Alpha-1 antitrypsin deficiency

Información en español Title

Other Names:

AAT deficiency; A1AT deficiency; AATD; AAT deficiency; A1AT deficiency; AATD; Alpha 1 antitrypsin deficiency See More

Categories:

Congenital and Genetic Diseases; Digestive Diseases; Kidney and Urinary Diseases; Congenital and Genetic Diseases; Digestive Diseases; Kidney and Urinary Diseases; Lung Diseases; Metabolic disorders; Newborn Screening See More

Summary Summary

Alpha-1 antitrypsin deficiency (AATD) is a hereditary disease where there is an increased risk of having chronic obstructive pulmonary disease (COPD), liver disease, skin problems (panniculitis) and vasculitis.^[1]^[2]^[3] Pulmonary problems occur in adults, and liver disease (cirrhosis) in adults and children. Age of onset and severity of AATD can vary based on how much ATT protein an affected person is missing. Signs and symptoms may include shortness of breath and wheezing, repeated infections of the lungs and liver, yellow skin, fatigue, rapid heartbeat when standing, vision problems, and weight loss. However, some people with AATD may not have any problems.^[4] AATD is caused by mutations in the SERPINA1 gene and it is inherited in a codominant manner.^[4] The mutations result in a deficiency or absence of the alpha-1 antitrypsin (AAT) protein in the blood. AAT is made in the liver and sent through the bloodstream to the lungs where it helps protect the lungs from damage. Having low levels of ATT (or no ATT) may damage the lungs. In the liver, damage results when there is a build-up of AAT.^[1]^[4]^[5] Treatment involves infusions of AAT. It may also include bronchodilators, antibiotics for upper respiratory tract infections, and in severe cases, lung transplantation.^[2]^[4]^[5]

Last updated: 1/3/2018

Symptoms Symptoms

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms	Other Names	Learn More: HPO ID
80%-99% of people have these symptoms
Emphysema		0002097
Hepatic failure	Liver failure	0001399
30%-79% of people have these symptoms
Hepatitis	Liver inflammation	0012115
Hepatomegaly	Enlarged liver	0002240
Jaundice	Yellow skin Yellowing of the skin [ more ]	0000952
5%-29% of people have these symptoms
Cirrhosis	Scar tissue replaces healthy tissue in the liver	0001394
Nephrotic syndrome		0000100
Percent of people who have these symptoms is not available through HPO
Autosomal recessive inheritance		0000007
Chronic obstructive pulmonary disease		0006510
Dyspnea	Trouble breathing	0002094
Elevated hepatic transaminase	High liver enzymes	0002910
Hepatocellular carcinoma		0001402

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Last updated: 9/1/2018

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Cause Cause

Alpha-1 antitrypsin deficiency (AATD) is caused by mutations in the SERPINA1 gene. This gene gives the body instructions to make a protein called alpha-1 antitrypsin (AAT), which protects the body from an enzyme called neutrophil elastase. Neutrophil elastase helps the body fight infections, but it can also attack healthy tissues (especially the lungs) if not controlled by AAT.^[4]^[2]

Mutations that cause AAT can cause a deficiency or absence of AAT, or a form of AAT that does not work well. This allows neutrophil elastase to destroy lung tissue, causing lung disease.^[4]^[1]

In addition, abnormal AAT can build up in the liver and cause damage to the liver. specially in people who have the allele ZZ (PI * ZZ) of AAT. Liver problems do not occur in people who have the null (that result in none or almost none AAT).^[1]

The severity of AATD may also be worsened by environmental factors such as exposure to tobacco smoke, dust, and chemicals.^[4]

Last updated: 1/3/2018

Diagnosis Diagnosis

Alpha-1 antitrypsin deficiency (AATD) may first be suspected in people with evidence of liver disease at any age, or lung disease (such as emphysema), especially when there is no obvious cause or it is diagnosed at a younger age.

