Alpha-1 antitrypsin PiMZ genotype is associated with chronic obstructive pulmonary disease in two racial groups

Marilyn G. Foreman, Carla Wilson, Dawn L. DeMeo, Craig P. Hersh, Terri H. Beaty, Michael H. Cho, John Ziniti, Douglas Curran-Everett, Gerard Criner, John E. Hokanson, Mark Brantly, Farshid N. Rouhani, Robert A. Sandhaus, James D. Crapo, Edwin K. Silverman

Research output: Contribution to journalArticlepeer-review


Rationale: Alpha-1 antitrypsin deficiency, caused primarily by homozygosity for the Z allele of the SERPINA1 gene, is a wellestablished genetic cause of chronic obstructive pulmonary disease (COPD). Whether the heterozygous PiMZ genotype for alpha-1 antitrypsin confers increased risk for COPD has been debated. Objectives:Weanalyzed 8,271 subjects in the Genetic Epidemiology of COPD (COPDGene) Study, hypothesizing that PiMZ would independently associate with COPD and COPD-related phenotypes. Methods: The COPDGene Study comprises a multiethnic, crosssectional, observational cohort of non-Hispanic white and African American current and former smokers with at least 10 pack-years of smoking who were enrolled for detailed clinical and genetic studies of COPD and COPD-related traits. We performed multivariate logistic regression analysis for moderate to severeCOPDand assessed Pi genotype with other relevant covariates in models stratified by race. We analyzed quantitative characteristics on the basis of volumetric computed tomography with generalized linear models controlling for genotype, scanner type, and similar covariates. Results: White PiMZ COPDGene subjects had significantly lower lung function, FEV1 percent predicted (68±28 vs. 75±27; P = 0.0005), and FEV1/FVC ratio (0.59 ±0.18 vs. 0.63 ±0.17; P = 0.0008), as well as more radiographic emphysema (P = 0.001), than subjects without alpha-1 antitrypsin Z risk alleles. Similarly, African American PiMZ subjects had lower lung function, FEV1 percent predicted (65±33 vs. 84±25; P = 0.009) and FEV1/FVC (0.61 ±0.21 vs. 0.71 ±0.15; P = 0.03). Conclusions: In the COPDGene Study, we demonstrate that PiMZ heterozygous individuals who smoke are at increased risk for COPD and obstructive lung function impairment compared with Z-allele noncarriers, regardless of race. Although severe alpha-1 antitrypsin deficiency is uncommon in African Americans, our study adds further support for initial targeted detection of all subjects with COPD for alpha-1 antitrypsin deficiency, including African Americans.

Original languageEnglish (US)
Pages (from-to)1280-1287
Number of pages8
JournalAnnals of the American Thoracic Society
Issue number8
StatePublished - Aug 2017


  • African Americans
  • Alpha-1 antitrypsin deficiency
  • Chronic obstructive pulmonary disease
  • Emphysema
  • Genetics

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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