Alpha 1 Antitrypsin Deficiency Pathophysiology, Symptoms, Diagnosis, Treatment
DOI:
https://doi.org/10.12775/QS.2025.40.59389Keywords
alpha-1-antitripsin, alpha-1-antitripsin deficiency diagnosis, alpha-1-antitripsin deficiency treatment, alpha-1-antitripsin symptomsAbstract
Introduction: This review paper aims to emphasize how Alpha-1-antitrypsin deficiency is how can lead to serious disease states, indicating the pathophysiology, symptoms, diagnostic possibilities, therapeutic methods and proving that early diagnostics for this deficiency can protect the patient from its serious consequences
Materials and methods: A review of chosen literature in the PubMed database was conducted, using the following keywords: „Alpha-1-antitrypsin deficiency”, „Alpha-1-antitrypsin”
Summary: Alpha-1-antitrypsin deficiency is a relatively common condition that is often overlooked in diagnostic evaluations. It can lead to serious health complications, substantially reduce quality of life, and even shorten a patient's lifespan. Early diagnosis is essential because it allows for the adoption of healthier lifestyle habits and more consistent health monitoring, which can help mitigate the condition’s long-term consequences.
Conclusions: Symptoms of alpha-1 antitrypsin deficiency are quite prevalent and can affect individuals across all age groups—from infants and children to adults and the elderly. This deficiency may lead to serious complications, including COPD, emphysema, asthma, liver cirrhosis, hepatocellular carcinoma (HCC). A deep understanding of its pathophysiology has enabled the development of improved diagnostic techniques and novel treatment strategies. For instance, in young adults with COPD and children exhibiting signs of liver disease, it is advisable to measure alpha-1 antitrypsin levels or perform genotyping. In cases where a significant deficiency is detected, initiating replacement therapy and closely monitoring the patient's health is crucial.
References
1. Hudock KM, Collins MS, Imbrogno MA, Kramer EL, Brewington JJ, Ziady A, Zhang N, Snowball J, Xu Y, Carey BC, Horio Y, O'Grady SM, Kopras EJ, Meeker J, Morgan H, Ostmann AJ, Skala E, Siefert ME, Na CL, Davidson CR, Gollomp K, Mangalmurti N, Trapnell BC, Clancy JP. Alpha-1 antitrypsin limits neutrophil extracellular trap disruption of airway epithelial barrier function. Front Immunol. 2023 Jan 10;13:1023553. doi: 10.3389/fimmu.2022.1023553. PMID: 36703990; PMCID: PMC9872031.
2. Barrecheguren M, Hidalgo PP, Gonçalves JMF, de Miguel Díez J. Diagnosis of Alpha-1 Antitrypsin Deficiency (AATD) in Primary Care. Open Respir Arch. 2024 Feb 19;6(2):100310. doi: 10.1016/j.opresp.2024.100310. PMID: 38560506; PMCID: PMC10981108.
3. Feitosa PH. Diagnosis and augmentation therapy for alpha-1 antitrypsin deficiency: current knowledge and future potential. Drugs Context. 2023 Jul 20;12:2023-3-1. doi: 10.7573/dic.2023-3-1. PMID: 37521109; PMCID: PMC10379007.
4. Dasí F. Alpha-1 antitrypsin deficiency. Med Clin (Barc). 2024 Apr 12;162(7):336-342. English, Spanish. doi: 10.1016/j.medcli.2023.10.014. Epub 2023 Nov 22. PMID: 37993348.
5. Shaik NA, Saud Al-Saud NB, Abdulhamid Aljuhani T, Jamil K, Alnuman H, Aljeaid D, Sultana N, El-Harouni AA, Awan ZA, Elango R, Banaganapalli B. Structural characterization and conformational dynamics of alpha-1 antitrypsin pathogenic variants causing alpha-1-antitrypsin deficiency. Front Mol Biosci. 2022 Nov 24;9:1051511. doi: 10.3389/fmolb.2022.1051511. PMID: 36504721; PMCID: PMC9730039.
6. Suri A, Patel D, Teckman J. Alpha-1-Antitrypsin Deficiency. Clin Liver Dis (Hoboken). 2022 Mar 27;19(3):89-92. doi: 10.1002/cld.1147. PMID: 35355837; PMCID: PMC8958251.
