic variants from buccal swabs or DBS sent by postal mail and with web registration has proven to be useful, and the system can improve the timely diagnosis of AATD.
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Affiliation(s)
- Jose Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Spain; CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain.
| | - Francisco Casas-Maldonado
- Servicio de Neumología. Hospital Universitario San Cecilio. Departamento de Medicina, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Maria Torres-Duran
- Servicio de Neumología. Hospital Álvaro Cunqueiro. NeumoVigo I+i Research Group, IIS Galicia Sur, Vigo, Spain
| | | | | | - Ines Carrascosa
- Servicio de Neumología. Hospital Urduliz-OSI Uribe, Vizcaya, Spain
| | - Myriam Calle
- Servicio de Neumología, Hospital Clínico de San Carlos. Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Osaba
- Progenika Biopharma, a Grifols Company, Derio, Vizcaya, Spain
| | - Noelia Rapun
- Progenika Biopharma, a Grifols Company, Derio, Vizcaya, Spain
| | | | - Marc Miravitlles
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, Spain; Servicio de Neumología. Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
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Mattman A, Gilfix BM, Chen SX, DeMarco ML, Kyle BD, Parker ML, Agbor TA, Jung B, Selvarajah S, Barakauskas VE, Vaags AK, Estey MP, Nelson TN, Speevak MD. Alpha-1-antitrypsin molecular testing in Canada: A seven year, multi-centre comparison. Clin Biochem 2020; 81:27-33. [DOI: 10.1016/j.clinbiochem.2020.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 10/24/2022]
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Sucena M, Gomes J, Guimarães C, Miravitlles M. Implementation of European Alpha-1 Research Collaboration (EARCO) in Portugal: the future starts now. Pulmonology 2020; 26:181-183. [DOI: 10.1016/j.pulmoe.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
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31
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Evers G, Schulze AB, Thrull M, Hering JP, Schülke C, Wiewrodt R, Wittkowski H, Schmidt LH, Mohr M. Alpha-1 Antitrypsin Deficiency and Pulmonary Morbidity in Patients with Primary Immunodeficiency Disease: A Single-Center Experience. Can Respir J 2020; 2020:4019608. [PMID: 32566054 DOI: 10.1155/2020/4019608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/22/2020] [Accepted: 05/06/2020] [Indexed: 01/20/2023] Open
Abstract
Background Alpha-1 antitrypsin deficiency (AATD) is of importance in the pathogenesis of pulmonary emphysema, chronic obstructive pulmonary diseases (COPD), and bronchiectasis. Various pulmonary disorders are a typical feature of primary immunodeficiency disease (PID). This includes recurrent pulmonary infections, immunodysregulation, and autoinflammatory diseases. As a result, incidence of acute and chronic pulmonary diseases is higher. Interestingly, pulmonary morbidity in PID and AATD share similar features. To study the coexistence of AATD in patients suffering from PID, we performed the underlying investigation. Methods We evaluated a study group of 149 patients (n = 149) with PID. In total, serum AAT concentrations were available for 110 patients (n = 110). For the identified patients, we analyzed both clinical associations and interactions. Results Among the investigated patients, reduced serum AAT levels were detected in 7 patients. With regard to the genotype, PI∗ZZ was found in 2 patients, whereas PI∗MZ was observed in 5 patients. Independent of the underlying phenotype, obstructive lung diseases were found in 2 patients with PI∗ZZ and 2 patients with PI∗MZ. Conclusions In Germany, the estimated percentage for PI∗ZZ and PI∗MZ is 0.01% and 1.9%, respectively. As demonstrated, the ratio in our study group was even higher. We identified seven patients with AATD. Since AATD contributes to pulmonary morbidity in PID patients, systematic underdiagnosis of the coexistence might yield a strong clinical impact. Hence, AAT analysis should be offered to all patients with confirmed PID diagnoses. To strengthen this finding, we suggest the investigation of larger databases.
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Sousa CS, Teixeira V, Pereira V, Pinheiro RB, Seixas S, Martins N. A rare case of pulmonary disease combining alpha-1-antitrypsin deficiency and common variable immunodeficiency. Pulmonology 2020; 26:406-409. [PMID: 32518030 DOI: 10.1016/j.pulmoe.2020.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- C S Sousa
- Pulmonology Department, Hospital Central do Funchal, Portugal.
| | - V Teixeira
- Pulmonology Department, Hospital Central do Funchal, Portugal
| | - V Pereira
- Gastroenterology Department, Hospital Central do Funchal, Portugal
| | - R B Pinheiro
- Pulmonology Department, Hospital Central do Funchal, Portugal
| | - S Seixas
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S), Porto, Portugal; Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), Porto, Portugal
| | - N Martins
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto (i3S), Porto, Portugal; Faculty of Medicine, University of Porto, Portugal; Pulmonology Department, Centro Hospitalar Universitário de São João, Portugal
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Bashir A, Hazari Y, Pal D, Maity D, Bashir S, Singh LR, Shah NN, Fazili KM. Aggregation of M3 (E376D) variant of alpha1- antitrypsin. Sci Rep 2020; 10:8290. [PMID: 32427833 PMCID: PMC7237413 DOI: 10.1038/s41598-020-64860-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 04/09/2020] [Indexed: 11/22/2022] Open
Abstract
Alpha1-antitrypsin (α1AT) is an abundant serine-protease inhibitor in circulation. It has an important role in neutralizing the neutrophil elastase activity. Different pathogenic point mutations like Z(E342K)-α1AT have been implicated in the development of liver cirrhosis and Chronic Obstructive Pulmonary Disease (COPD), the latter being a cluster of progressive lung diseases including chronic bronchitis and emphysema. M3-α1AT (376Glu > Asp) is another variant of α1AT which so far is largely being considered as normal though increased frequency of the variant has been reported in many human diseases including COPD. We also observed increased frequency of M3-α1AT in COPD cases in Kashmiri population. The frequency of heterozygous (AC) genotype in cases and controls was 58.57% and 27.61% (odds-ratio 6.53 (2.27-15.21); p < 0.0001) respectively, while homozygous CC genotype was found to be 21.42% and 6.66% (odds-ratio 10.56 (3.63-18.64); p < 0.0001) respectively. Comparative in vitro investigations that include trypsin‒antitrypsin assay, Circular Dichroism spectroscopy and dynamic light scattering performed on wild-type (M-α1AT), M3-α1AT, and Z-α1AT proteins along with the molecular dynamics simulations revealed that M3-α1AT has properties similar to Z-α1AT capable of forming aggregates of varied size. Our maiden observations suggest that M3-α1AT may contribute to the pathogenesis of COPD and other disorders by mechanisms that warrant further investigations.
