Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis.
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Strnad P
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Buch S
Medical Department 1, University Hospital Dresden, Dresden, Germany.
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Hamesch K
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Fischer J
Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
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Rosendahl J
Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
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Schmelz R
Medical Department 1, University Hospital Dresden, Dresden, Germany.
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Brueckner S
Medical Department 1, University Hospital Dresden, Dresden, Germany.
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Brosch M
Medical Department 1, University Hospital Dresden, Dresden, Germany.
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Heimes CV
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Woditsch V
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Scholten D
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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Nischalke HD
Department of Internal Medicine I, University of Bonn, Bonn, Germany.
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Janciauskiene S
Clinic for Pneumology, German Center for Lung Research (DZL), Medical University Hannover, Hannover, Germany.
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Mandorfer M
Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
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Trauner M
Clinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
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Way MJ
Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
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McQuillin A
Molecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK.
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Reichert MC
Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Krawczyk M
Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Casper M
Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Lammert F
Department of Medicine II, Saarland University Medical Center, Homburg, Germany.
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Braun F
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
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von Schönfels W
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
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Hinz S
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
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Burmeister G
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
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Hellerbrand C
Institute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
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Teufel A
Department of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
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Feldman A
Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
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Schattenberg JM
Department of Medicine I, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
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Bantel H
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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Pathil A
Department of Internal Medicine IV, Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany.
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Demir M
Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
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Kluwe J
I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Boettler T
Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
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Ridinger M
Department of Psychology, University of Konstanz, Konstanz, Germany.
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Wodarz N
Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
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Soyka M
Psychiatric Hospital, Ludwig Maximilians University, Munich, Germany.
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Rietschel M
Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
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Kiefer F
Faculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
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Weber T
Department for Clinical Research, University Hospital Bern, Bern, Switzerland.
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Marhenke S
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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Vogel A
Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
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Hinrichsen H
Department of Gastroenterology, University Hospital Kiel, Kiel, Germany.
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Canbay A
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
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Schlattjan M
Department of Gastroenterology and Hepatology, University Duisburg-Essen, Essen, Germany.
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Sosnowsky K
Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
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Sarrazin C
Department of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
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von Felden J
I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Geier A
Division of Hepatology, Department of Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany.
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Deltenre P
Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
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Sipos B
Institute of Pathology, University of Tuebingen, Tuebingen, Germany.
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Schafmayer C
Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
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Nothnagel M
Cologne Center for Genomics, University of Cologne, Cologne, Germany.
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Aigner E
Department of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
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Datz C
Department of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria.
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Stickel F
Department of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
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Morgan MY
Institute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
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Hampe J
Medical Department 1, University Hospital Dresden, Dresden, Germany.
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Berg T
Section of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
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Trautwein C
Medical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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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.
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Language
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Open access status
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green
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Persistent URL
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https://sonar.ch/global/documents/278764
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