Confirming the diagnosis involves a blood test showing a low serum concentration of the alpha-1 antitrypsin (AAT) protein, and either:

detecting a functionally deficient AAT protein variant by isoelectric focusing (a method for detecting mutations); or
detecting SERPINA1 gene mutations on both copies of the gene with molecular genetic testing. (This confirms the diagnosis when the above-mentioned tests are not performed or their results are not in agreement.)^[6]

Specialists involved in the diagnosis may include primary care doctors, pulmonologists (lung specialists), and/or hepatologists (liver specialists).^[7]

Last updated: 4/7/2016

Treatment Treatment

The treatment is basically done by giving the enzyme alpha-1 antitrypsin (intravenous infusion of purified, human AAT) to prevent the progression of lung disease, aiming to increase the level of alpha-1 antitrypsin in the blood. Skin problems usually get better when the enzyme is given. It is recommended to avoid smoking and drinking.

Other treatments include: ^[2]^[8]^[9]

Bronchodilators and inhaled steroids can help open the airways and make breathing easier
Lung volume reduction surgery
Lung transplantation for patients with advanced emphysema due to severe AAT deficiency
Liver transplantation for patients with severe liver disease. After a liver transplant the AAT deficiency is corrected, because normal donor liver produces and secretes normal AAT
Antibiotics if there are infections.

It is also recommended: ^[2]

Vaccination against hepatitis A and B
Preventive vaccines against influenza and pneumococcal vaccines.

Ongoing research for other treatments include:^[2]^[8]^[9]

Gene therapy to replace the abnormal gene with a normal SERPINA1 gene (gene therapy) in the liver cells
Nasal spray with alpha-1 antitrypsin
Synthetic inhibitors of human neutrophil elastase (intravenously and orally) which theoretically could provide protection against lung damage
Antioxidant therapy with vitamins A, C and E and N-acetylcysteine for the treatment of emphysema
Medications to increase blood levels of AAT and decrease liver damage (Rapamycin and carbamazepine).

Treatment with purified alpha-1 antitrypsin is indicated only when individuals:^[2]^[8]

Are older than 18 years of age
Have levels of alpha-1 antitrypsin in blood that are less than 11 micromoles / liter
Have pulmonary function tests (spirometer ) that show airway obstruction
Do not smoke or have stopped smoking for at least the last 6 months
Are willing to be treated at the hospital
Do not have immunoglobulin A deficiency (because the therapy with alpha-1 may contain traces of immunoglobulin type A (IgA), and patients with IgA deficiency may have antibodies against IgA)
In some cases it is also done in people who have normal airflow but who have a CT scan that shows emphysema in the lung.

Patients with severe alpha-1 antitrypsin deficiency should have lung function test every six to 12 months. Liver function should be evaluated periodically in people with two abnormal copies of the Z allele (PI * ZZ). In cases of liver disease, liver ultrasound should be done every 6 to 12 months to monitor for fibrotic changes and liver cancer (hepatocellular carcinoma).^[2]

Last updated: 1/3/2018

Management Guidelines

Orphanet Emergency Guidelines is an article which is expert-authored and peer-reviewed that is intended to guide health care professionals in emergency situations involving this condition.

FDA-Approved Treatments

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products.

Alpha1-Proteinase Inhibitor (Human) (Brand name: Prolastin) - Manufactured by Grifols United States
FDA-approved indication: For chronic replacement therapy of individuals having congenital deficiency of alpha1- proteinase inhibitor with clinically demonstrable panacinar emphysema.
National Library of Medicine Drug Information Portal

Find a Specialist Find a Specialist

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources

Alpha-1 Foundation Genetic Counseling Center. The Call Center offers information and resources to individuals, family members and medical professionals on the genetics of Alpha-1 and provides information on testing options. Contact 800-785-3177 to ask a genetic counselor questions about alpha 1 antitrypsin deficiency.
To find a medical professional who specializes in genetics, you can ask your doctor for a referral or you can search for one yourself. Online directories are provided by the American College of Medical Genetics and the National Society of Genetic Counselors. If you need additional help, contact a GARD Information Specialist. You can also learn more about genetic consultations from Genetics Home Reference.

Research Research

Research helps us better understand diseases and can lead to advances in diagnosis and treatment. This section provides resources to help you learn about medical research and ways to get involved.