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Affiliation(s)
- Arif Bashir
- UPR Signalling Laboratory, Department of Biotechnology, University of Kashmir, Srinagar, 190006, Jammu and Kashmir, India.
| | - Younis Hazari
- UPR Signalling Laboratory, Department of Biotechnology, University of Kashmir, Srinagar, 190006, Jammu and Kashmir, India
- Laboratory of Proteostasis Control and Biomedicine, Faculty of Medicine, University of Chile, Av. Independencia, 1027, Santiago, Chile
| | - Debnath Pal
- Department of Computational and Data Sciences (CDS), Indian Institute of Sciences, Bengaluru, 560012, India
| | - Dibyajyoti Maity
- Department of Computational and Data Sciences (CDS), Indian Institute of Sciences, Bengaluru, 560012, India
| | - Samirul Bashir
- UPR Signalling Laboratory, Department of Biotechnology, University of Kashmir, Srinagar, 190006, Jammu and Kashmir, India
| | | | - Naveed Nazir Shah
- Department of Chest Medicine, Govt. Medical College, Srinagar, 190001, Jammu and Kashmir, India
| | - Khalid Majid Fazili
- UPR Signalling Laboratory, Department of Biotechnology, University of Kashmir, Srinagar, 190006, Jammu and Kashmir, India.
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Xiong H, Huang Q, He C, Shuai T, Yan P, Zhu L, Yang K, Liu J. Prevalence of chronic obstructive pulmonary disease at high altitude: a systematic review and meta-analysis. PeerJ 2020; 8:e8586. [PMID: 32280564 PMCID: PMC7134014 DOI: 10.7717/peerj.8586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
Background and objective Recently, several studies have investigated the prevalence of chronic obstructive pulmonary disease (COPD) at high altitude (>1,500 m). However, much remains to be understood about the correlation between altitude and COPD. We aimed to summarize the prevalence of COPD at high-altitudes and find out if altitude could be a risk factor for COPD. Methods We searched PubMed/Medline, Cochrane Library, Web of Science, SCOPUS, OVID, Chinese Biomedical Literature Database (CBM) and Embase databases from inception to April 30th, 2019, with no language restriction. We used STATA 14.0 to analyze the extracted data. A random-effect model was used to calculate the combined OR and 95% CI. Heterogeneity was assessed by the I2 statistic versus P-value. We performed a subgroup analysis to analyze possible sources of heterogeneity. The Egger’s test and the Begg’s test were used to assess any publication bias. Results We retrieved 4,574 studies from seven databases and finally included 10 studies (54,578 participants). Males ranged from 18.8% to 49.3% and the population who smoked ranged from 3.3% to 53.3%. The overall prevalence of COPD at high-altitude was 10.0% (95% CI [0.08–0.12], P < 0.001). In a subgroup analysis, based on different regions, the results showed that the prevalence in Asia was higher than that in Europe and America. Seven studies compared the relationship between the prevalence of COPD at high-altitudes and the lowlands. The results showed that altitude was not an independent risk factor for the prevalence of COPD (ORadj = 1.18, 95% CI [0.85–1.62], P = 0.321). There was no publication bias among the studies. Conclusions Our study found a higher prevalence of COPD at high-altitudes than those from average data. However, altitude was not found to be an independent risk factor for developing COPD (PROSPERO Identifier: CRD42019135012).
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Affiliation(s)
- Huaiyu Xiong
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qiangru Huang
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Chengying He
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Tiankui Shuai
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Peijing Yan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, China
| | - Lei Zhu
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Institute of Clinical Research and Evidence Based Medicine, The Gansu Provincial Hospital, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jian Liu
- The First Clinical Medical College of the First Hospital of Lanzhou University, Lanzhou, China.,Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
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Cazzola M, Stolz D, Rogliani P, Matera MG. α 1-Antitrypsin deficiency and chronic respiratory disorders. Eur Respir Rev 2020; 29:29/155/190073. [PMID: 32051168 DOI: 10.1183/16000617.0073-2019] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/28/2019] [Indexed: 01/09/2023] Open
Abstract
α1-antitrypsin deficiency (AATD) is a hereditary disorder associated with a risk of developing liver disease and pulmonary emphysema, and other chronic respiratory disorders (mainly asthma and bronchiectasis); Z variant is the commonest deficient variant of AAT. Determining AAT concentration in serum or plasma and identifying allelic variants by phenotyping or genotyping are fundamental in the diagnosis of AATD. Initial evaluation and annual follow-up measurement of lung function, including post-bronchodilator forced expiratory volume in 1 s and gas transfer inform on disease progression. Lung densitometry is the most sensitive measure of emphysema progression, but must not be use in the follow-up of patients in routine clinical practice. The exogenous administration of purified human serum-derived AAT is the only approved specific treatment for AATD in PiZZ. AAT augmentation therapy is not recommended in PiSZ, PiMZ or current smokers of any protein phenotype, or in patients with hepatic disease. Lung volume reduction and endoscopic bronchial valve placement are useful in selected patients, whereas the survival benefit of lung transplant is unclear. There are several new lines of research in AATD to improve the diagnosis and evaluation of the response to therapy and to develop genetic and regenerative therapies and other treatments.
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Affiliation(s)
- Mario Cazzola
- Unit of Respiratory Medicine, Dept Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital of Basel, Basel, Switzerland
| | - Paola Rogliani
- Unit of Respiratory Medicine, Dept Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Maria Gabriella Matera
- Unit of Pharmacology, Dept Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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36
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Belmonte I, Nuñez A, Barrecheguren M, Esquinas C, Pons M, López-Martínez RM, Ruiz G, Blanco-Grau A, Ferrer R, Genescà J, Miravitlles M, Rodríguez-Frías F. Trends in Diagnosis of Alpha-1 Antitrypsin Deficiency Between 2015 and 2019 in a Reference Laboratory. Int J Chron Obstruct Pulmon Dis 2020; 15:2421-2431. [PMID: 33116457 PMCID: PMC7548232 DOI: 10.2147/copd.s269641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/28/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) remains largely underdiagnosed despite recommendations of healthcare institutions and programmes designed to increase awareness. The objective was to analyse the trends in AATD diagnosis during the last 5 years in a Spanish AATD reference laboratory. METHODS This was a retrospective revision of all alpha-1 antitrypsin (AAT) determinations undertaken in our laboratory from 2015 to 2019. We analysed the number of AAT determinations performed and described the characteristics of the individuals tested, as well as the medical specialties and the reasons for requesting AAT determination. RESULTS A total of 3507 determinations were performed, of which 5.5% corresponded to children. A significant increase in the number of AAT determinations was observed from 349 in 2015 to 872 in 2019. Among the samples, 57.6% carried an intermediate AATD (50-119 mg/dL) and 2.4% severe deficiency (<50 mg/dL). The most frequent phenotype in severe AATD individuals was PI*ZZ (78.5%), and aminotransferase levels were above normal in around 43% of children and 30% of adults. Respiratory specialists requested the highest number of AAT determinations (31.5%) followed by digestive diseases and internal medicine (27.5%) and primary care physicians (19.7%). The main reason for AAT determination in severe AATD adults was chronic obstructive pulmonary disease (41.7%), but reasons for requesting AAT determination were not reported in up to 41.7% of adults and 58.3% of children. CONCLUSION There is an increase in the frequency of AATD testing despite the rate of AAT determination remaining low. Awareness about AAT is probably increasing, but the reason for testing is not always clear.
