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Background  Alpha-1 antitrypsin (A1AT) deficiency, caused by the Z allele  (p.E342K)  and S allele  (p.E264V)  in the  SERPINA1  gene, can induce liver and pulmonary disease. Different mechanisms appear to be responsible for the pathogenesis of these divergent disease expressions. The  c.-1973T  > C  polymorphism located in the  SERPINA1  promoter region is found more frequent in A1AT deficiency patients with liver disease compared to patients with pulmonary disease, but data are lacking regarding contribution to the development of liver diseases caused by other aetiologies.    Aim  To study the prevalence of  c.-1973T  > C , Z allele and S allele in a cohort of patients with liver disease of various aetiologies compared with healthy controls and to evaluate its effect on disease progression.    Methods  A total of 297 patients with liver disease from various aetiologies and 297 age and gender matched healthy controls were included. The  c.-1973T  > C  polymorphism and Z and S alleles of the  SERPINA1  gene were analyzed by real-time PCR.    Results   c.-1973T  > C  was similarly distributed between patients with liver disease of various origins and healthy controls. Furthermore, the distribution of  c.-1973T  > C  was independent from aetiology subgroup. In patients with liver disease mean ages at of onset of liver disease were 44.4, 42.3 and 40.7 years for the  c.-1973  T/T, T/C and C/C genotype respectively (NS). S allele heterozygosity was increased in patients with drug induced liver injury (DILI), (OR 4.3; 95%CI 1.1-17.2).    Conclusion  In our study,  c.-1973T  > C  polymorphism was not a risk factor for liver disease of various aetiologies. In addition, S allele heterozygosity might contribute to the development of DILI.

Prevalence of genetic polymorphisms in the promoter region of the alpha-1 antitrypsin (SERPINA1) gene in chronic liver disease: a case control study