Clinical Research Resources

ClinicalTrials.gov lists trials that are related to Alpha-1 antitrypsin deficiency. Click on the link to go to ClinicalTrials.gov to read descriptions of these studies.

Please note: Studies listed on the ClinicalTrials.gov website are listed for informational purposes only; being listed does not reflect an endorsement by GARD or the NIH. We strongly recommend that you talk with a trusted healthcare provider before choosing to participate in any clinical study.

Organizations Organizations

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Alpha-1 Awareness UK
PO Box 2866
Eastville
BRISTOL
BS5 5EE
United Kingdom
E-mail: info@Alpha1Awareness.org.uk.
Website: http://www.Alpha1Awareness.org.uk
Alpha-1 Canada
1638 Northway Avenue
Windsor, ON, N9B 3L9 Canada
Toll-free: 888-669-4583
Telephone: 519-258-1444
Fax: 519-258-1614
E-mail: info@alpha1canada.ca
Website: http://www.alpha1canada.ca
Alpha-1 Foundation
3300 Ponce de Leon Blvd.
Coral Gables, FL 33134
Toll-free: 877-228-7321
Telephone: 305-567-9888
Fax: 305-567-1317
E-mail: info@alpha-1foundation.org
Website: http://www.alpha-1foundation.org/

Organizations Providing General Support

American Liver Foundation
39 Broadway Street
Suite 2700
New York, NY 10006
Toll-free: 1-800-465-4837
Telephone: +1-212-668-1000
E-mail: https://liverfoundation.org/for-patients/contact-us/
Website: http://www.liverfoundation.org/

Do you know of an organization? We want to hear from you.

Living With Living With

Living with a genetic or rare disease can impact the daily lives of patients and families. These resources can help families navigate various aspects of living with a rare disease.

Financial Resources

National Organization for Rare Disorders (NORD) has Disease-Specific Assistance Programs designed to help patients with out-of-pocket costs such as monthly insurance premiums or deductibles. In addition, some programs may provide financial assistance for additional expenses related to a patient's diagnosis such as travel to see a specialist.
Patient Services, Inc (PSI) provides financial support and guidance for qualified patients with specific chronic diseases. PSI helps patients find solutions to the social and economic problems confronting patients with chronic conditions.

Learn More Learn More

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

Genetics Home Reference (GHR) contains information on Alpha-1 antitrypsin deficiency. This website is maintained by the National Library of Medicine.
MedlinePlus was designed by the National Library of Medicine to help you research your health questions, and it provides more information about this topic.
The National Heart, Lung, and Blood Institute (NHLBI) has information on this topic. NHLBI is part of the National Institutes of Health and supports research, training, and education for the prevention and treatment of heart, lung, and blood diseases.
The National Human Genome Research Institute's (NHGRI) website has an information page on this topic. NHGRI is part of the National Institutes of Health and supports research on the structure and function of the human genome and its role in health and disease.
The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

GeneReviews provides current, expert-authored, peer-reviewed, full-text articles describing the application of genetic testing to the diagnosis, management, and genetic counseling of patients with specific inherited conditions.
Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine.
Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
PubMed is a searchable database of medical literature and lists journal articles that discuss Alpha-1 antitrypsin deficiency. Click on the link to view a sample search on this topic.

Selected Full-Text Journal Articles

Sandhaus RA, Turino G, Brantly ML, et al. The Diagnosis and Management of Alpha-1 Antitrypsin Deficiency in the Adult. Chronic Obstr Pulm Dis (Miami). 2016; 3(3):668-682.

GARD Answers GARD Answers

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know. Submit a new question

I have been recently diagnosed with the alpha-1 antitrypsin deficiency gene along with my brother. He found out he had it and told the family we should get checked because it's inherited. I'm level 25 and he is level 30. My question is what is the treatment process for the disease? My brother and I are almost 60 but our kids are still young. What would the process be for them? See answer
My birth mother's maternal half-sister died from this disease. What are the chances of me or one of my six children having this genetic disorder? See answer
I think I may have alpha-1-antitrypsin deficiency. How is it diagnosed? Who should I talk to? See answer
What are the chances of having alpha 1-antitrypsin deficiency and panniculitis? See answer