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Affiliation(s)
- Irene Belmonte
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Alexa Nuñez
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès). Barcelona, Spain
| | - Miriam Barrecheguren
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Cristina Esquinas
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mònica Pons
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron; Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa M López-Martínez
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Gerard Ruiz
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Blanco-Grau
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Roser Ferrer
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Joan Genescà
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d’Hebron; Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
- Correspondence: Marc Miravitlles Pneumology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, P. Vall d’Hebron 119-129, Barcelona08035, Spain Email
| | - Francisco Rodríguez-Frías
- Department of Clinical Biochemistry, Hospital Universitari Vall d’Hebron, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
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Ruiz M, Lacaille F, Berthiller J, Joly P, Dumortier J, Aumar M, Bridoux-Henno L, Jacquemin E, Lamireau T, Broué P, Rivet C, Belmalih A, Restier L, Chapuis-Cellier C, Bouchecareilh M, Lachaux A. Liver disease related to alpha1-antitrypsin deficiency in French children: The DEFI-ALPHA cohort. Liver Int 2019; 39:1136-1146. [PMID: 30589493 DOI: 10.1111/liv.14035] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 02/13/2023]
Abstract
BACKGROUND & AIMS To identify prognostic factors for liver disease in children with alpha-1 antitrypsin deficiency, irrespective of phenotype, using the DEFI-ALPHA cohort. METHODS Retrospective, then prospective from 2010, multicentre study including children known to have alpha-1 antitrypsin blood concentration below 0.8 g/L, born in France since 1989. Clinical and biological data were collected. Liver disease was classified as "severe" (portal hypertension, liver failure, liver transplantation or death); "moderate" (persistent abnormal liver biology without portal hypertension); and "mild/none" (normal or almost normal liver biology and native liver). Prognostic factors for severe liver disease were evaluated using a Cox semiparametric model. RESULTS In January 2017, 153 patients from 19 centres had been included; genotypes were PIZZ in 81.9%, PISZ in 8.1%, other in 10.0%. Mean ± SD follow-up was 4.7 ± 2.1 years. Half of patients had moderate liver disease. Twenty-eight children (18.3%) had severe liver disease (mean age 2.5 years, range: 0-11.6): diagnosis of alpha-1 antitrypsin deficiency was made before two months of age in 65.4%, genotypes were PIZZ in 25 (89.3%), PISZ in 2, PIMlike Z in 1, 15 children underwent liver transplantation, 1 child died at 3 years of age. Neonatal cholestasis was significantly associated with severe liver disease (P = 0.007). CONCLUSION Alpha-1 antitrypsin-deficient patients presenting with neonatal cholestasis were likely to develop severe liver disease. Some patients with non-homozygous ZZ genotype can develop severe liver disease, such as PISZ and M variants, when associated with predisposing factors. Further genetic studies will help to identify other factors involved in the development of liver complications.
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Affiliation(s)
- Mathias Ruiz
- Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France
| | - Florence Lacaille
- Gastroentérologie, Hépatologie et Nutrition pédiatriques, Hôpital Universitaire Necker-Enfants Malades, Paris, France
| | - Julien Berthiller
- Unité de support méthodologique du groupement Est, Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon, France
| | - Philippe Joly
- Inter-university Laboratory of Human Movement Science, University Lyon - University Claude Bernard Lyon 1, Villeurbanne, France.,Laboratoire de Biochimie et biologie moléculaire Grand-Est, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Dumortier
- Hépatologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Madeleine Aumar
- Gastroentérologie, Hépatologie et Nutrition pédiatrique, Centre d'investigation clinique CHU Lille, University of Lille, Lille, France
| | - Laure Bridoux-Henno
- Gastroentérologie, Hépatologie et Nutrition pédiatriques, CHU Rennes, Rennes, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Pediatric Liver Transplantation Unit and National Reference Centre for Rare Pediatric Liver Diseases, Hepatinov, Bicêtre Universitary Hospital, University of Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France.,Inserm, UMR-S1174, University of Paris-Sud, Orsay, France
| | - Thierry Lamireau
- Gastroentérologie, Hépatologie et Nutrition pédiatriques, Bordeaux, France
| | - Pierre Broué
- Gastroentérologie, Hépatologie, Nutrition, Diabétologie pédiatriques, Maladies héréditaires du métabolisme, CHU Toulouse, Toulouse, France
| | - Christine Rivet
- Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Abdelouahed Belmalih
- Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Lioara Restier
- Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - Colette Chapuis-Cellier
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France.,Laboratoire d'Immunologie, Centre de Biologie Sud, Hospices Civils de Lyon, Lyon, France
| | - Marion Bouchecareilh
- INSERM, UMR1053 Bordeaux Research In Translational Oncology, University Bordeaux, BaRITOn, Bordeaux, France
| | - Alain Lachaux
- Hépatologie, Gastroentérologie et Nutrition pédiatriques, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France.,Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France
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Lopes AP, Mineiro MA, Costa F, Gomes J, Santos C, Antunes C, Maia D, Melo R, Canotilho M, Magalhães E, Vicente I, Valente C, Gonçalves BG, Conde B, Guimarães C, Sousa C, Amado J, Brandão ME, Sucena M, Oliveira MJ, Seixas S, Teixeira V, Telo L. Portuguese consensus document for the management of alpha-1-antitrypsin deficiency. Pulmonology 2019; 24 Suppl 1:1-21. [PMID: 30473034 DOI: 10.1016/j.pulmoe.2018.09.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/12/2018] [Accepted: 09/14/2018] [Indexed: 01/08/2023] Open
Abstract
Alpha-1-antitrypsin deficiency (AATD) is a genetic autosomal codominant disorder caused by mutations in SERPINA1 gene. It is one of the most prevalent genetic disorders, although it remains underdiagnosed. Whereas at international level there are several areas of consensus on this disorder, in Portugal, inter-hospital heterogeneity in clinical practice and resources available have been adding difficulties in reaching a diagnosis and in making therapeutic decisions in this group of patients. This raised a need to draft a document expressing a national consensus for AATD. To this end, a group of experts in this field was created within the Portuguese Pulmonology Society - Study group on AATD, in order to elaborate the current manuscript. The authors reviewed the existing literature and provide here general guidance and extensive recommendations for the diagnosis and management of AATD that can be adopted by Portuguese clinicians from different areas of Medicine. This article is part of a supplement entitled "Portuguese consensus document for the management of alpha-1-antitrypsin deficiency" which is sponsored by Sociedade Portuguesa de Pneumologia.