7. Quinn M, Ellis P, Pye A, Turner AM. Obstacles to Early Diagnosis and Treatment of Alpha-1 Antitrypsin Deficiency: Current Perspectives. Ther Clin Risk Manag. 2020 Dec 16;16:1243-1255. doi: 10.2147/TCRM.S234377. PMID: 33364772; PMCID: PMC7751439.
8. Santos G, Turner AM. Alpha-1 antitrypsin deficiency: an update on clinical aspects of diagnosis and management. Fac Rev. 2020 Oct 28;9:1. doi: 10.12703/b/9-1. PMID: 33659933; PMCID: PMC7886062.
9. Fraughen DD, Ghosh AJ, Hobbs BD, Funk GC, Meischl T, Clarenbach CF, Sievi NA, Schmid-Scherzer K, McElvaney OJ, Murphy MP, Roche AD, Clarke L, Strand M, Vafai-Tabrizi F, Kelly G, Gunaratnam C, Carroll TP, McElvaney NG. Augmentation Therapy for Severe Alpha-1 Antitrypsin Deficiency Improves Survival and Is Decoupled from Spirometric Decline-A Multinational Registry Analysis. Am J Respir Crit Care Med. 2023 Nov 1;208(9):964-974. doi: 10.1164/rccm.202305-0863OC. PMID: 37624745; PMCID: PMC10870866.
10. Stoller JK, Hupertz V, Aboussouan LS. Alpha-1 Antitrypsin Deficiency. 2006 Oct 27 [updated 2023 Jun 1]. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A, editors. GeneReviews® [Internet]. Seattle (WA): University of Washington, Seattle; 1993–2025. PMID: 20301692.
11. Turner AM, Ficker JH, Vianello A, Clarenbach CF, Janciauskiene S, Chorostowska-Wynimko J, Stolk J, McElvaney NG. Advancing the understanding and treatment of lung pathologies associated with alpha 1 antitrypsin deficiency. Ther Adv Respir Dis. 2025 Jan-Dec;19:17534666251318841. doi: 10.1177/17534666251318841. PMID: 39980299; PMCID: PMC11843710.
12. Pires Ferreira D, Gruntman AM, Flotte TR. Gene therapy for alpha-1 antitrypsin deficiency: an update. Expert Opin Biol Ther. 2023 Mar;23(3):283-291. doi: 10.1080/14712598.2023.2183771. Epub 2023 Mar 2. PMID: 36825473.
13. Pavičić T, Ćelap I, Njegovan M, Tešija Kuna A, Štefanović M. α-1 Antitrypsin Genotype-Phenotype Discrepancy in a 42-Year-Old Man Who Carries the Null-Allele. Lab Med. 2020 May 6;51(3):301-305. doi: 10.1093/labmed/lmz059. PMID: 31583408.
14. Leung DH, Sorensen LG, Ye W, Hawthorne K, Ng VL, Loomes KM, Fredericks EM, Alonso EM, Heubi JE, Horslen SP, Karpen SJ, Molleston JP, Rosenthal P, Sokol RJ, Squires RH, Wang KS, Kamath BM, Magee JC; Childhood Liver Disease Research Network (ChiLDReN). Neurodevelopmental Outcomes in Children With Inherited Liver Disease and Native Liver. J Pediatr Gastroenterol Nutr. 2022 Jan 1;74(1):96-103. doi: 10.1097/MPG.0000000000003337. PMID: 34694263; PMCID: PMC8673857.
15. D. R Nelson, J. Teckman, A. M Di Bisceglie, D. A Brenner. Diagnosis and management of patients with α1-antitrypsin (A1AT) deficiency Clin Gastroenterol Hepatol. 2012 Jun;10(6):575-80. doi: 10.1016/j.cgh.2011.12.028. Epub 2011 Dec 23.
16. M Q Sultan, B Charfeddine, A. Rassul Hussain Al-Salih, Evaluation of the diagnostic performance of Alpha-1-Antitrypsin in early detection of hepatocellular carcinoma. Cell Mol Biol (Noisy-le-grand). 2023 Dec 20;69(14):177-185. doi: 10.14715/cmb/2023.69.14.29.
