Alpha -Antitrypsin Deficiency
The new england journal of medicine Review Article Dan L. Longo, M.D., Editor Alpha1-Antitrypsin Deficiency Pavel Strnad, M.D., Noel G. McElvaney, D.Sc., and David A. Lomas, Sc.D. lpha1-antitrypsin (AAT) deficiency is one of the most common From the Department of Internal Med genetic diseases. Most persons carry two copies of the wild-type M allele icine III, University Hospital RWTH of SERPINA1, which encodes AAT, and have normal circulating levels of the (Rheinisch–Westfälisch Technische Hoch A schule) Aachen, Aachen, Germany (P.S.); protein. Ninety-five percent of severe cases of AAT deficiency result from the homo- the Irish Centre for Genetic Lung Dis zygous substitution of a single amino acid, Glu342Lys (the Z allele), which is present ease, Royal College of Surgeons in Ire in 1 in 25 persons of European descent (1 in 2000 persons of European descent land, Beaumont Hospital, Dublin (N.G.M.); and UCL Respiratory, Division of Medi are homozygotes). Mild AAT deficiency typically results from a different amino cine, Rayne Institute, University College acid replacement, Glu264Val (the S allele), which is found in 1 in 4 persons in the London, London (D.A.L.). Address re Iberian peninsula. However, many other alleles have been described that have vari- print requests to Dr. Lomas at UCL Re spiratory, Rayne Institute, University Col able effects, such as a lack of protein production (null alleles), production of mis- lege London, London WC1E 6JF, United folded protein, or no effect on the level or function of circulating AAT (Table 1). Kingdom, or at d .
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