Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have studied the clinical histories and liver biopsy findings in 1951 consecutive adult patients with suspected chronic liver disease, and in four known PiZ-homozygous alpha 1-antitrypsin-deficient patients with emphysema (candidates for lung transplant) and no known liver disease, in order to assess the importance of periportal alpha 1-antitrypsin granules in the liver and their possible causal role in liver disease, and to assess the value of possible screening tests. Periportal granules were found in 30 (1.5 per cent) of the 1951 liver biopsies and in all four known PiZ-homozygous subjects. They were the sole putative aetiological agent in eight of 85 patients (9.4 per cent) with otherwise cryptogenic cirrhosis and present in 2.5 per cent of patients with cirrhosis of known aetiology (alcohol, autoimmune etc.). All but one were Z phenotype (seven homozygotes, 22 heterozygotes). alpha 1-Antitrypsin granules were seen in 12 patients (including three of four lung transplant candidates) with no histological chronic liver disease. Determination of serum alpha 1-antitrypsin levels was quite unhelpful in identifying these patients. This study does not support the concept that periportal alpha 1-antitrypsin granules are necessarily pathogenic, but in some cases they may be causally related to otherwise cryptogenic liver disease. The presence of granules gave no important diagnostic, therapeutic or prognostic information.
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PMID:Alpha 1-antitrypsin granules in the liver--always important? 221 74

Healthy, nonsmoking human volunteers were exposed to environmentally relevant concentrations of NO2 followed by bronchoalveolar lavage (BAL) to study whether NO2 exposure decreases the functional activity of alpha-1-proteinase inhibitor (alpha 1-PI) in the lung. Two 3-h exposure protocols with intermittent exercise were employed and BAL was performed 3.5 h after exposure. The first exposure protocol with nine subjects involved three 2-ppm "peaks" with a 0.05 ppm background, whereas the second protocol with 15 subjects was a continuous exposure to 1.5 ppm NO2. All subjects were randomly exposed to either air or NO2, with at least a 2-wk interval between treatments, and the BAL fluids obtained after air exposure served as the controls. The BAL fluids were analyzed for alpha 1-PI elastase inhibitory activity, the immunologic concentration of alpha 1-PI, total protein, and albumin. The ratio of alpha 1-PI activity to its immunologic concentration was taken as the functional activity of alpha 1-PI, and possible changes in the amount of alpha 1-PI in the lung were assessed by examining the ratio of the immunologic concentration of alpha 1-PI to total protein. Neither of the NO2 exposure protocols resulted in a decrease in the functional activity of alpha 1-PI, nor were there alterations in the immunologic levels of alpha 1-PI. These data suggest that short-term exposures to low levels of NO2 do not result in a lung-localized deficiency of active alpha 1-PI, which has been hypothesized to be a contributing factor in the pathogenesis of emphysema.
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PMID:Inhalation of nitrogen dioxide fails to reduce the activity of human lung alpha-1-proteinase inhibitor. 222 79

Coal miners develop focal emphysema characterized by dilatation of second- and third-order respiratory bronchioles with coal mine dust-laden macrophages infiltrating the wall. A reticulin network with small amounts of collagen and atrophy of smooth muscle occurs. To evaluate the mechanisms of lung injury associated with this lesion, 17 long-term non- or ex-smoking West Virginia underground coal miners underwent bronchoalveolar lavage (BAL) and were compared to healthy nonsmoker and smoker controls. The coal miners had evidence of an alveolar macrophage-neutrophil alveolitis with a significant increase in neutrophils/microliter of epithelial lining fluid and an increased gallium lung scan index (206 +/- 26 units). Alveolar macrophages lavaged from coal miners spontaneously released exaggerated amounts of superoxide anion and hydrogen peroxide in vitro compared to nonsmoking controls. Coal workers had significantly elevated levels of neutrophil elastase in BAL fluid complexed with alpha 1-antitrypsin (P less than 0.01) and normal levels of alpha 1-antitrypsin. An accumulation of activated, dust-laden inflammatory cells with increased release of oxidants and elastase may contribute to the development of focal emphysema identified at postmortem in miners with coal workers' pneumoconiosis.
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PMID:Basic mechanisms leading to focal emphysema in coal workers' pneumoconiosis. 222 76

