Journal article

Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis.

  • Strnad P Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
  • Buch S Medical Department 1, University Hospital Dresden, Dresden, Germany.
  • Hamesch K Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
  • Fischer J Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
  • Rosendahl J Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
  • Schmelz R Medical Department 1, University Hospital Dresden, Dresden, Germany.
  • Brueckner S Medical Department 1, University Hospital Dresden, Dresden, Germany.
  • Brosch M Medical Department 1, University Hospital Dresden, Dresden, Germany.
  • Heimes CV Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
  • Woditsch V Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
  • Scholten D Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
  • Nischalke HD Department of Internal Medicine I, University of Bonn, Bonn, Germany.
  • Janciauskiene S Clinic for Pneumology, German Center for Lung Research (DZL), Medical University Hannover, Hannover, Germany.
  • Mandorfer M Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
  • Trauner M Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
  • Way MJ Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
  • McQuillin A Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK.
  • Reichert MC Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
  • Krawczyk M Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
  • Casper M Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
  • Lammert F Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
  • Braun F Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
  • von Schönfels W Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
  • Hinz S Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
  • Burmeister G Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
  • Hellerbrand C Institute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
  • Teufel A Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
  • Feldman A Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
  • Schattenberg JM Department of Medicine I, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
  • Bantel H Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Pathil A Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany.
  • Demir M Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
  • Kluwe J I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Boettler T Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
  • Ridinger M Department of Psychology, University of Konstanz, Konstanz, Germany.
  • Wodarz N Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
  • Soyka M Psychiatric Hospital, Ludwig Maximilians University, Munich, Germany.
  • Rietschel M Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
  • Kiefer F Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
  • Weber T Department for Clinical Research, University Hospital Bern, Bern, Switzerland.
  • Marhenke S Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Vogel A Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
  • Hinrichsen H Department of Gastroenterology, University Hospital Kiel, Kiel, Germany.
  • Canbay A Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
  • Schlattjan M Department of Gastroenterology and Hepatology, University Duisburg-Essen, Essen, Germany.
  • Sosnowsky K Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
  • Sarrazin C Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
  • von Felden J I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
  • Geier A Division of Hepatology, Department of Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany.
  • Deltenre P Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
  • Sipos B Institute of Pathology, University of Tuebingen, Tuebingen, Germany.
  • Schafmayer C Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
  • Nothnagel M Cologne Center for Genomics, University of Cologne, Cologne, Germany.
  • Aigner E Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
  • Datz C Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria.
  • Stickel F Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
  • Morgan MY Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
  • Hampe J Medical Department 1, University Hospital Dresden, Dresden, Germany.
  • Berg T Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
  • Trautwein C Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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  • 2018-08-03
Published in:
  • Gut. - 2019
English OBJECTIVE
Homozygous alpha1-antitrypsin (AAT) deficiency increases the risk for developing cirrhosis, whereas the relevance of heterozygous carriage remains unclear. Hence, we evaluated the impact of the two most relevant AAT variants ('Pi*Z' and 'Pi*S'), present in up to 10% of Caucasians, on subjects with non-alcoholic fatty liver disease (NAFLD) or alcohol misuse.


DESIGN
We analysed multicentric case-control cohorts consisting of 1184 people with biopsy-proven NAFLD and of 2462 people with chronic alcohol misuse, both cohorts comprising cases with cirrhosis and controls without cirrhosis. Genotyping for the Pi*Z and Pi*S variants was performed.


RESULTS
The Pi*Z variant presented in 13.8% of patients with cirrhotic NAFLD but only in 2.4% of counterparts without liver fibrosis (p<0.0001). Accordingly, the Pi*Z variant increased the risk of NAFLD subjects to develop cirrhosis (adjusted OR=7.3 (95% CI 2.2 to 24.8)). Likewise, the Pi*Z variant presented in 6.2% of alcohol misusers with cirrhosis but only in 2.2% of alcohol misusers without significant liver injury (p<0.0001). Correspondingly, alcohol misusers carrying the Pi*Z variant were prone to develop cirrhosis (adjusted OR=5.8 (95% CI 2.9 to 11.7)). In contrast, the Pi*S variant was not associated with NAFLD-related cirrhosis and only borderline with alcohol-related cirrhosis (adjusted OR=1.47 (95% CI 0.99 to 2.19)).


CONCLUSION
The Pi*Z variant is the hitherto strongest single nucleotide polymorphism-based risk factor for cirrhosis in NAFLD and alcohol misuse, whereas the Pi*S variant confers only a weak risk in alcohol misusers. As 2%-4% of Caucasians are Pi*Z carriers, this finding should be considered in genetic counselling of affected individuals.
Language
  • English
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https://sonar.ch/global/documents/278764
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