Clinical symptoms of α-1-antitrypsin deficiency (AlATD) may originate either in the liver in children and adults or in the lung only in adults. Neonatal cholestasis, intrahepatic bile duct hypoplasia, chronic hepatitis, acute liver failure, and cirrhosis are the most common hepatic manifestations. Except for liver transplantation, there is no effective treatment of progressive hepatic disease associated with AlATD. Eighty to 90% of adults with AlATD develop destructive pulmonary emphysema, which seems to be caused by the unchecked action of proteases on lung tissue. Nonsmoking is an important measure to avoid emphysema. There have been attempts at replacement therapy with human AlAT, which are supposed to stop the development of emphysema. A1ATD must be considered when the a 1-globulin peak is missing in the cellulose acetate protein electrophoresis. It is confirmed by a serum level of Al AT below 100 mg/dl. The phenotype (Pi type) is determined by proof of one or two of the main deficiency alleles Z or S by acid starch gel electrophoresis or by isoelectric focusing. The normal level of AIAT in serum is between 150 and 350 mg/dl. It is coded by two M alleles (Pi-type MM). The most important deficiency variant is the homozygous Pi-type ZZ, in which the serum level of A1AT is between 10% and 20% of normal.
KeywordsCellulose Arthritis Starch Hepatitis Estrogen
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