To study the pulmonary structural remodeling in pulmonary lymphangiomyomatosis, electron microscopy and light and electron microscopic immunohistochemical observations for elastin and alpha 1-antitrypsin were performed on five open lung biopsy samples. Lung specimens showed emphysema-like changes in areas of abnormally accumulated smooth muscle cells. In the alveolar walls having accumulated smooth muscle cells, elastic fibers were decreased in number, disrupted, granular, and occasionally accumulated. Ultrastructurally, elastic fibers in areas of smooth muscle cell accumulation showed poorly outlined amorphous components and a few microfibrils, and occasionally showed electron-dense granular deposits in and around the amorphous components. Spiraling collagen fibrils were frequently found associated with these abnormal elastic fibers. Immunohistochemistry for elastin showed even staining of amorphous components of elastic fibers in the areas of smooth muscle cell accumulation. alpha 1-Antitrypsin was also detected evenly in amorphous components of elastic fibers in the areas of smooth muscle cell accumulation. It is proposed that the emphysema-like lesions of lymphangiomyomatosis are mediated by the degradation of elastic fibers, and these degraded elastic fibers are related to an imbalance of the elastase/alpha 1-antitrypsin system similar to the probable pathogenesis of emphysema.
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PMID:Role of elastic fiber degradation in emphysema-like lesions of pulmonary lymphangiomyomatosis. 207 Nov 16

The PiZ mutation of the gene coding for alpha 1-antitrypsin results in a serum deficiency of this protein leading to early onset emphysema and liver disease. The PiZ gene has a Z-specific point mutation in exon V together with a point mutation in exon III which is also present in some normal (PiM) individuals. There has thus far been no system to study the effects of PiZ point mutations in tissue culture. We constructed plasmids containing alpha 1-antitrypsin cDNA synthetically altered at either exon III or exon V mutation sites and linked to simian virus 40 promoter sequences. Such constructs with the exon V mutation were transfected into monkey COS1 cells followed by analysis of expression of alpha 1-antitrypsin gene products. COS1 cells normally synthesize virtually no alpha 1-antitrypsin mRNA or protein. alpha 1-Antitrypsin mRNA is transcribed at high levels in cells transfected with either M or Z plasmids. Immunologic staining of COS1 cells within 48 h of transfection localizes alpha 1-antitrypsin protein to specific regions of the cytoplasm. This extranuclear localization is also observed with human HepG2 hepatoma cells, which synthesize alpha 1-antitrypsin at high levels, and with human SK-Hep1 hepatoma cells transfected with an M plasmid. The cloned synthetically altered alpha 1-antitrypsin genes provide a system for dissecting contributions of distinct point mutations to the pathological effects of the PiZ protein.
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PMID:Expression of PiM-and PiZ-mutated forms of the human alpha 1-antitrypsin gene in transfected monkey COS1 cells. 226 18

We calculated specific lung elastance (Es,L) as the change of lung elastic recoil pressure (Pel,L) required to produce a given fractional change in lung volume (delta VL/VL,0) as a function of transpulmonary pressure (PL) from published data in normal lungs, and in patients with chronic obstructive pulmonary disease (COPD) or alpha 1-antitrypsin deficiency (alpha 1-AD). Es,L, in normal lungs, is the bulk modulus, and was systematically greater than PL.dEs,L/dPL increased with VL.PL at Es,L = 30 cm H2O decreased with age in normal lungs, but Es,L at PL = 8 cm H2O showed no age relationship. In both COPD and alpha 1-AD Es,L and dEs,L/dPL were increased compared to normal lungs. We conclude that Es,L is a curvilinear function of PL in normal lungs, COPD and alpha 1-AD, and is systematically greater than PL. The increase in Es,L and dEs,L/dPL in COPD and alpha 1-AD compared to normals probably represents two distinct abnormalities in the elastic properties of emphysematous lungs: (1) an increase in resting length of alveolar walls accounting for hyperinflation, and (2) a decrease in extensibility of alveolar walls once they become stressed. Using total lung capacity (TLC) as an index of the former and Es,L as an index of the latter, we showed no correlation between either and FEV1. Thus abnormalities in lung elastic properties in emphysema do not account for chronic expiratory flow limitation in emphysema. Furthermore, the increased values of Es,L in emphysema suggest that emphysematous airspaces are poorly ventilated. As they are presumably poorly perfused, emphysema per se may not disturb ventilation perfusion ratios seriously.
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PMID:Reexamination of the elastic properties of emphysematous lungs. 227 17

