1. Association of circulating Z-polymer with adverse clinical outcomes and liver fibrosis in adults with alpha-1 antitrypsin deficiency.
- Author
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Fromme M, Rademacher L, Amzou S, Cook CD, Zacharias I, Zhang L, Ripollone JE, and Strnad P
- Subjects
- Humans, Male, Female, Middle Aged, Adult, Liver Transplantation, Elasticity Imaging Techniques, Biomarkers blood, Aged, Mutation, Proportional Hazards Models, Case-Control Studies, Liver pathology, Liver diagnostic imaging, alpha 1-Antitrypsin Deficiency complications, alpha 1-Antitrypsin Deficiency blood, alpha 1-Antitrypsin Deficiency diagnosis, alpha 1-Antitrypsin Deficiency genetics, Liver Cirrhosis blood, Liver Cirrhosis etiology, Liver Cirrhosis diagnosis, Liver Cirrhosis pathology, alpha 1-Antitrypsin blood, alpha 1-Antitrypsin genetics, Genotype
- Abstract
Background: Circulating polymerized mutant Z-alpha-1 antitrypsin (Z-polymer) constitutes a characteristic feature in alpha-1 antitrypsin deficiency (AATD), but there is limited knowledge about its association with adverse clinical outcomes and liver fibrosis. We explored this association using data from a large cohort of adults with AATD., Methods: A total of 836 (431 PiZZ, 405 PiMZ) adults with AATD and 312 controls (PiMM) from the European Alpha-1 Liver Cohort (2015-2020) were included. Time-to-event analyses were conducted for adults with the PiZZ genotype followed for adverse clinical outcomes (earliest occurrence of liver-related hospitalization, liver transplant or all-cause mortality). Cox proportional hazard models were used to describe the association between binary circulating Z-polymer levels and adverse clinical outcomes. Correlations between baseline circulating Z-polymer levels and baseline liver fibrosis (liver stiffness measurement [LSM] determined by transient elastography [FibroScan®]) were evaluated. The analyses were stratified by augmentation therapy status., Results: Of 324 adults with the PiZZ genotype and longitudinal follow-up data, 28 reported adverse clinical outcomes. Higher baseline circulating Z-polymer levels were associated with an increased risk of adverse clinical outcomes in both crude (hazard ratio [95% confidence interval, CI], 2.88 [1.21, 6.87]) and age-adjusted (1.96 [0.78, 4.94]) analyses. In adults with the PiZZ genotype, circulating Z-polymer levels were weakly positively correlated with baseline LSM (Spearman's rho [95% CI]: 0.21 [0.11, 0.31]). Similar results were observed after stratification by augmentation therapy status., Conclusions: In adults with the PiZZ genotype, higher circulating Z-polymer levels were associated with a shorter time to adverse clinical outcome, and positively correlated with baseline LSM. Circulating Z-polymer levels may be a prognostic biomarker of clinically relevant disease in AATD., (© 2024 The Author(s). United European Gastroenterology Journal published by Wiley Periodicals LLC on behalf of United European Gastroenterology.)
- Published
- 2024
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