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Affiliation(s)
- A P Lopes
- Centro Hospitalar e Universitário de Coimbra (HUC); Alpha-1-antitrypsin deficiency study group coordinator.
| | | | - F Costa
- Centro Hospitalar e Universitário de Coimbra (HG)
| | | | | | | | - D Maia
- Centro Hospital Lisboa Central
| | - R Melo
- Hospital Prof. Doutor Fernando da Fonseca
| | | | | | | | | | | | - B Conde
- Centro Hospitalar de Trás os Montes e Alto Douro
| | | | - C Sousa
- Centro Hospitalar de São João
| | - J Amado
- Unidade Local de Saúde de Matosinhos
| | - M E Brandão
- Centro Hospitalar de Trás os Montes e Alto Douro
| | | | | | - S Seixas
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto (I3S); Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP)
| | - V Teixeira
- Serviço de Saúde da Região Autónoma da Madeira (SESARAM)
| | - L Telo
- Centro Hospitalar Lisboa Norte
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39
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Deshayes S, Martin Silva N, Grandhomme F, Khoy K, Mariotte D, Boutemy J, Maigné G, Brière-Bellier C, Delmas C, Bienvenu B, Lobbedez T, de Boysson H, Aouba A. Clinical Effect of Alpha-1 Antitrypsin Deficiency in Antineutrophil Cytoplasmic Antibody-associated Vasculitis: Results from a French Retrospective Monocentric Cohort. J Rheumatol 2019; 46:1502-1508. [PMID: 30824651 DOI: 10.3899/jrheum.180591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Deficiency in alpha-1 antitrypsin (AAT) is a possible pathogenic cofactor in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). However, the clinical effect of AAT deficiency remains poorly established in this setting. This study aimed to describe the clinical phenotypes and outcomes of AAV according to AAT phenotypes. METHODS This study was conducted retrospectively at Caen University Hospital and included all consecutive granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) patients with positive proteinase 3-ANCA or myeloperoxidase-ANCA, from January 2000 or September 2011, respectively, to June 2016. AAT dosage (nephelometry) and phenotyping (isoelectric focusing in agarose gel) were performed. RESULTS Among the 142 patients with AAV, including 88 GPA and 54 MPA, 102 (72%) had the MM phenotype, 5 (4%) had a nonpolymerogenic M-variant phenotype, 18 (13%) had the deficient allele MZ, 12 (8%) had MS, 2 (1%) had ZZ, 2 (1%) had SZ, and 1 (1%) had SS. M, Z, and S allele frequencies were 84%, 8%, and 6%, respectively. No association was observed between AAT deficiency and ANCA subtype or AAV phenotype, except for intraalveolar hemorrhage (IAH), which was more frequent in patients harboring at least 1 of the deficient Z or S alleles than in those without any deficient alleles (p < 0.01). Global, renal, or relapse-free survival rates were similar for all subgroups. CONCLUSION This study shows that AAT deficiency confers, independently of ANCA subtype, a higher risk of IAH. Prospective studies are required to refine these data and to assess the need for replacement therapy in AAT-deficient patients with AAV.
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Affiliation(s)
- Samuel Deshayes
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Nicolas Martin Silva
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Frédérique Grandhomme
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Kathy Khoy
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Delphine Mariotte
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Jonathan Boutemy
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Gwénola Maigné
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Claire Brière-Bellier
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Claire Delmas
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Boris Bienvenu
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Thierry Lobbedez
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Hubert de Boysson
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France.,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie
| | - Achille Aouba
- From the Department of Internal Medicine, the Department of Biochemistry, the Department of Immunology, and the Department of Nephrology, Normandie Université, UNICAEN, Centre Hospitalier Universitaire (CHU) de Caen Normandie, Caen; Department of Infectious Diseases, CH Mémorial, Saint-Lô, France. .,S. Deshayes, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; N. Martin Silva, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; F. Grandhomme, MD, Department of Biochemistry, Normandie Université, UNICAEN, CHU de Caen Normandie; K. Khoy, PharmD, PhD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; D. Mariotte, PharmD, Department of Immunology, Normandie Université, UNICAEN, CHU de Caen Normandie; J. Boutemy, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; G. Maigné, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; C. Brière-Bellier, MD, Department of Infectious Diseases, CH Mémorial; C. Delmas, MD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; B. Bienvenu, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; T. Lobbedez, MD, PhD, Department of Nephrology, Normandie Université, UNICAEN, CHU de Caen Normandie; H. de Boysson, MD, MSc, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie; A. Aouba, MD, PhD, Department of Internal Medicine, Normandie Université, UNICAEN, CHU de Caen Normandie.
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Horváth I, Canotilho M, Chlumský J, Chorostowska-Wynimko J, Corda L, Derom E, Ficker JH, Kneussl M, Miravitlles M, Sucena M, Thabut G, Turner AM, van ’t Wout E, McElvaney NG. Diagnosis and management of α 1-antitrypsin deficiency in Europe: an expert survey. ERJ Open Res 2019; 5:00171-2018. [PMID: 30863774 PMCID: PMC6409083 DOI: 10.1183/23120541.00171-2018] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/12/2018] [Indexed: 01/09/2023] Open
Abstract
Despite recent improvements, α1-antitrypsin deficiency (AATD) remains a rarely diagnosed and treated condition. To assess the variability of AATD diagnosis/treatment in Europe, and to evaluate clinicians' views on methods to optimise management, specialist AATD clinicians were invited to complete a web-based survey. Surveys were completed by 15 physicians from 14 centres in 13 European countries. All respondents perceived the AATD diagnosis rate to be low in their country; 77% of physicians believed that ∼15% of cases were diagnosed. Low awareness was perceived as the greatest barrier to diagnosis. Spirometry was considered more practical than quantitative computed tomography (QCT) for monitoring AATD patients in clinical practice; QCT was considered more useful in trials. AAT therapy provision was reported to be highly variable: France and Germany were reported to treat the highest proportion (∼60%) of diagnosed patients, in contrast to the UK and Hungary, where virtually no patients receive AAT therapy. Most clinicians supported self-administration and extended dosing intervals to improve convenience of AAT therapy. This survey indicates that AATD diagnosis and management are highly heterogeneous in Europe; European cooperation is essential to generate data to support access to AAT therapy. Improving convenience of AAT therapy is an ongoing objective.
