Respiratory Medicine Unit, Spedali Civili.
Department of Clinical and Experimental Sciences, University of Brescia, Brescia.
Curr Opin Allergy Clin Immunol. 2021 Feb 1;21(1):46-51. doi: 10.1097/ACI.0000000000000711.
The aim of the article is to highlight the association between α1-antitrypsin deficiency (AATD) and asthma.
AATD is one of the most common and underrecognized autosomal disorders associated with an increased risk of developing liver and lung diseases. An association between α1-antitrypsin and asthma has been suggested, especially with severe forms of this disease. Many studies have shown an increased prevalence of asthma in the α1-antitrypsin-deficient population overtime (4-38%). The biological mechanism underlying these two conditions and able to bind them has not yet been well investigated. As α1-antitrypsin is the main inhibitor of the serine proteinase and it is an important anti-inflammatory protein with pronounced immunomodulatory activities, it can be hypothesized that the link between AATD and asthma might be represented by the elastase/antielastase imbalance and the proinflammatory effect that occurs because of the reduction of this protein.
There is a strong need for further researches to better understand the molecular mechanisms binding AATD and asthma. It is also recommendable to screen for AATD, late-onset asthma patients, and/or those with not fully reversible airways obstruction.
目的综述：本文旨在强调α1-抗胰蛋白酶缺乏症（AATD）与哮喘之间的关联。
最近发现：AATD 是最常见和最容易被忽视的常染色体疾病之一，与肝脏和肺部疾病的风险增加有关。已经有人提出 α1-抗胰蛋白酶与哮喘之间存在关联，尤其是在这种疾病的严重形式中。许多研究表明，随着时间的推移（4-38%），α1-抗胰蛋白酶缺乏人群中哮喘的患病率增加。这两种情况的潜在生物学机制及其结合机制尚未得到很好的研究。由于 α1-抗胰蛋白酶是丝氨酸蛋白酶的主要抑制剂，也是一种具有显著免疫调节活性的重要抗炎蛋白，因此可以假设 AATD 和哮喘之间的联系可能代表弹性蛋白酶/抗弹性蛋白酶失衡以及由于这种蛋白减少而发生的促炎作用。
总结：需要进一步研究以更好地了解将 AATD 和哮喘联系起来的分子机制。还建议对迟发性哮喘患者和/或气道阻塞不完全可逆的患者进行 AATD 筛查。
