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ALPHA-1-ANTITRYPSIN DEFICIENCY |
1 Department of Internal Medicine, University of Brescia, Brescia, Italy
2 Unit of Pneumology, IRCCS Gaslini Institute, Genova, Italy
3 Biochemistry Laboratory, Ospedali Riuniti di Bergamo, Italy
Correspondence to:
Correspondence to:
Dr M Malerba
Department of Internal Medicine, University of Brescia, 1° Divisione di Medicina, Spedali Civili, Pzza Spedali Civili 1, 25100 Brescia, Italy; malerba{at}master.cci.unibs.it
ABSTRACT
Background: Severe alpha-1-antitrypsin deficiency (AATD), due to homozygosity for the protease inhibitor (Pi) Z allele, is a genetic risk factor for chronic obstructive pulmonary disease (COPD). In a previous study the sputum of severe AATD subjects with airflow obstruction showed a pattern of cellular inflammation similar to COPD patients. It is uncertain whether heterozygotes for the Z allele or intermediate deficiency (PiMZ) have an increased risk of developing COPD.
Methods: Sputum cell counts and the supernatant level of the neutrophil chemoattractant interleukin (IL)-8 were investigated by sputum induction in 10 non-smoker asymptomatic PiMZ subjects with normal pulmonary function, 10 patients with stable COPD, and 10 age matched normal subjects. Data are expressed as mean (SD).
Results: The mean (SD) number of neutrophils was significantly higher (p<0.01) in the sputum of PiMZ subjects (84.5 (22.2) x104/ml) and patients with COPD (126.9 (18.8) x104/ml) than in matched normal subjects (55.0 (8.7) x104/ml). IL-8 levels were increased in PiMZ subjects (828.5 (490.6) ng/ml; median 1003.0 ng/ml; range 1260–100 ng/ml) and in COPD patients (882.5 (524.3) ng/ml; median 934.9 ng/ml; range 1506–258 mg/ml) compared with normal subjects (3.5 (0.5) ng/ml; median 3.5 ng/ml; range 4.5–2.5 ng/ml). There was a significant positive correlation between IL-8 supernatant concentration and neutrophil count in PiMZ subjects (p = 0.036; r = 0.66). An inverse correlation was observed between the percentage of neutrophils and forced expiratory volume in 1 second (% predicted) in patients with COPD (p = 0.04; r = –0.43).
Conclusions: These findings indicate that PiMZ subjects without airflow obstruction may have an IL-8 related neutrophilic inflammation in the airways, similar to stable COPD patients, suggesting an increased risk of developing pulmonary changes.
Abbreviations: AAT, alpha-1-trypsin; AATD, alpha-1-trypsin deficiency; COPD, chronic obstructive pulmonary disease; FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; IL, interleukin; TLCO, carbon monoxide transfer factor
Keywords: 
1-antitrypsin deficiency; induced sputum; airway inflammation; chronic obstructive pulmonary disease
Relevant Article
Thorax 2006 61: 93.
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