From the Guidelines
Elevated alpha-1 antitrypsin levels are not a primary concern requiring specific treatment, but rather indicate an underlying inflammatory process that should be investigated and managed accordingly. Alpha-1 antitrypsin (AAT) elevation is typically an acute phase reactant response to inflammation, infection, or tissue injury in the body. Common causes include acute infections, chronic inflammatory conditions like rheumatoid arthritis or inflammatory bowel disease, certain cancers, pregnancy, and use of oral contraceptives or estrogen therapy. No specific treatment is needed for the elevated AAT itself; instead, management should focus on identifying and treating the underlying cause. It's worth noting that augmentation therapy has been shown to be beneficial in specific cases, such as moderately advanced emphysema due to severe alpha-1 antitrypsin deficiency, where it can reduce mortality and slow disease progress 1. However, this is a distinct scenario from elevated AAT levels. Diagnostic workup may include:
- A complete blood count
- Comprehensive metabolic panel
- C-reactive protein
- Erythrocyte sedimentation rate to assess inflammation Additional testing should be guided by clinical symptoms. It's crucial to distinguish this from alpha-1 antitrypsin deficiency, which is a genetic disorder with low AAT levels that can lead to lung and liver disease. Elevated AAT is physiologically protective, as AAT functions as a protease inhibitor that prevents excessive tissue damage from enzymes released during inflammation.
From the Research
Elevated Alpha 1 Antitrypsin
Elevated alpha 1 antitrypsin levels can be associated with various clinical conditions. The following points summarize the key aspects:
- Elevated alpha 1 antitrypsin levels can occur in response to inflammation, as seen in chronic obstructive pulmonary disease (COPD) patients 2.
- A study found that COPD patients with higher serum alpha 1 antitrypsin levels had a worse systemic inflammation status and higher 10-year mortality 2.
- Alpha 1 antitrypsin deficiency is a genetic disorder associated with early onset COPD and liver disease, but elevated levels are not typically associated with these conditions 3, 4.
- The diagnosis and management of alpha 1 antitrypsin deficiency involve testing for the condition in all adults with symptomatic fixed airflow obstruction, as well as family testing of first-degree relatives 5.
- Elevated alpha 1 antitrypsin levels are not typically considered a diagnostic criterion for alpha 1 antitrypsin deficiency, which is characterized by low serum levels of the protein 4.
Clinical Implications
The clinical implications of elevated alpha 1 antitrypsin levels include:
- Association with worse systemic inflammation status and higher mortality in COPD patients 2.
- Potential for misdiagnosis or delayed diagnosis of alpha 1 antitrypsin deficiency, as elevated levels may not be typically associated with the condition 3, 4.
- Importance of considering alpha 1 antitrypsin levels in the context of other clinical and laboratory findings, rather than relying solely on elevated levels for diagnosis or management decisions 5, 6.