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Affiliation(s)
- Ildikó Horváth
- Dept of Pulmonology, National Koranyi Institute for Pulmonology in Budapest, Budapest, Hungary
| | - Maria Canotilho
- Dept of Pneumology, Hospital of Santo Andre – Centro Hospitalar de Leiria, Leiria, Portugal
| | - Jan Chlumský
- Dept of Pneumology, Thomayer Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Joanna Chorostowska-Wynimko
- Dept of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Luciano Corda
- Dept of Internal Medicine, Respiratory Disease Unit, Spedali Civili, Brescia, Italy
| | - Eric Derom
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Joachim H. Ficker
- 3rd Medical Dept, Nuremberg General Hospital/Paracelsus Medical University, Nuremberg, Germany
| | - Meinhard Kneussl
- Dept of Internal Medicine II and Pneumology at Wilhelminenspital Wien, Vienna, Austria
| | - Marc Miravitlles
- Pulmonology Dept, University Hospital Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Maria Sucena
- Pulmonology Dept, Centro Hospitalar de São João, Porto, Portugal
| | - Gabriel Thabut
- Dept of Pneumology and Lung Transplantation, Bichat Hospital, Paris, France
| | - Alice M. Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emily van ’t Wout
- Leiden University Medical Centre, Dept of Pulmonology, Leiden, Netherlands
| | - N. Gerard McElvaney
- Dept of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland
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Hall R, Hall IP, Sayers I. Genetic risk factors for the development of pulmonary disease identified by genome-wide association. Respirology 2018; 24:204-214. [PMID: 30421854 DOI: 10.1111/resp.13436] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/31/2018] [Accepted: 09/20/2018] [Indexed: 12/17/2022]
Abstract
Chronic respiratory diseases are a major cause of morbidity and mortality. Asthma and chronic obstructive pulmonary disease (COPD) combined affect over 500 million people worldwide. While environmental factors are important in disease progression, asthma and COPD have long been known to be heritable with genetic components playing an important role in the risk of developing disease. Identification of genetic variation contributing to disease progression is important for a number of reasons including identification of risk alleles, understanding underlying disease mechanisms and development of novel therapies. Genome-wide association studies (GWAS) have been successful in identifying many loci associated with lung function, COPD and asthma. In recent years, meta-analyses and improved imputation have facilitated the growth of GWAS in terms of numbers of subjects and the number of single nucleotide polymorphisms (SNP) that can be interrogated. As a consequence, there has been a significant increase in the number of signals associated with asthma, COPD and lung function. SNP that have shown association with lung function reassuringly show a significant overlap with SNP associated with COPD giving a glimpse at pathways that may be involved in COPD mechanisms including genes in, for example, developmental pathways. In asthma, association signals are often in or near genes involved in both adaptive and innate immune response pathways, epithelial cell homeostasis and airway structural changes. The challenges now are translating these genetic signals into a new understanding of lung biology, understanding how variants impact health and disease and how they may provide opportunities for therapeutic intervention.
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Affiliation(s)
- Robert Hall
- Division of Respiratory Medicine, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Ian P Hall
- Division of Respiratory Medicine, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Ian Sayers
- Division of Respiratory Medicine, NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Sieluk J, Levy J, Sandhaus RA, Silverman H, Holm KE, Mullins CD. Costs of Medical Care Among Augmentation Therapy Users and Non-Users with Alpha-1 Antitrypsin Deficiency in the United States. Chronic Obstr Pulm Dis 2018; 6:6-16. [PMID: 30775420 DOI: 10.15326/jcopdf.6.1.2017.0187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: This study is the first to utilize a large claims database to estimate medical costs of patients with alpha-1 antitrypsin deficiency (AATD) in the United States. Methods: Adult AATD patients were identified from the OptumLabs™ Data Warehouse. Insurer and patient out-of-pocket costs were categorized into the following cost buckets, stratified by augmentation therapy use: physician visits (PV), emergency department visits (ED), inpatient stays (IP), augmentation therapy (AUG), other prescription drug costs (RX), and other costs (OTH). Costs were weighted and adjusted to 2017 U.S. dollars using the medical care component of the consumer price index. Results: The study cohort consisted of9117 AATD patients followed for 53,872 person years observed between 1993 and 2015. The annual costs among AATD patients totaled $127,537 among augmentation therapy users and $15,874 among non-users. The major drivers of annual costs to the insurer among the 7975 patients not on augmentation therapy were: PV: $5352 (37.7%) and IP: $4506 (31.8%). Among the 1142 augmentation users, major annual cost drivers to the insurer were PV: $15,064 (12.3%) and AUG: $82,002 (66.7%). Annual patient out-of-pocket costs were $4601 (AUG: $2084 [45.3%]; RX: $940 [20.4%]) and $1689 (PV: $727 [43.0%]; RX: $589 [34.9%]) among augmentation therapy users and non-users, respectively. Averaged across the entire cohort, the average annual costs per AATD patient were $22,975, paid by insurers ($21,100) and patients ($1875). Conclusions: Annual medical costs among patients with AATD are $127,537 and $15,874 among augmentation therapy users and non-users, respectively, with 75.3% of the cost difference attributable to AUG.
