Short-term supplementation therapy does not affect elastin degradation in severe alpha(1)-antitrypsin deficiency. The American-Italian AATD Study Group

We evaluated the ability of intravenous supplementation therapy with alpha(1)-antitrypsin (AAT) to reduce the rate of urinary excretion of desmosine (DES), a specific marker of elastin degradation, in eight men and four women with emphysema due to severe, congenital deficiency of AAT (range 17-69 mg/dl). Nine were former cigarette smokers, two were current smokers, and one reported never smoking; their mean age was 54 (SD 12) yr and their mean FEV(1) was 41 (18%) of predicted. Urinary DES was measured by isotope dilution and HPLC. Prior to the start of AAT supplementation, mean DES excretion was 13.0 (5.0) microg/g creatinine, 73% higher than in healthy nonsmokers. During 8 wk of supplementation therapy, mean urinary DES excretion was 13.0 (5.9) microg/g creatinine, unchanged from the baseline period (p = 0.85 by repeated measures ANOVA). We conclude that baseline levels of elastin degradation in emphysematous patients with severe AAT deficiency were abnormally high and that 8 wk of AAT supplementation therapy did not appreciably reduce the rate of elastin degradation. These findings raise the possibilities that protective levels of AAT in the lungs are insufficient or that elastin degradation in the lungs of these subjects is not dependent upon neutrophil elastase at this time.

[Clinical consequences and diagnosis of congenital alpha 1-antitrypsin deficiency]

alpha 1-Antitrypsin deficiency is associated with predisposition to developing liver cirrhosis in early childhood and emphysema in adult life. One of the common variants PiZ leads to accumulation of the abnormal protein in hepatocytes and cell damage. Emphysema is a consequence of the protease-antiprotease imbalance. Understanding of the mechanism of disease allows early diagnostics and therapeutic intervention.

[The significance of congenital inhibitor deficiency in acute pancreatitis]

In the past few years, genotype influence on the occurrence and developmental course of acute pancreatitis is ever more frequently accounted for. Forty-three patients presenting mild (2), medium-severe (33) and severe (6) form of the disease are covered by the study, undertaken with the purpose to assay the role played by some immunoglobulins and polymorphic plasma proteins in this particular disease. In evaluating plasma proteins a deficit of the protease inhibitor Alpha1 antitrypsin is found in twelve patients. However in two cases only Alpha1 antitrypsin deficit is associated with deficiency of the other protease inhibitor--the Alpha2 macroglobulin. In acute pancreatitis patients a genetically determined deficit of protease inhibitory activity is documented, considered a good reason to undertake conservative management using protease inhibitors in the initial phases of the condition.