17. Veith M, Klemmer A, Anton I, El Hamss R, Rapun N, Janciauskiene S, Kotke V, Herr C, Bals R, Vogelmeier CF, Greulich T. Diagnosing Alpha-1-Antitrypsin Deficiency Using A PCR/Luminescence-Based Technology. Int J Chron Obstruct Pulmon Dis. 2019 Nov 18;14:2535-2542. doi: 10.2147/COPD.S224221. PMID: 31819391; PMCID: PMC6873957.
18. M. Cornillet, H. Zemack, H. Jansson, E. Sparrelid, E.Ellis, N. K Björkström, Increased Prevalence of Alpha-1-Antitrypsin Deficiency in Patients with Biliary Tract Cancer and Its Associated Clinicopathological Features. Cells. 2023 Jun 19;12(12):1663. doi:10.3390/cells12121663.
19. Al Ashry HS, Strange C. COPD in individuals with the PiMZ alpha-1 antitrypsin genotype. Eur Respir Rev. 2017 Oct 25;26(146):170068. doi: 10.1183/16000617.0068-2017. PMID: 29070580; PMCID: PMC9488576.
20. Green CE, Vayalapra S, Hampson JA, Mukherjee D, Stockley RA, Turner AM. PiSZ alpha-1 antitrypsin deficiency (AATD): pulmonary phenotype and prognosis relative to PiZZ AATD and PiMM COPD. Thorax. 2015 Oct;70(10):939-45. doi: 10.1136/thoraxjnl-2015-206906. Epub 2015 Jul 3. PMID: 26141072.
21. Serban KA, Petrache I. Alpha-1 Antitrypsin and Lung Cell Apoptosis. Ann Am Thorac Soc. 2016 Apr;13 Suppl 2(Suppl 2):S146-9. doi: 10.1513/AnnalsATS.201505-312KV. PMID: 27115949; PMCID: PMC5466181.
22. Lin HC, Kasi N, Quiros JA. Alpha1-Antitrypsin Deficiency: Transition of Care for the Child With AAT Deficiency into Adulthood. Curr Pediatr Rev. 2019;15(1):53-61. doi: 10.2174/1573396314666181113094517. PMID: 30421678; PMCID: PMC6696823.
23. Patel D, McAllister SL, Teckman JH. Alpha-1 antitrypsin deficiency liver disease. Transl Gastroenterol Hepatol. 2021 Apr 5;6:23. doi: 10.21037/tgh.2020.02.23. PMID: 33824927; PMCID: PMC7829072.
24. Miravitlles M, Dirksen A, Ferrarotti I, Koblizek V, Lange P, Mahadeva R, McElvaney NG, Parr D, Piitulainen E, Roche N, Stolk J, Thabut G, Turner A, Vogelmeier C, Stockley RA. European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency. Eur Respir J. 2017 Nov 30;50(5):1700610. doi: 10.1183/13993003.00610-2017. PMID: 29191952.
25. Torres-Durán M, Lopez-Campos JL, Barrecheguren M, Miravitlles M, Martinez-Delgado B, Castillo S, Escribano A, Baloira A, Navarro-Garcia MM, Pellicer D, Bañuls L, Magallón M, Casas F, Dasí F. Alpha-1 antitrypsin deficiency: outstanding questions and future directions. Orphanet J Rare Dis. 2018 Jul 11;13(1):114. doi: 10.1186/s13023-018-0856-9. PMID: 29996870; PMCID: PMC6042212.
26. Tanash HA, Nilsson PM, Nilsson JA, Piitulainen E. Survival in severe alpha-1-antitrypsin deficiency (PiZZ). Respir Res. 2010 Apr 26;11(1):44. doi: 10.1186/1465-9921-11-44. PMID: 20420704; PMCID: PMC2867977.
27. Stoller JK, Tomashefski J Jr, Crystal RG, Arroliga A, Strange C, Killian DN, Schluchter MD, Wiedemann HP. Mortality in individuals with severe deficiency of alpha1-antitrypsin: findings from the National Heart, Lung, and Blood Institute Registry. Chest. 2005 Apr;127(4):1196-204. doi: 10.1378/chest.127.4.1196. PMID: 15821195.