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Affiliation(s)
- Jan Sieluk
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore.,OptumLabs, Cambridge, Massachusetts
| | - Joseph Levy
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore
| | - Robert A Sandhaus
- Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, Colorado
| | | | - Kristen E Holm
- Division of Medical, Behavioral, and Community Health, National Jewish Health, Denver, Colorado
| | - C Daniel Mullins
- Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore
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Suárez-Lorenzo I, de Castro FR, Cruz-Niesvaara D, Herrera-Ramos E, Rodríguez-Gallego C, Carrillo-Diaz T. Alpha 1 antitrypsin distribution in an allergic asthmatic population sensitized to house dust mites. Clin Transl Allergy 2018; 8:44. [PMID: 30410723 PMCID: PMC6214172 DOI: 10.1186/s13601-018-0231-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/27/2018] [Indexed: 02/13/2023] Open
Abstract
Background and objective Severe alpha1 antitrypsin deficiency has been clearly associated with pulmonary emphysema, but its relationship with bronchial asthma remains controversial. Some deficient alpha 1 antitrypsin (AAT) genotypes seem to be associated with asthma development. The objective of this study was to analyze the distribution of AAT genotypes in asthmatic patients allergic to house dust mites (HDM), and to asses a possible association between these genotypes and severe asthma. Methods A cross-sectional cohort study of 648 patients with HDM allergic asthma was carried out. Demographic, clinical and analytical variables were collected. PI*S and PI*Z AAT deficient alleles of the SERPINA1 gene were assayed by real-time PCR. Results Asthma was intermittent in 253 patients and persistent in 395 patients (246 mild, 101 moderate and 48 severe). One hundred and forty-five asthmatic patients (22.4%) with at least one mutated allele (S or Z) were identified. No association between the different genotypes and asthma severity was found. No significant differences in all clinical and functional tests, as well as nasal eosinophils, IgA and IgE serum levels were observed. Peripheral eosinophils were significantly lower in patients with the PI*MS genotype (p = 0.0228). Neither association between deficient AAT genotypes or serum ATT deficiency (AATD) and development of severe asthma, or correlation between ATT levels and FEV1 was observed. Conclusion In conclusion, the distribution of AAT genotypes in HDM allergic asthmatic patients did not differ from those found in Spanish population. Neither severe ATTD or deficient AAT genotypes appear to confer different clinical expression of asthma.
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Affiliation(s)
- I Suárez-Lorenzo
- 1Postgraduate and Doctoral School, Universidad de Las Palmas de Gran Canaria, Camino Real de San Roque, 1, 35015 Las Palmas de Gran Canaria, Las Palmas Spain
| | - F Rodríguez de Castro
- 2Pneumology Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - D Cruz-Niesvaara
- Allergy Unit, Hospital General de Fuerteventura, Puerto del Rosario, Spain
| | - E Herrera-Ramos
- 4Immunology Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - C Rodríguez-Gallego
- 4Immunology Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - T Carrillo-Diaz
- 5Allergy Unit, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
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Greulich T, Rodríguez-Frias F, Belmonte I, Klemmer A, Vogelmeier CF, Miravitlles M. Real world evaluation of a novel lateral flow assay (AlphaKit® QuickScreen) for the detection of alpha-1-antitrypsin deficiency. Respir Res 2018; 19:151. [PMID: 30103740 PMCID: PMC6090649 DOI: 10.1186/s12931-018-0826-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/08/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Alpha-1-Antitrypsin (AAT) deficiency (AATD) is a hereditary disorder that manifests primarily as pulmonary emphysema and liver cirrhosis. The clinically most relevant mutation causing AATD is a single nucleotide polymorphism Glu342Lys (Z-mutation). Despite the recommendation to test every COPD patient, the condition remains severely underdiagnosed with a delay of several years between first symptoms and diagnosis. The Grifols' AlphaKit® QuickScreen is a novel qualitative point-of-care (POC) in vitro screening test developed for the detection of the Z AAT protein in capillary whole blood. The objective of this prospective, international, multi-center, diagnostic, interventional real-world study was to assess the performance of this device for the detection of AATD in test-naïve COPD patients. METHODS 1044 test-naïve COPD patients were recruited from 9 centers in Spain and 10 centers in Germany, ranging from primary to tertiary care. To evaluate the performance of the test, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated compared with the gold standard (genotyping). RESULTS Genotyping and phenotyping of all 1019 evaluable samples revealed 4.12% of patients as carriers of at least one Z-allele, while 0.29% carried the homozygous genotype Pi*ZZ. The evaluation of the test's ability to detect the PiZ protein yielded the following results: specificity 97.8%, sensitivity 73.8%, negative predictive value 98.9%, and positive predictive value 58.5%. All false negatives (n = 11) were heterozygote Pi*MZ samples. CONCLUSIONS The tested device can be used as an appropriate tool to exclude AATD in primary care and in the overall COPD population, except in patients with a high a-priori- probability of AATD.
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Affiliation(s)
- Timm Greulich
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany.
- German Centre for Lung Research (DZL), Marburg, Germany.
- Respiratory Medicine, University Hospital of Gießen and Marburg, 35043, Marburg, Germany.
| | - Francisco Rodríguez-Frias
- Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
- CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto Nacional de Salud Carlos III, Madrid, Spain
| | - Irene Belmonte
- Liver Pathology Unit, Departments of Biochemistry and Microbiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Andreas Klemmer
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
- German Centre for Lung Research (DZL), Marburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Centre Giessen and Marburg, Philipps-University, Marburg, Germany
- German Centre for Lung Research (DZL), Marburg, Germany
| | - Marc Miravitlles
- Pneumology Department, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
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Calle Rubio M, Soriano JB, López- Campos JL, Soler-Cataluña JJ, Alcázar Navarrete B, Rodríguez González- Moro JM, Miravitlles M, Barrecheguren M, Fuentes Ferrer ME, Rodriguez Hermosa JL. Testing for alpha-1 antitrypsin in COPD in outpatient respiratory clinics in Spain: A multilevel, cross-sectional analysis of the EPOCONSUL study. PLoS One 2018; 13:e0198777. [PMID: 29953442 PMCID: PMC6023216 DOI: 10.1371/journal.pone.0198777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/24/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Alpha-1 antitrypsin deficiency (AATD) is the most common hereditary disorder in adults, but is under-recognized. In Spain, the number of patients diagnosed with AATD is much lower than expected according to epidemiologic studies. The objectives of this study were to assess the frequency and determinants of testing serum α1-antitrypsin (AAT) levels in COPD patients, and to describe factors associated with testing. METHODS EPOCONSUL is a cross-sectional clinical audit, recruiting consecutive COPD cases over one year. The study evaluated serum AAT level determination in COPD patients and associations between individual, disease-related, and hospital characteristics. RESULTS A total of 4,405 clinical records for COPD patients from 57 Spanish hospitals were evaluated. Only 995 (22.5%) patients had serum AAT tested on some occasion. A number of patient characteristics (being male [OR 0.5, p < 0.001], ≤55 years old [OR 2.38, p<0.001], BMI≤21 kg/m2 [OR 1.71, p<0.001], FEV1(%)<50% [OR 1.35, p<0.001], chronic bronchitis [OR 0.79, p < 0.001], Charlson index ≥ 3 [OR 0.66, p < 0.001], or history or symptoms of asthma [OR 1.32, p<0.001]), and management at a specialized COPD outpatient clinic [OR 2.73,p<0.001] were identified as factors independently associated with ever testing COPD patients for AATD. Overall, 114 COPD patients (11.5% of those tested) had AATD. Of them, 26 (22.8%) patients had severe deficiency. Patients with AATD were younger, with a low pack-year index, and were more likely to have emphysema (p<0.05). CONCLUSION Testing of AAT blood levels in COPD patients treated at outpatient respiratory clinics in Spain is infrequent. However, when tested, AATD (based on the serum AAT levels ≤100 mg/dL) is detected in one in five COPD patients. Efforts to optimize AATD case detection in COPD are needed.
