Heterozygous carriage of the alpha1-antitrypsin Pi*Z variant increases the risk to develop liver cirrhosis.
Strnad PMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Buch SMedical Department 1, University Hospital Dresden, Dresden, Germany.
Hamesch KMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Fischer JSection of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
Rosendahl JSection of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
Schmelz RMedical Department 1, University Hospital Dresden, Dresden, Germany.
Brueckner SMedical Department 1, University Hospital Dresden, Dresden, Germany.
Brosch MMedical Department 1, University Hospital Dresden, Dresden, Germany.
Heimes CVMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Woditsch VMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Scholten DMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
Nischalke HDDepartment of Internal Medicine I, University of Bonn, Bonn, Germany.
Janciauskiene SClinic for Pneumology, German Center for Lung Research (DZL), Medical University Hannover, Hannover, Germany.
Mandorfer MClinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
Trauner MClinic for Gastroenterology und Hepatology, Medical University Vienna, Vienna, Austria.
Way MJInstitute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
McQuillin AMolecular Psychiatry Laboratory, Division of Psychiatry, University College London, London, UK.
Reichert MCDepartment of Medicine II, Saarland University Medical Center, Homburg, Germany.
Krawczyk MDepartment of Medicine II, Saarland University Medical Center, Homburg, Germany.
Casper MDepartment of Medicine II, Saarland University Medical Center, Homburg, Germany.
Lammert FDepartment of Medicine II, Saarland University Medical Center, Homburg, Germany.
Braun FDepartment of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
von Schönfels WDepartment of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Hinz SDepartment of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Burmeister GDepartment of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Hellerbrand CInstitute of Biochemistry, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany.
Teufel ADepartment of Internal Medicine I, University Hospital Regensburg, Regensburg, Germany.
Feldman ADepartment of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
Schattenberg JMDepartment of Medicine I, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany.
Bantel HDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Pathil ADepartment of Internal Medicine IV, Gastroenterology and Hepatology, University of Heidelberg, Heidelberg, Germany.
Demir MClinic for Gastroenterology and Hepatology, University Hospital of Cologne, Cologne, Germany.
Kluwe JI. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Boettler TDepartment of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
Ridinger MDepartment of Psychology, University of Konstanz, Konstanz, Germany.
Wodarz NDepartment of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany.
Soyka MPsychiatric Hospital, Ludwig Maximilians University, Munich, Germany.
Rietschel MFaculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Kiefer FFaculty of Medicine Mannheim, Central Institute of Mental Health, University of Heidelberg, Mannheim, Germany.
Weber TDepartment for Clinical Research, University Hospital Bern, Bern, Switzerland.
Marhenke SDepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Vogel ADepartment of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
Hinrichsen HDepartment of Gastroenterology, University Hospital Kiel, Kiel, Germany.
Canbay ADepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University, Magdeburg, Germany.
Schlattjan MDepartment of Gastroenterology and Hepatology, University Duisburg-Essen, Essen, Germany.
Sosnowsky KDepartment of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
Sarrazin CDepartment of Internal Medicine 1, J.W. Goethe University Hospital Frankfurt, Frankfurt, Germany.
von Felden JI. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Geier ADivision of Hepatology, Department of Medicine II, University Hospital Wuerzburg, Wuerzburg, Germany.
Deltenre PDivision of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.
Sipos BInstitute of Pathology, University of Tuebingen, Tuebingen, Germany.
Schafmayer CDepartment of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany.
Nothnagel MCologne Center for Genomics, University of Cologne, Cologne, Germany.
Aigner EDepartment of Internal Medicine I, University Hospital Salzburg, Salzburg, Austria.
Datz CDepartment of Internal Medicine, Hospital Oberndorf, Teaching Hospital of the Paracelsus Private University of Salzburg, Oberndorf, Austria.
Stickel FDepartment of Gastroenterology and Hepatology, University Hospital of Zurich, Zurich, Switzerland.
Morgan MYInstitute for Liver & Digestive Health, Division of Medicine, Royal Free Campus, University College London, London, UK.
Hampe JMedical Department 1, University Hospital Dresden, Dresden, Germany.
Berg TSection of Hepatology, Department of Internal Medicine, University Hospital Leipzig, Leipzig, Germany.
Trautwein CMedical Clinic III, Gastroenterology, Metabolic Diseases and Intensive Care, University Hospital RWTH Aachen, Aachen, Germany.
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.