We studied alpha 1-antitrypsin deficiency in a large family of 10 siblings: 3 subjects had PiZZ phenotype, but only 1 had emphysema; 2 subjects had no respiratory complaint. The patient with emphysema was a heavy smoker. According to the literature, this case suggests that, in PiZZ phenotype, emphysema appears earlier and is more severe if the patients smoke.
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PMID:Alpha-1-antitrypsin deficiency in a large sibship. 228 7

We assessed lung function, liver function, and smoking attitudes and behavior in 22 adolescents with homozygous alpha 1-antitrypsin deficiency whose condition had been detected through neonatal screening in the early 1970s. All subjects had normal lung volumes, expiratory flow rates, and diffusing capacity except for two siblings with mild asthma whose values reverted to the normal range after administration of an inhaled bronchodilator. Liver function was normal in all subjects with the exception of one boy who had an isolated elevation of alkaline phosphatase activity. Smoking attitudes, as determined by questionnaire, did not differ from those of 130 control subjects, but smoking initiation rates were significantly lower (p = 0.02). We believe that the issue of neonatal screening for alpha 1-antitrypsin deficiency should be reexamined because augmentation therapy for adults with emphysema is now available, and screening followed by family-based smoking intervention may lead to a nonsmoking life-style. The latter is especially important because the current weight of epidemiologic evidence strongly suggests that in nonsmokers with this condition, severe emphysema may never develop or, if it does, it will do so at a much later age than in smokers.
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PMID:Long-term follow-up of a cohort of children with alpha-1-antitrypsin deficiency. 229 95

Human leukocyte elastase (HLE) has been demonstrated on lung elastic fibers in areas of pulmonary emphysema. In vitro studies in our laboratory have shown that HLE-elastin complexes may be remarkably stable. We tested the possibility that elastin-bound HLE may retain catalytic activity in the presence of inhibitors that are effective against free HLE and found: (1) alpha-1-proteinase inhibitor (alpha 1PI), antileukoprotease (ALP), and eglin C inhibited free HLE on an approximately 1:1 molar basis, measured with either 3H-elastin or a synthetic peptide substrate; (2) the ability of each inhibitor to control catalytic activity of HLE when complexed with elastin was impaired (e.g., in a 24-h assay, a 70-fold molar excess of alpha 1PI gave only 93% inhibition of HLE); and (3) a chloromethyl ketone inhibitor of HLE gave qualitatively similar results, although at the low enzyme concentrations used it was a less effective inhibitor of free and elastin-bound enzyme than were the polypeptide inhibitors. Further, we found evidence for two distinct mechanisms of inhibition of elastin-bound HLE. alpha 1PI and eglin C prevented elastin solubilization largely by enhancing net dissociation of HLE from the complexes; enzyme remaining bound to the substrate retained essentially full activity. In contrast, ALP and the chloromethyl ketone prevented elastin solubilization by binding to the complexes and inhibiting the enzyme in situ. These results may have implications regarding progressive elastin solubilization in vivo and should stimulate further investigation of enzyme activity in heterogeneous systems in which one or more reactants are insoluble.
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PMID:Inhibition of human leukocyte elastase bound to elastin: relative ineffectiveness and two mechanisms of inhibitory activity. 231 May 84

Environmental and genetic factors contribute to familial chronic obstructive airways disease. The genetic component could be polygenic or in some families be associated with one or two major genes. It is assumed that most cases of familial chronic obstructive airways disease are polygenic, but this conclusion is based on insufficient data. The use of linkage analysis using DNA probes for specific genes that may have a direct role in the disease process should facilitate our understanding of the genetics. Genetic deficiency of alpha1-antitrypsin is associated with predisposition to pulmonary emphysema. In the absence of alpha 1-antitrypsin deficiency I suggest that a study of serine-proteinase inhibitors on chromosome 14 may identify a significant proportion of families where only one major gene is important.
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PMID:Serine proteinase inhibitors on chromosome 14 and the genetics of familial chronic obstructive airways disease. 231 25


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