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Diagnosing α1-antitrypsin deficiency: how to improve the current algorithm

Noel G. McElvaney
European Respiratory Review 2015 24: 52-57; DOI: 10.1183/09059180.10010814
Noel G. McElvaney
Respiratory Research Division, Dept of Medicine, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland
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  • For correspondence: gmcelvaney@rcsi.ie
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  • FIGURE 1
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    FIGURE 1

    a) Forced expiratory volume in 1 s (FEV1) and b) FEV1/forced vital capacity (FVC) ratio in index and non-index patients with PI*SZ α1-antitrypsin deficiency included in the Danish α1-antitrypsin deficiency register. Data from [14].

  • FIGURE 2
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    FIGURE 2

    a) Isoelectric focusing electrophoresis of a rare Mmalton variant (homozygous) showing unusual M-like and Z-like bands, which was confirmed by b) DNA sequencing. Data from the Irish National Targeted Detection Programme (courtesy of N.G. McElvaney).

Tables

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  • TABLE 1

    Indications for adult lung transplants between January 1995 and June 2012

    DiagnosisTotal#
    COPD/emphysema12 602 (33.5)
    Idiopathic pulmonary fibrosis8904 (23.7)
    Cystic fibrosis6231 (16.6)
    α1-antitrypsin deficiency2182 (5.8)
    Idiopathic pulmonary arterial hypertension1160 (3.1)
    Other pulmonary fibrosis1383 (3.7)
    Bronchiectasis1015 (2.7)
    Sarcoidosis954 (2.5)
    Re-transplantation: obliterative bronchiolitis568 (1.5)
    Connective tissue disease488 (1.3)
    Obliterative bronchiolitis¶396 (1.1)
    Lymphangioleiomyomatosis391 (1.0)
    Re-transplantation+402 (1.1)
    Congenital heart disease325 (0.9)
    Cancer36 (0.1)
    Other544 (1.4)
    • Data are presented as n (%). COPD: chronic obstructive pulmonary disease #: n = 37 581; ¶: not re-transplantation; +: not obliterative bronchiolitis. Reproduced with modification from [11] with permission from the publisher.

  • TABLE 2

    Results from a family-based study to determine the risk of chronic obstructive pulmonary disease in PI*MM and PI*MZ individuals

    Genotypep-value
    PI*MM#PI*MZ¶
    FEV1/FVC
     Never-smoker0.81 (0.75–0.85)0.77 (0.73–0.83)ns
     Ever-smoker0.77 (0.72–0.81)0.71 (0.58–0.77)0.0013
    FEV1 % predicted
     Never-smoker101.3 (88.7–110.6)102.2 (88.3–108.4)ns
     Ever-smoker94.8 (82.1–102.4)82.3 (63.1–94.4)0.0009
    FEF25–75% % predicted
     Never-smoker84.1 (70.7–100.8)76.1 (63.6–99.4)ns
     Ever-smoker64.8 (52.2–90.2)47.7 (22.7–66.8)0.0002
    • Data are presented as median (interquartile range). FEV1: forced expiratory volume in 1 s; FVC: forced vital capacity; FEF25–75%: forced expiratory flow at 25–75% of FVC; ns: nonsignificant. #: n=99; ¶: n=89. Reproduced from [13] with permission from the publisher.

  • TABLE 3

    Rare α1-antitrypsin variants detected during screening of >12 000 patients in Ireland

    MutationMolecular basisPatients nCellular effectDisease risk
    IArg39Cys107Intracellular accumulationLung and liver
    FArg223Cys40Reduced antiprotease activityLung
    MmaltonΔPhe516Intracellular accumulation and polymerisationLung and liver
    MwurzburgPro369Ser1No AAT producedLung and liver
    Q0dublin370Phe - ΔT - 373Stop4No AAT producedLung
    Q0bolton362Pro - ΔC - 373Stop2No AAT producedLung
    Q0cork180Thr - ΔAC - 190Stop1No AAT producedLung
    • AAT: α1-antitrypsin. Data from the Irish National Targeted Detection Programme (courtesy of N.G. McElvaney).

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Diagnosing α1-antitrypsin deficiency: how to improve the current algorithm
Noel G. McElvaney
European Respiratory Review Mar 2015, 24 (135) 52-57; DOI: 10.1183/09059180.10010814

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Diagnosing α1-antitrypsin deficiency: how to improve the current algorithm
Noel G. McElvaney
European Respiratory Review Mar 2015, 24 (135) 52-57; DOI: 10.1183/09059180.10010814
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