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Original article
A study of common Mendelian disease carriers across ageing British cohorts: meta-analyses reveal heterozygosity for alpha 1-antitrypsin deficiency increases respiratory capacity and height
  1. Teri-Louise North1,
  2. Yoav Ben-Shlomo1,
  3. Cyrus Cooper2,3,4,
  4. Ian J Deary5,6,
  5. John Gallacher7,
  6. Mika Kivimaki8,
  7. Meena Kumari8,9,
  8. Richard M Martin1,10,
  9. Alison Pattie5,
  10. Avan Aihie Sayer2,
  11. John M Starr6,
  12. Andrew Wong11,
  13. Diana Kuh11,
  14. Santiago Rodriguez1,
  15. Ian N M Day1
  1. 1School of Social and Community Medicine, University of Bristol, Bristol, UK
  2. 2MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
  3. 3National Institute for Health Research Nutrition Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
  4. 4National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
  5. 5Department of Psychology, University of Edinburgh, Edinburgh, UK
  6. 6Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, UK
  7. 7Department of Psychiatry, University of Oxford, Oxford, UK
  8. 8Department of Epidemiology and Public Health, UCL, London, UK
  9. 9ISER, University of Essex, Essex, UK
  10. 10University of Bristol/University Hospitals Bristol NHS Foundation Trust National Institute for Health Research Bristol Nutrition Biomedical Research Unit, University of Bristol, Bristol, UK
  11. 11MRC Unit for Lifelong Health and Ageing at UCL, London, UK
  1. Correspondence to Professor Ian N M Day, School of Social and Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK;{at}


Background Several recessive Mendelian disorders are common in Europeans, including cystic fibrosis (CFTR), medium-chain-acyl-Co-A-dehydrogenase deficiency (ACADM), phenylketonuria (PAH) and alpha 1-antitrypsin deficiency (SERPINA1).

Methods In a multicohort study of >19 000 older individuals, we investigated the relevant phenotypes in heterozygotes for these genes: lung function (forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC)) for CFTR and SERPINA1; cognitive measures for ACADM and PAH; and physical capability for ACADM, PAH and SERPINA1.

Results Findings were mostly negative but lung function in SERPINA1 (protease inhibitor (PI) Z allele, rs28929474) showed enhanced FEV1 and FVC (0.13 z-score increase in FEV1 (p=1.7×10−5) and 0.16 z-score increase in FVC (p=5.2×10−8)) in PI-MZ individuals. Height adjustment (a known, strong correlate of FEV1 and FVC) revealed strong positive height associations of the Z allele (1.50 cm increase in height (p=3.6×10−10)).

Conclusions The PI-MZ rare (2%) SNP effect is nearly four times greater than the ‘top’ common height SNP in HMGA2. However, height only partially attenuates the SERPINA1-FEV1 or FVC association (around 50%) and vice versa. Height SNP variants have recently been shown to be positively selected collectively in North versus South Europeans, while the Z allele high frequency is localised to North Europe. Although PI-ZZ is clinically disadvantageous to lung function, PI-MZ increases both height and respiratory function; potentially a balanced polymorphism. Partial blockade of PI could conceivably form part of a future poly-therapeutic approach in very short children. The notion that elastase inhibition should benefit patients with chronic obstructive pulmonary disease may also merit re-evaluation. PI is already a therapeutic target: our findings invite a reconsideration of the optimum level in respiratory care and novel pathway potential for development of agents for the management of growth disorders.

  • Alpha 1-Antitrypsin
  • Mendelian carriers
  • height
  • HALCion

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