Liver Disease in Alpha1-Antitrypsin Deficiency Detected by Screening of 200,000 Infants

New England Journal of Medicine (Impact Factor: 55.87). 07/1976; 294(24):1316-21. DOI: 10.1056/NEJM197606102942404
Source: PubMed


We prosepctively studied 200,000 newborns to determine the frequency and clinical characteristics of alpha1-antitrypsin deficiency. One hundred and twenty Pi Z, 48 Pi SZ, two PI Z-and one Pi S-infants were identified and followed to the age of six months. Fourteen of 120 Pi Z infants had prolonged obstructive jaundice, nine with severe clinical and laboratory evidence of liver disease. Five had only laboratory evidence of liver disease. Eight other Pi Z infants had minimal abnormalities in serum bilirubin and hepatic enzyme activity and variable hepatosplenomegaly. All 22 Pi Z infants with hepatic abnormalities, two thirds of whom were made, appeared healthy at six months of age. Ninety-eight Pi Z infants did not have clinical liver disease, but liver-function tests gave abnormal results in 44 of 84 at three months, and in 36 of 60 at six months of age. The number of small-for-gestational-age infants was greater (P less than 0.001) among those with clinical liver disease. None of the 48 Pi SZ infants had clinical liver disease, but 10 of 42 at three months and one of 22 at six months of age had abnormal liver function. The Pi Z and Pi SZ phenotypes are associated with covert or readily apparent hepatic dysfunction in the first three months of life.

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    • "Patients who exhibit features of liver disease during infancy can present within the first two months of life with persistent jaundice, hepatomegaly, and elevated serum conjugated bilirubin and transaminase levels. A prospective Swedish national screening study initiated in the 1970s provides important insights into the natural history of ATD [7]. In that study, Sveger et al. screened 200,000 newborns, of whom 120 were ZZ homozygotes. "
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    ABSTRACT: Alpha-1-antitrypsin deficiency (ATD) is one of the most common genetic causes of liver disease and is a prototype of liver diseases caused by the pathologic accumulation of aggregated mutant alpha-1-antitrypsin Z (ATZ) within liver cells. In the case of ATD-associated liver disease, the resulting "gain-of-function" toxicity can lead to serious clinical manifestations, including cirrhosis and hepatocellular carcinoma. Currently, the only definitive therapy for ATD-associated liver disease is liver transplantation, but recent efforts have demonstrated the exciting potential for novel therapies that target disposal of the mutant protein aggregates by harnessing a cellular homeostasis mechanism called autophagy. In this review, we will summarize research advances on autophagy and genetic liver diseases. We will discuss autophagy enhancer strategies for liver disease due to ATD and another genetic liver disease, inherited hypofibrinogenemia, caused by the proteotoxic effects of a misfolded protein. On the basis of recent evidence that autophagy plays a role in cellular lipid degradation, we also speculate about autophagy enhancer strategies for treatment of hepatic lipid storage diseases such as cholesterol ester storage disease.
    Full-text · Article · Jun 2014 · BioMed Research International
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    • "A significant number of adult patients with ATD who come to clinical attention have other causes of liver disease, including alcoholic liver disease, non-alcoholic steatohepatitis, or features of hemochromatosis or autoimmune liver disease. Much of what is known about the prevalence of liver disease in ATD and its outcome comes from a prospective, relatively unbiased study started in Sweden in the 1970s (Piitulainen et al., 2005; Sveger, 1976). In this nationwide screening study, 200,000 newborns were screened and 127 homozygotes identified. "
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    ABSTRACT: The classical form of α1-antitrypsin deficiency (ATD) is an autosomal co-dominant disorder that affects ~1 in 3000 live births and is an important genetic cause of lung and liver disease. The protein affected, α1-antitrypsin (AT), is predominantly derived from the liver and has the function of inhibiting neutrophil elastase and several other destructive neutrophil proteinases. The genetic defect is a point mutation that leads to misfolding of the mutant protein, which is referred to as α1-antitrypsin Z (ATZ). Because of its misfolding, ATZ is unable to efficiently traverse the secretory pathway. Accumulation of ATZ in the endoplasmic reticulum of liver cells has a gain-of-function proteotoxic effect on the liver, resulting in fibrosis, cirrhosis and/or hepatocellular carcinoma in some individuals. Moreover, because of reduced secretion, there is a lack of anti-proteinase activity in the lung, which allows neutrophil proteases to destroy the connective tissue matrix and cause chronic obstructive pulmonary disease (COPD) by loss of function. Wide variation in the incidence and severity of liver and lung disease among individuals with ATD has made this disease one of the most challenging of the rare genetic disorders to diagnose and treat. Other than cigarette smoking, which worsens COPD in ATD, genetic and environmental modifiers that determine this phenotypic variability are unknown. A limited number of therapeutic strategies are currently available, and liver transplantation is the only treatment for severe liver disease. Although replacement therapy with purified AT corrects the loss of anti-proteinase function, COPD progresses in a substantial number of individuals with ATD and some undergo lung transplantation. Nevertheless, advances in understanding the variability in clinical phenotype and in developing novel therapeutic concepts is beginning to address the major clinical challenges of this mysterious disorder.
    Full-text · Article · Apr 2014 · Disease Models and Mechanisms
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    • "Kjell Ohlsson, Jan Olof Jeppson, Magne Fagerhöl and Diane Cox, the latter arriving in Malmö from Norway and Canada, respectively, focused their work on the explanation of the complex electrophoretic heterogeneity of AAT, eventually contributing to the development of Pi nomenclature for AAT variants [6-8]. In the meantime, Christeer Larson provided evidence for the interaction of smoking with AATD [9], thus contributing to the current oxidation stress/proteinase imbalance hypothesis of the pathogenesis of emphysema, and Tomas Sveger performed the Swedish newborn national screening for AATD, a hallmark event in the epidemiology of the disorder [10]. To complete the Scandinavian perspective, the same investigators detected the inclusion of AAT within hepatocytes of AATD subjects with liver disease [11], a finding that was however anticipated a few years before by Dr Sharp and colleagues in the US [12]. "
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    ABSTRACT: In 1963, six cases of alpha1-antitrypsin deficiency were reported in the scientific literature, as well as an attempt to treat pulmonary alveolar proteinosis by a massive washing of the lung (whole lung lavage). Now, fifty years later, it seems the ideal moment not only to commemorate these publications, but also to point out the influence both papers had in the following decades and how knowledge on these two fascinating rare respiratory disorders progressed over the years. This paper is therefore not aimed at being a comprehensive review for both disorders, but rather at comparing the evolution of alpha1-antitrypsin, a rare disorder, with that of pulmonary alveolar proteinosis, an ultra-rare disease. We wanted to emphasize how all stakeholders might contribute to the dissemination of the awareness of rare diseases, that need to be chaperoned from the ghetto of neglected disorders to the dignity of recognizable and treatable disorders.
    Full-text · Article · Sep 2013 · Orphanet Journal of Rare Diseases
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