Low incidence of alpha 1-antitrypsin deficiency among Filipinos with neonatal cholestatis.

AIM

Alpha 1-antitrypsin (AAT) deficiency is the most common genetic cause of liver disease in children. The Pi*S carrier rate among Filipinos is <1%. Its significance in Filipino infants with neonatal cholestasis has not been investigated. The aim of the study was to determine the incidence of AAT deficiency among Filipino infants presenting with neonatal cholestasis.

METHODS

Genotype determination that detects PiS and PiZ alleles was performed using Elucigene AAT reagents (Cellmark Diagnostics, UK). AAT inclusions were identified by light microscopy using periodic acid-Schiff (PAS) stain.

RESULTS

Ninety-six infants (mean age: 89 days, 48 males) with a history of jaundice since 2 weeks old and a direct bilirubin level>20% of the total were recruited. Only one patient (1 month old, male) was positive for PiS allele and 95 were negative for PiS and PiZ alleles, with an annual incidence of 0.7%. Of the 96, 49 infants underwent diagnostic percutaneous liver biopsy. All liver biopsy specimen were subjected to PAS stain and two infants, 2 and 4 months old, both with idiopathic neonatal hepatitis, had suspicious findings of AAT globules that was confirmed on immunostain. Both infants were negative for PiS alleles. The only patient positive for Pi*S allele was negative for PAS globule on liver biopsy.

CONCLUSION

Our results showed a low incidence of AAT deficiency caused by the PiS and PiZ alleles among Filipino infants presenting with neonatal cholestasis, similar to the low carrier rate in the population.