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Alpha-1 antitrypsin (AAT) is a protein whose main function is the inhibition of neutrophil elastase. The gene that encodes AAT is transmitted by simple autosomal codominant Mendelian inheritance through two alleles, one from each parent. The normal allele is designated Pi*M, and the most common deficient alleles are the Pi*S and Pi*Z alleles, which encode abnormal proteins that undergo polymerization in the liver. Therefore, 80-90% of the Z proteins and 40-50% of the S proteins are retained within the hepatocytes, grouped into polymers. The loss of the anti-inflammatory and antiproteolytic activity, together with the pro-inflammatory effects of polymers, contribute to protein degradation and the exacerbation of inflammation, resulting in an increased risk of developing COPD, with a predominance of emphysema, especially in smokers.AAT deficiency (AATD) is a rare disease and, like most such diseases, is underdiagnosed. The diagnosis is usually made late (at an average patient age of 45 years), and estimates suggest that 85% of patients with AATD have gone un diagnosed.

Diagnosing alpha-1 antitrypsin deficiency: does it prevent or improve the course of COPD?