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Affiliation(s)
- Myriam Calle Rubio
- Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
- * E-mail:
| | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Consultant on Methodology and Research of SEPAR, Universidad Autónoma de Madrid, Madrid, España
| | - José Luis López- Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias. Instituto de Biomedicina de Sevilla (IBiS). Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Sevilla, España
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid. España
| | | | - Bernardino Alcázar Navarrete
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid. España
- Pulmonary Department, Hospital de Alta Resolución de Loja, Granada, España
| | | | - Marc Miravitlles
- Pulmonary Department, Hospital Universitari Vall d’Hebron, Barcelona, España
- CIBER de Enfermedades Respiratorias (CIBERES). Barcelona, España
| | | | - Manuel E. Fuentes Ferrer
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
- UGC de Medicina Preventiva, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Juan Luis Rodriguez Hermosa
- Pulmonary Department, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, España
- Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, España
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Abstract
Alpha-1-antitrypsin deficiency (AATD) is one of the most frequent genetic causes of liver and lung diseases. Despite its known association with chronic obstructive pulmonary disease (COPD), AATD is largely unrecognised and underdiagnosed. Cases of AATD exist within every COPD or spirometry population but must be actively investigated. AATD is a laboratory diagnosis that must be confirmed by a blood test. A number of clinical 'clues' can raise suspicion of AATD, potentially facilitating earlier diagnosis and initiation of appropriate treatment. Alpha-1-antitrypsin augmentation therapy has a clear role in patients with severe AATD and a FEV1 ≤65% predicted. Emerging evidence suggests that attenuating the decline in lung density may prolong the time to respiratory failure.
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Affiliation(s)
- Timm Greulich
- a Department of Medicine , Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg , Marburg , Germany
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47
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McCarthy C, Lara Gallego B, Trapnell BC, McCormack FX. Epidemiology of Rare Lung Diseases: The Challenges and Opportunities to Improve Research and Knowledge. Adv Exp Med Biol 2018; 1031:419-442. [PMID: 29214586 DOI: 10.1007/978-3-319-67144-4_24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Rare lung diseases encompass a broad spectrum of conditions and affect an estimated 1.2-2.5 million people in North America and 1.5-3 million people in Europe. While individual rare lung diseases affect less than 1 in 2000 individuals, collectively they have a significant impact upon the population at large. Hence it is vital to understand firstly the epidemiology and subsequently the pathogenesis and clinical course of these disorders. Through a greater understanding of these aspects of disease, progress can be made in reducing symptoms, containing healthcare costs and utilizing resources efficiently. Furthermore, a greater understanding of the pathobiology of rare lung diseases can inform both the pathogenesis and management of more common pulmonary disorders.In this chapter we review how epidemiological approaches and the utilization of patient registries has improved the knowledge and management of rare lung diseases. We further focus on the epidemiology of several of the more widely known rare pulmonary disorders, including idiopathic pulmonary fibrosis (IPF), cystic fibrosis (CF) and alpha-1 antitrypsin deficiency (AATD). To conclude we describe how patient advocacy groups and foundations have driven advances in research and management of ultra-rare lung diseases, namely, the major strides made in the management and understanding of lymphangioleiomyomatosis (LAM) and pulmonary alveolar proteinosis (PAP).We conclude that the models used to study some of the rarest of diseases may be successfully adopted by other rare and common disease communities, leading to improved care and the possibility of novel therapeutic options.
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Affiliation(s)
- Cormac McCarthy
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA. .,Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA. .,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.
| | - Beatriz Lara Gallego
- Respiratory Medicine Department, Coventry University Hospital, Third Floor, East wing. Clifford Bridge Road, Coventry, CV2 2DX, Warwickshire, UK
| | - Bruce C Trapnell
- Translational Pulmonary Science Center Cincinnati Children's Hospital, 3333 Burnet Avenue, CCRF S4621, 45229-3039, Cincinnati, OH, USA.,Rare Lung Diseases Clinical (RLDC), Cincinnati, OH, USA.,Medicine and Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, CCRF R4029, 45229-3039, Cincinnati, OH, USA
| | - Francis X McCormack
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH, 45267-0564, USA
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Matamala N, Lara B, Gomez-Mariano G, Martínez S, Retana D, Fernandez T, Silvestre RA, Belmonte I, Rodriguez-Frias F, Vilar M, Sáez R, Iturbe I, Castillo S, Molina-Molina M, Texido A, Tirado-Conde G, Lopez-Campos JL, Posada M, Blanco I, Janciauskiene S, Martinez-Delgado B. Characterization of Novel Missense Variants of SERPINA1 Gene Causing Alpha-1 Antitrypsin Deficiency. Am J Respir Cell Mol Biol 2018; 58:706-716. [PMID: 29232161 DOI: 10.1165/rcmb.2017-0179oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The SERPINA1 gene is highly polymorphic, with more than 100 variants described in databases. SERPINA1 encodes the alpha-1 antitrypsin (AAT) protein, and severe deficiency of AAT is a major contributor to pulmonary emphysema and liver diseases. In Spanish patients with AAT deficiency, we identified seven new variants of the SERPINA1 gene involving amino acid substitutions in different exons: PiSDonosti (S+Ser14Phe), PiTijarafe (Ile50Asn), PiSevilla (Ala58Asp), PiCadiz (Glu151Lys), PiTarragona (Phe227Cys), PiPuerto Real (Thr249Ala), and PiValencia (Lys328Glu). We examined the characteristics of these variants and the putative association with the disease. Mutant proteins were overexpressed in HEK293T cells, and AAT expression, polymerization, degradation, and secretion, as well as antielastase activity, were analyzed by periodic acid-Schiff staining, Western blotting, pulse-chase, and elastase inhibition assays. When overexpressed, S+S14F, I50N, A58D, F227C, and T249A variants formed intracellular polymers and did not secrete AAT protein. Both the E151K and K328E variants secreted AAT protein and did not form polymers, although K328E showed intracellular retention and reduced antielastase activity. We conclude that deficient variants may be more frequent than previously thought and that their discovery is possible only by the complete sequencing of the gene and subsequent functional characterization. Better knowledge of SERPINA1 variants would improve diagnosis and management of individuals with AAT deficiency.
