The molecular and cellular pathology of α₁-antitrypsin deficiency

Trends Mol Med. 2014 Feb;20(2):116-27. doi: 10.1016/j.molmed.2013.10.007. Epub 2013 Dec 25.


Since its discovery 50 years ago, α₁-antitrypsin deficiency has represented a case study in molecular medicine, with careful clinical characterisation guiding genetic, biochemical, biophysical, structural, cellular, and in vivo studies. Here we highlight the milestones in understanding the disease mechanisms and show how they have spurred the development of novel therapeutic strategies. α₁-Antitrypsin deficiency is an archetypal conformational disease. Its pathogenesis demonstrates the interplay between protein folding and quality control mechanisms, with aberrant conformational changes causing liver and lung disease through combined loss- and toxic gain-of-function effects. Moreover, α₁-antitrypsin exemplifies the ability of diverse proteins to self-associate into a range of morphologically distinct polymers, suggesting a mechanism for protein and cell evolution.

Keywords: cirrhosis; conformational disease; emphysema; misfolding; protein evolution; α(1)-antitrypsin deficiency.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Endoplasmic Reticulum / metabolism
  • Humans
  • Protein Multimerization
  • Protein Processing, Post-Translational
  • Proteolysis
  • Unfolded Protein Response
  • alpha 1-Antitrypsin / chemistry
  • alpha 1-Antitrypsin / genetics
  • alpha 1-Antitrypsin / metabolism
  • alpha 1-Antitrypsin Deficiency / etiology*
  • alpha 1-Antitrypsin Deficiency / pathology*
  • alpha 1-Antitrypsin Deficiency / therapy


  • alpha 1-Antitrypsin