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1-Antitrypsin Deficiency
* From the Department of Internal Medicine, University of Utah Health Sciences Center, Salt Lake City, UT.
Correspondence to: Edward J. Campbell, MD, University of Utah School of Medicine, 50 North Medical Dr, Salt Lake City, UT 84132
| Introduction |
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1-antitrypsin
1-Antitrypsin
(AAT)
deficiency is the most prevalent potentially fatal hereditary disease
in white individuals, and is an important risk factor for
pulmonary emphysema, especially in cigarette smokers. Traditional
enzyme kinetics provide a poor explanation for the increased risk of
lung injury in AAT deficiency. We have found that when millimolar
concentrations of leukocyte elastase are released from single azurophil
granules of activated neutrophils, they transiently overwhelm local
proteinase inhibitors, leading to evanescent quantum bursts of
proteolytic activity. Catalysis is quenched when enzyme
concentration no longer exceeds that of pericellular
inhibitors.1
2
Herein, we tested the possibility that
quantum proteolytic events are abnormal in AAT deficiency. We incubated
neutrophils on opsonized fluoresceinated fibronectin in serum from
individuals with various AAT phenotypes, and then measured and modeled
quantum proteolytic events. The mean areas of the events in serum from
heterozygotes (Pi MZ and Pi SZ) were 16.1 ± (SEM) 4.0
µm2 and 14.2 ± 3.3 µm2,
respectively, which were slightly (but significantly) larger than those
in serum from normals (Pi M), which were 9.7 ± 1.2
µm2. In marked contrast, events in serum from
AAT-deficient individuals were 97.4 ± 7.8 µm2.
Diffusion modeling predicted that local elastase concentrations exceed
AAT concentrations for <20 ms and >80 ms in Pi M and Pi Z
individuals, respectively. Thus, quantum proteolytic events are
abnormally large and prolonged in AAT deficiency, leading directly to
an increased risk of tissue injury in the immediate vicinity of
activated neutrophils. These results have potentially important
implications for the pathogenesis and prevention of lung disease in AAT
deficiency.
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