Alpha-1-antitrypsin deficiency (AATD)

AATD is a rare autosomal recessive condition caused by a mutation in the SERPINA1 gene leading to decreased production of the neutrophil-elastase protective protein alpha-1 antitrypsin, which increases the risk of serious lung and liver disease.1,5

Liver disease associated with AAT deficiency (ZZ phenotype) has a variety of clinical presentations, including neonatal cholestasis, chronic hepatitis, cirrhosis or rarely, hepatocellular carcinoma.4,6 AATD accounts for around 5 to 10% of cases of neonatal cholestasis. Only a small proportion of ZZ patients (10 to 15%) develop neonatal cholestasis, due to abnormal storage of ZZ AAT within hepatocytes. Around 30% of those neonates develop chronic liver disease. Lung disease appears in adulthood.1,5-7


AATD should be suspected by paediatricians in case of:5

1. Protocole national de diagnostic et de soins : Déficits de synthèse des acides biliaires primaires. Centre de Référence Coordonnateur de l’Atrésie des Voies Biliaires et des Cholestases Génétiques; 2019.

4. INSERM. Orphanet. European Union: The portal for rare diseases and orphan drugs. 2021 (accessed 09/2021 at

5. Torres-Durán M, Lopez-Campos JL, Barrecheguren M, et al. Alpha-1 antitrypsin deficiency: outstanding questions and future directions. Orphanet J Rare Dis 2018;13:114.

6. Alpha-1 antitrypsin deficiency. Genetics Home Reference, U.S. National Library of Medicine, 2013. at

7. Patel D, Teckman JH. Alpha-1-antitrypsin deficiency liver disease. Clin Liver Dis 2018;22:643-55.