28. Mayer AS, Stoller JK, Vedal S, Ruttenber AJ, Strand M, Sandhaus RA, Newman LS. Risk factors for symptom onset in PI*Z alpha-1 antitrypsin deficiency. Int J Chron Obstruct Pulmon Dis. 2006;1(4):485-92. doi: 10.2147/copd.2006.1.4.485. PMID: 18044105; PMCID: PMC2707814.
29. Graham RP, Dina MA, Howe SC, Butz ML, Willkomm KS, Murray DL, Snyder MR, Rumilla KM, Halling KC, Highsmith WE Jr. SERPINA1 Full-Gene Sequencing Identifies Rare Mutations Not Detected in Targeted Mutation Analysis. J Mol Diagn. 2015 Nov;17(6):689-94. doi: 10.1016/j.jmoldx.2015.07.002. Epub 2015 Aug 28. PMID: 26321041.
30. de Serres F, Blanco I. Role of alpha-1 antitrypsin in human health and disease. J Intern Med. 2014 Oct;276(4):311-35. doi: 10.1111/joim.12239. Epub 2014 May 13. PMID: 24661570.
31. Stirpe E, Bardaro F. Alpha1-antitrypsin deficiency and asthma. Monaldi Arch Chest Dis. 2022 Feb 22;92(4). doi: 10.4081/monaldi.2022.2179. PMID: 35225443.
32. Tuder RM, Janciauskiene SM, Petrache I. Lung disease associated with alpha1-antitrypsin deficiency. Proc Am Thorac Soc. 2010 Nov;7(6):381-6. doi: 10.1513/pats.201002-020AW. PMID: 21030517; PMCID: PMC3136958.
33. Sapey E. Neutrophil Modulation in Alpha-1 Antitrypsin Deficiency. Chronic Obstr Pulm Dis. 2020 Jul;7(3):247-259. doi: 10.15326/jcopdf.7.3.2019.0164. PMID: 32697897; PMCID: PMC7857711.
34. Fazleen A, Wilkinson T. The emerging role of proteases in α1-antitrypsin deficiency and beyond. ERJ Open Res. 2021 Nov 22;7(4):00494-2021. doi: 10.1183/23120541.00494-2021. PMID: 34820446; PMCID: PMC8607071.
35. Miravitlles M, Anzueto A, Barrecheguren M. Nine controversial questions about augmentation therapy for alpha-1 antitrypsin deficiency: a viewpoint. Eur Respir Rev. 2023 Dec 6;32(170):230170. doi: 10.1183/16000617.0170-2023. PMID: 38056890; PMCID: PMC10698548.
36. Bukhari H, Mattman A, Ritchie G, Burns L, Yoshida E, Schaeffer D, Yang HM. Molecular confirmation of alpha 1-antitrypsin deficiency in liver transplant setting: A province-wide experience. Hepatol Forum. 2023 Dec 7;5(2):68-72. doi: 10.14744/hf.2022.2022.0032. PMID: 38487736; PMCID: PMC10936117.
37. Stone H, Pye A, Stockley RA. Disease associations in alpha-1-antitrypsin deficiency. Respir Med. 2014 Feb;108(2):338-43. doi: 10.1016/j.rmed.2013.10.006. Epub 2013 Oct 14. PMID: 24176989.
38. Feitosa PHR, Castellano MVCO, Costa CHD, Cardoso ADRO, Pereira LFF, Fernandes FLA, Costa FM, Felisbino MB, Oliveira AFF, Jardim JR, Miravitlles M. Recommendations for the diagnosis and treatment of alpha-1 antitrypsin deficiency. J Bras Pneumol. 2024 Dec 6;50(5):e20240235. doi: 10.36416/1806-3756/e20240235. PMID: 39661838; PMCID: PMC11601085.
39. Stoller JK, Aboussouan LS. Alpha1-antitrypsin deficiency. Lancet. 2005 Jun 25-Jul 1;365(9478):2225-36. doi: 10.1016/S0140-6736(05)66781-5. PMID: 15978931.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Kamil Kościelecki , Agnieszka Kalisz, Aleksandra Okońska, Julia Kozakiewicz, Iwona Skorulska, Patrycja Długozima, Aleksandra Głowacka, Weronika Barbara Grywińska, Paulina Grzeszczuk, Klaudia Mączewska

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 171
Number of citations: 0