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Affiliation(s)
- Nerea Matamala
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
| | - Beatriz Lara
- 2 Respiratory Medicine Department, Coventry University Hospital, Coventry, United Kingdom
| | - Gema Gomez-Mariano
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
| | - Selene Martínez
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
| | - Diana Retana
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
| | - Taiomara Fernandez
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
| | | | - Irene Belmonte
- 4 Biochemistry Department, Hospital Vall d'Hebron, Barcelona, Spain
| | | | - Marçal Vilar
- 5 Instituto de Biomedicina de Valencia, Consejo Superior de Investigaciones Cientificas (CSIC), Valencia, Spain
| | - Raquel Sáez
- 6 Immunology and Genetics, Hospital Donosti, San Sebastián, Spain
| | - Igor Iturbe
- 7 Pneumology, Hospital de Zumárraga, Gipuzkoa, Spain
| | | | - María Molina-Molina
- 9 Pulmonary Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospital de Llobregat, Barcelona, Spain
| | - Anna Texido
- 10 Pneumology, Hospital Universitari Sant Joan de Reus, Reus (Tarragona), Spain
| | - Gema Tirado-Conde
- 11 Complejo Hospitalario Universitario Granada, Parque Tecnológico de las Ciencias de la Salud, Granada, Spain
| | - Jose Luis Lopez-Campos
- 13 Consorcio Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), and
- 12 Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocio/Universidad de Sevilla, Sevilla, Spain
| | - Manuel Posada
- 1 Molecular Genetics Unit, Instituto de Investigación de Enfermedades Raras (IIER)
- 14 Consorcio Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Ignacio Blanco
- 15 Spanish Registry of Patients with Alpha-1 Antitrypsin Deficiency (REDAAT), Spanish Society of Pneumology (SEPAR), Fundación Española de Pulmón (RESPIRA), Barcelona, Spain
| | - Sabina Janciauskiene
- 16 Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany; and
- 17 Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
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49
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Abstract
Alpha-1 antitrypsin deficiency (AATD) is an autosomal co-dominant disease characterised by low serum levels of this molecule. Its epidemiology remains unknown in many countries, mainly due to its underdiagnosed state and lack of patients' registries. We aim to evaluate and characterise a sample of Portuguese individuals tested for AATD, between 2006 and 2015, based on a retrospective analysis from the database of a laboratory offering AATD genetic diagnosis service. 1684 individuals were considered, covering almost every region in Portugal. Genetic diagnosis resulted from requests of clinicians from different areas of expertise, mainly pulmonology (35.5%). Most subjects could be distributed into more common genotypes: MZ (25.4%, n = 427), MS (15.5%, n = 261), SZ (11.2%, n = 188), ZZ (9.4%, n = 158) and SS (5.6%, n = 95). 9.5% of the subjects were found to carry at least one rare deleterious allele, including the recently described PGaia, Q0Oliveira do Douro, Q0Vila Real and a novel SGaia variant. This study comprises 417 subjects (24.7%) with severe to very severe AATD and 761 carriers (45.2%), 22.7% of those identified by familial screening. The present study represents the most complete survey of AATD in Portugal so far and discloses a high rate of severe and very severe deficiency cases, attributed not only to ZZ and SZ genotypes but also to a large number of rare combinations with other null and deficiency alleles. It also uncovers a low awareness to AATD among the medical community, highlighting the need to create a Portuguese national registry and AATD guidelines and increase the awareness about this condition.
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Affiliation(s)
- Leonor Meira
- a Pulmonology Department , Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro Porto , Portugal
| | - Rita Boaventura
- a Pulmonology Department , Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro Porto , Portugal
| | - Susana Seixas
- b Instituto de Investigação e Inovação em Saúde, Universidade do Porto (I3S) , Porto , Portugal.,c Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP) , Porto , Portugal
| | - Maria Sucena
- a Pulmonology Department , Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro Porto , Portugal
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50
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Hadzik-Blaszczyk M, Zdral A, Zielonka TM, Rozy A, Krupa R, Falkowski A, Wardyn KA, Chorostowska-Wynimko J, Zycinska K. SERPINA1 Gene Variants in Granulomatosis with Polyangiitis. Adv Exp Med Biol 2018; 1070:9-18. [PMID: 29460271 DOI: 10.1007/5584_2018_156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Alpha-1 antitrypsin (A1AT) deficiency is one of the most common genetic disorders in Caucasian population. There is a link between granulomatosis with polyangiitis (GPA) and most frequent variants of SERPINA1 gene encoding severe alpha-1 antitripsin deficiency. However, the potential effect of Pi*Z, Pi*S as well as other SERPINA1 variants on clinical course of vasculitis are not well understood. The aim of the study was to analyze the potential effect of A1AT protein phenotype representing the SERPINA1 gene variants on the clinical course of GPA. The study group consisted of 64 subjects with GPA, stratified according to the disease severity: patients in active phase (group I, n = 12), patients during remission on treatment (group II, n = 40) or untreated (group III, n = 12). Normal Pi*MM SERPINA1 genotype was detected by means of real-time polymerase chain reaction (PCR) or direct sequencing in 59 patients, Pi*MZ genotype in 2, and Pi*IM, Pi*MS or Pi*SZ in 1 patient respectively. The patients with abnormal Pi*Z, Pi*S, or Pi*I allele constituted 17% in group I, 5% in group II, and 8% in group III. The serum content of A1AT and high sensitivity C-reactive protein (hsCRP) assessed by nephelometry did not differ between the groups. Interestingly, the mean serum antiPR3-antibodies level detected by Elisa method was significantly greater in the GPA patients with Pi*Z, Pi*S, or Pi*I SERPINA1 variants than in the Pi*MM homozygotes. In summary, heterozygous Pi*MZ, Pi*MS, and Pi*SZ genotype was detected in 7.8% of total group of GPA patients, and in 10.5% of those with lung lesions. The abnormal alleles of Pi*S and Pi*Z may affect the clinical course of the disease.
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Affiliation(s)
| | - Aneta Zdral
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Tadeusz M Zielonka
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland.
| | - Ada Rozy
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Renata Krupa
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland
| | - Andrzej Falkowski
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland
| | - Kazimierz A Wardyn
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland
| | - Joanna Chorostowska-Wynimko
- Department of Genetics and Clinical Immunology, National Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Katarzyna Zycinska
- Department of Family Medicine, Internal and Metabolic Diseases, Warsaw Medical University, Warsaw, Poland
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